Summary: A new study reports on the worrying numbers of children and teens admitted to hospital each year for prescription opioid poisoning.
Thousands of children are hospitalized annually for prescription opioid poisonings, and in recent years, hospitalization rates have nearly doubled among children of all ages, according to a new Yale study that shows toddlers and older teens are particularly at risk.
These findings, based on a review of hospital discharge records over a 16-year period, show the impact of the prescription opioid crisis on children and the need for strategies to address it, said the researchers.
The study was published Oct. 31 in JAMA Pediatrics.
Prescription opioids include common painkillers such as oxycodone, hydrocodone, and fentanyl. In adults, the growing use and abuse of these drugs are linked to a rise in hospitalizations for opioid poisonings. To gauge the impact of these trends on children, the Yale team conducted a comprehensive analysis of hospitalizations attributed to opioid poisonings in children and adolescents.
First author Julie Gaither and the Yale team analyzed data from the Kids’ Inpatient Database, a national source that compiles data on children admitted to U.S. hospitals. The researchers examined discharge records for patients aged 1 to 19 who were hospitalized for opioid poisonings. Using data from 1997 to 2012, they identified more than 13,000 such records.
The researchers found that hospitalizations for opioid poisonings in children rose significantly during the period studied, with the greatest increases seen in the youngest kids and the oldest teens. “Over 16 years, poisonings from prescription opioids in children and teens increased nearly twofold,” Gaither said. “Those most vulnerable to opioid exposure were children ages 1 to 4 and 15 to 19. In toddlers and preschoolers, rates more than doubled over time.”
Gaither noted that prescription opioid poisonings among children less than 10 years of age were primarily of an accidental nature, but among older teens, suicidal intent was the primary cause.
A silver lining in the data is that hospitalizations among older teens did decrease slightly in the most recent years. “For 15 to 19 year olds, we saw a slight decrease, 7%, in hospitalizations from 2009 to 2012,” said Gaither.
Despite this decrease, “the take-home message is that prescription opioid poisonings are likely to remain a growing problem among children unless greater attention is directed toward the pediatric community,” she noted.
The researchers described multiple strategies for addressing the risks of opioid exposure in children, including changes to the packaging and storage of prescription opioid medications. They also discussed parent education, clinical practice guidelines for prescribing opioid painkillers to children, and programs to prevent opioid misuse among adolescents.
Other Yale authors include Dr. John M. Leventhal, Dr. Sheryl A. Ryan, and Dr. Deepa R. Camenga.
Funding: The study was supported by grants from the National Institute on Drug Abuse.
Source: Ziba Kashef – Yale
Image Source: NeuroscienceNews.com image is adapted from the Yale press release.
Original Research: Full open access research for “National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012” by Julie R. Gaither, PhD, MPH, RN; John M. Leventhal, MD; Sheryl A. Ryan, MD; and Deepa R. Camenga, MD, MHS in JAMA Pediatrics. Published online October 31 2016 doi:10.1001/jamapediatrics.2016.2154
National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012
Importance National data show a parallel relationship between recent trends in opioid prescribing practices and hospitalizations for opioid poisonings in adults. No similar estimates exist describing hospitalizations for opioid poisonings in children and adolescents.
Objective To describe the incidence and characteristics of hospitalizations attributed to opioid poisonings in children and adolescents.
Design, Setting, and Participants Retrospective analysis of serial cross-sectional data from a nationally representative sample of US pediatric hospital discharge records collected every 3 years from January 1, 1997, through December 31, 2012. The Kids’ Inpatient Database was used to identify 13 052 discharge records for patients aged 1 to 19 years who were hospitalized for opioid poisonings. Data were analyzed within the collection time frame.
Main Outcomes and Measures Poisonings attributed to prescription opioids were identified by codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. In adolescents aged 15 to 19 years, poisonings attributed to heroin were also identified. Census estimates were used to calculate incidence per 100 000 population. The Cochran-Armitage test for trend was used to assess for changes in incidence over time.
Results From 1997 to 2012, a total of 13 052 (95% CI, 12 500-13 604) hospitalizations for prescription opioid poisonings were identified. The annual incidence of hospitalizations for opioid poisonings per 100 000 children aged 1 to 19 years rose from 1.40 (95% CI, 1.24-1.56) to 3.71 (95% CI, 3.44-3.98), an increase of 165% (P for trend, <.001). Among children 1 to 4 years of age, the incidence increased from 0.86 (95% CI, 0.60-1.12) to 2.62 (95% CI, 2.17-3.08), an increase of 205% (P for trend, <.001). For adolescents aged 15 to 19 years, the incidence increased from 3.69 (95% CI, 3.20-4.17) to 10.17 (95% CI, 9.48-10.85), an increase of 176% (P for trend, <.001). In this age group, poisonings from heroin increased from 0.96 (95% CI, 0.75-1.18) to 2.51 (95% CI, 2.21-2.80), an increase of 161% (P for trend, <.001); poisonings involving methadone increased from 0.10 (95% CI, 0.03-0.16) to 1.05 (95% CI, 0.87-1.23), an increase of 950% (P for trend, <.001).
Conclusions and Relevance During the course of 16 years, hospitalizations attributed to opioid poisonings rose nearly 2-fold in the pediatric population. Hospitalizations 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.
“Triggers for Violent Criminality in Patients With Psychotic “National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012” by Julie R. Gaither, PhD, MPH, RN; John M. Leventhal, MD; Sheryl A. Ryan, MD; and Deepa R. Camenga, MD, MHS in JAMA Pediatrics. Published online October 31 2016 doi:10.1001/jamapediatrics.2016.2154