Kids' Exposure to Buprenorphine Skyrockets

Diana Swift

June 28, 2018

The number of children aged 19 years and younger exposed to buprenorphine, an opiate widely prescribed to treat pain and opioid use disorder, has been rising since 2007, according to a study published online June 25 in Pediatrics.

Researchers led by Sara Post, MS, from the Center for Injury Research and Policy, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio, report that the overall exposure rate per million children increased by 215.6% during 2007 to 2010, going from 6.4 to 20.2. After dropping by 42.6% during 2010 to 2013 to 11.6 per million, it rose again by 8.6% to 12.6 per million in 2016.

Post's group found that during 2007 to 2016, poison control centers in the National Poison Data System received reports of 11,275 children and adolescents with exposure to buprenorphine. Overall, 53.1% of exposures occurred in boys, and the mean age of affected children was a surprising 3.8 years.

Most of the exposures took place in residences, involved a single product, and occurred by ingestion. Overall, 21.2% of contacts with the drug had serious medical consequences such as respiratory depression, bradycardia, hypotension, and cyanosis, and 11 affected youngsters died.

Earlier this year, Medscape Medical News reported that pediatric opioid-related admission to intensive care units almost doubled during 2004 to 2015.

"Although buprenorphine is important for medication-assisted treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes," according to senior author Gary A. Smith, MD, DrPH, from the Department of Pediatrics, College of Medicine, at The Ohio State University in Columbus.

The study looked at the age groups younger than 6 years, 6 to 12 years, and 13 to 19 years. Overall, 86.1% of contacts with the drug occurred in the youngest group, and 89.2% of contacts were reported as unintentional.

For single-substance exposures (97.3%), children younger than 6 years had greater odds of hospital admission and a serious medical outcome than adolescents aged 13 to 19 years. In those younger than 6 years, 48.1% of exposures led to hospital admission and 21.4% had a serious medical outcome, with seven deaths reported in this age group.

Adolescents aged 13 to 19 years made up 11.1% of exposures, and in this age category 77.1% of exposures were intentional, including 12.0% for suspected suicide attempts. More than a quarter of exposures (27.7%) involved the use of more than one substance. In this age group, 21.5% of exposures resulted in hospital admission and 22.0% in a serious medical outcome, including four deaths, all of which involved other substances such as alcohol or benzodiazepines.

But the exposure rate per million adolescents has declined: after increasing by 195.0% from 2.0 in 2007 to 5.9 in 2010, the rate dropped by 47.5% to 3.1 from 2010 to 2016, despite the widespread prescribing of this drug. As for the temporary overall drop in exposures during 2010 to 2013, the authors write, "One factor may be a shift in buprenorphine prescriptions to a population less likely to have young children in the home."

According to the authors, prevention strategies are urgently needed and should be tailored to different stakeholders. Manufacturers, for instance, should use unit-dose packaging for buprenorphine products to reduce the chance of unintentional exposure. "Safe storage of all opioids, including buprenorphine, is crucial," Smith said. "Parents and caregivers who use buprenorphine need to store it safely: up, away, and out of sight in a locked cabinet is best."

In addition, healthcare providers need to warn childcare providers of the dangers of buprenorphine exposure and give instructions on safe storage and disposal. Adolescents should be informed of the risks of substance abuse and misuse. "Suspected suicide accounted for 12% of teen exposures, highlighting the need for access to mental health services for this age group," Smith said.

One author was supported by a research stipend from the Center for Injury Research and Policy at Nationwide Children's Hospital, funded by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, and the Child Injury Prevention Alliance. One author has been retained to comment on a legal case involving buprenorphine. The other authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 25, 2018. Full text

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