Within the alarming rise in opioid addiction and overdose, statistics is an even more tragic rise in opioid exposure of children. A study by researchers at the Yale School of Medicine found that, between 1997 and 2012, hospitalizations attributed to opioid poisonings rose nearly 2-fold in the pediatric population.1
The authors' objective was to describe the incidence and characteristics of hospitalizations attributed to opioid poisonings in children and adolescents. Although national data show a parallel relationship between recent trends in opioid prescribing practices and hospitalizations for opioid poisonings in adults, no similar estimates had existed to describe hospitalizations for opioid poisonings in children and adolescents, they wrote.1
The study, published online October 31, 2016, in JAMA Pediatrics, reported that "hospitalizations for opioid poisoning increased across all age groups, yet young children and older adolescents were most vulnerable to the risks of opioid exposure. Mitigating these risks will require comprehensive strategies that target opioid storage, packaging, and misuse."
In their conclusion, the authors wrote that "....recent data indicate that the United States is making progress in gaining control of the epidemic caused by opioid analgesics. Our research, however, suggests 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 US population."1
They recommended a combination of public health interventions, such as parent education and consumer-product regulations to reduce pediatric exposure to opioids and greater resources to address opioid misuse and abuse during adolescence.
"Of particular importance are prevention programs that address the overlap in opioid misuse and depression among adolescents," the authors wrote. "Finally, for clinicians who treat acute and chronic pain in children, national clinical practice guidelines for opioid prescribing that include pediatric-specific recommendations are urgently needed."
The study involved a retrospective analysis of 13,052 national hospital discharge records over the 16-year period. The data showed that:
* Hospitalization rates were highest in older adolescents.
* The largest percentage increase in hospitalizations over time occurred among the youngest children (toddlers and preschoolers).
* The annual incidence of hospitalizations for opioid poisonings per 100,000 children aged 1 to 19 years rose from 1.40 to 3.71, an increase of 165%.
* Among children 1 to 4 years of age, the incidence increased from 0.86 to 2.62, an increase of 205%.
* For adolescents aged 15 to 19 years, the incidence increased from 3.69 to 10.17, an increase of 176%. In this age group, poisonings from heroin increased from 0.96 to 2.51, an increase of 161%; poisonings involving methadone increased from 0.10 to 1.05, an increase of 950%.
* In 1997, males accounted for 34.7% of hospitalizations; by 2012, this proportion was 47.4%.
* Children were predominately white (73.5%) and covered by private insurance (48.8%); however, the proportion insured by Medicaid increased from 24.1% in 1997 to 44.0% in 2012.
The authors also analyzed opioid poisonings by intent, finding that:
* Among children younger than 10 years, 16 poisonings (0.92%) were attributed to suicide or self-inflicted injury from 1997 to 2012.
* In children 10 to 14 years of age, the incidence of poisonings attributed to suicide or self-inflicted injury increased from 0.62 in 1997 to 0.85 in 2012, an increase of 37%.
* The incidence of poisonings attributed to accidental intent increased from 0.17 in 1997 to 0.31 in 2012, an increase of 82%.
* These trends were more marked in adolescents 15 to 19 years of age. Poisonings attributed to suicide or self-inflicted injury increased by 140%, whereas those attributed to accidental intent increased by 303%.
Most of the opioid poisonings were for prescription opioid poisonings-across all time points. However, poisonings involving heroin increased from 0.96 in 1997 to 2.51 in 2012, an increase of 161%. Poisonings involving methadone increased from 0.10 in 1997 to 1.05 in 2012, an increase of 950%.
The authors received funding from the National Institute on Drug Abuse (NIDA) and disclosed that the NIDA had no role in the design of the study or preparation of the manuscript.
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