Growing numbers of children and young people are ending up in the emergency room because of prescription opioid poisoning, often following an attempted suicide or accidental poisoning.
According to a report published in JAMA, the number of cases in this age group rose by more than 200 percent between 1997 and 2012.
Prescription drug poisoning is now the number one cause of injury-related death in the United States.
In 2014, opioid use led to 18,893 deaths in the U.S., and the number of addictions and nonfatal overdoses is on the rise. Emergency department visits related to prescription opioid use are now on a par with those linked to illegal drug use.
Widespread use of opioid analgesics to treat chronic pain has been blamed for the rise. From 1999-2010, there was a fourfold increase in sales of prescription opioids, and also a fourfold increase in the number of deaths from prescription opioids among people aged 15-64 years. In the 15-24-year age group, the increase was sixfold.
Opioids are among the most commonly prescribed drugs in the U.S., used in millions of households.
Prescription opioids are responsible for most drug poisonings in children under 6 years. The majority of these poisonings involve drugs prescribed for adults.
Concern about opioid poisonings among children
Previous studies have revealed a drastic increase in the number of hospitalizations for opioid dependence, abuse, and poisoning in adults, but the figures for young people were unknown.
Julie R. Gaither, of the Yale School of Medicine in New Haven, CT, and coauthors wanted to know how opioid poisonings affect children aged 1-19 years.
Heroin addiction often stems from prescription opioid use. Methadone is often prescribed to help heroin addicts kick their habit. While not widely used, it has been linked to a relatively high number of poisonings. For this reason, the team also looked at overdose and poisoning by heroin and methadone in 15- to 19-year-olds.
The U.S. Food and Drug Administration's (FDA's) recent approval of oxycodone hydrochloride (OxyContin) for children in some circumstances has made the need for information more urgent.
Opioid poisoning fatal in 176 cases
The team examined hospital discharge records from 1997-2012. They found that 13,052 children and adolescents were hospitalized for opioid poisonings, including a number of poisonings from heroin among 15- to 19-year-olds.
In 176 cases, or 1.3 percent, this was fatal.
Results showed that from 1997-2012, hospitalizations for opioid poisoning increased:
- By 165 percent in children aged 1-19 years, from 1.40 to 3.71 per 100,000 children
- By 205 percent in children aged 1-4 years
- By 176 percent among 15-19-year-olds.
In addition, the incidence of heroin poisoning rose by 161 percent, and methadone poisoning increased by 950 percent.
In terms of background, 73.5 percent of the children were white, and 48.8 percent had private health insurance.
Among those aged under 10 years, 16 poisonings were related to suicide or self-inflicted injury. In the 10- to 14-year age group, the rate of poisonings or self-inflicted injury due to suicide or self-injury rose from 0.62 percent in 1997 to 0.85 percent in 2012.
The number of accidental poisonings among children under 10 years rose by 82 percent, from 0.17 per 100,000 children in 1997 to 0.31 per 100,000 in 2012.
In the 15- to 19-year age group, opioid poisonings due to suicide or self-inflicted injury rose by 140 percent, while accidental poisonings more than tripled.
A need for intervention
One limitation of the study is that the codes used to collect the data are subject to error and miscoding. In addition, say the authors, the data only goes up to 2012, so the results do not give a complete picture of the current situation.
However, the authors conclude that:
"Poisonings by prescription and illicit opioids are likely to remain a persistent and growing problem in the young unless greater attention is directed toward the pediatric community, who make up nearly one quarter of the U.S. population."
The authors call for more public health interventions into pediatric exposure to opioids and more resources to address opioid misuse in those aged 15-19 years. They also call for national practice guidelines on opioid prescription, with specific guidelines for pediatric use.