'Unprecedented' Rise in Pediatric Opioid Poisonings

Troy Brown, RN

October 31, 2016

Hospitalizations for pediatric opioid poisonings almost doubled from 1997 to 2012, according to a retrospective analysis published online October 31 in JAMA Pediatrics. The highest hospitalization rates occurred among older adolescents, but the largest increase in hospitalizations over time was seen in children aged 1 to 4 years.

Mortality rates attributed to opioids are also alarming. Retail sales of prescription opioids rose fourfold from 1999 to 2010, and deaths attributed to opioid overdose increased by the same amount among 15- to 64-year-olds. However, deaths increased sixfold in those aged 15 to 24 years.

These mortality data only tell part of the story, write Julie R. Gaither, PhD, MPH, RN, from Yale School of Medicine, New Haven, Connecticut, and the Department of Veterans Affairs, West Haven, Connecticut, and colleagues.

As these medications have become more available, the rise in opioid addiction and nonfatal overdoses has been "unprecedented," they write.

"Emergency department...visits for opioid-related indications have risen substantially in children and adults during the past 2 decades; [emergency department] visits for prescription opioid overdose, abuse, and misuse now rival those for illicit drugs, including heroin and cocaine," the researchers explain. "Even in children younger than 6 years, opioids, followed closely by benzodiazepines, now account for most of the drug poisonings in this age group; in nearly all these poisonings, the child was exposed to a prescription intended for an adult in the household."

The researchers analyzed US pediatric hospital discharge data for 13,052 hospitalizations from January 1, 1997, through December 31, 2012, to examine trends in hospitalizations for opioid poisonings in children and adolescents. They also examined poisonings related to methadone: Although prescription rates for methadone are low, the drug is associated with a disproportionate number of drug poisonings, the authors write.

During the 16-year study period, the annual incidence of hospitalizations for opioid poisonings rose from 1.40 (95% confidence interval [CI], 1.24 - 1.56) to 3.71 (95% CI, 3.44 - 3.98) per 100,000 children, an increase of 165% (P for trend < .001).

The largest increase was seen among children aged 1 to 4 years: The incidence among this group rose from 0.86 per 100,000 children (95% CI, 0.60 - 1.12) in 1997 to 2.62 (95% CI, 2.17 - 3.08) in 2012, an increase of 205% (P for trend < .001).

Among adolescents aged 15 to 19 years, the incidence rose by 176%, from 3.69 per 100,000 (95% CI, 3.20 - 4.17) in 1997 to 10.17 (95% CI, 9.48 - 10.85) in 2012 (P for trend < .001). Poisonings from heroin also increased among adolescents in this age group, from 0.96 per 100,000 (95% CI, 0.75 - 1.18) to 2.51 (95% CI, 2.21 - 2.80), an increase of 161% (P for trend < .001).

Meanwhile, methadone poisonings skyrocketed among 15- to 19-year-olds, rising from 0.10 per 100,000 (95% CI, 0.03 - 0.16) to 1.05 (95% CI, 0.87 - 1.23), an increase of 950% (P for trend < .001). "Methadone is among the most misused of prescription drugs and is commonly diverted for illicit (nonmedical) purposes, such as getting high or to enhance the effects of alcohol or other drugs," the researchers explain. The authors believe the incidence of methadone-related poisonings may be slowing.

"[F]urther resources should be directed toward addressing opioid misuse and abuse during adolescence," the authors write. "Of particular importance are prevention programs that address the overlap in opioid misuse and depression among adolescents."

"Mitigating the effects of prescription opioid exposure will require comprehensive strategies that really address opioid packaging, storage, and misuse, and specifically we believe that public health interventions such as prescriber and patient education programs are needed," Dr Gaither said in a related podcast.

The authors have disclosed no relevant financial relationships.

JAMA Pediatr. Published online October 31, 2016. Full text

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