In the Journals

Children face increasing risk of accidental opioid ingestion

Hospitalizations from opioid poisonings more than doubled in children and adolescents during the last two decades, according to recent study findings.

“The increased availability of these medications has resulted in an unprecedented rise in opioid addiction and nonfatal overdoses,” Julie R. Gaither, PhD, MPH, from the department of epidemiology and public health at Yale School of Medicine, and colleagues wrote. “ED visits for opioid-related indications have risen substantially in children and adults during the past two decades; ED visits for prescription opioid overdose, abuse and misuse now rival those for illicit drugs, including heroin and cocaine.

Julie R. Gaither

“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.”

To determine the trends in hospitalizations associated with opioid poisonings in children and adolescents, Gaither and colleagues conducted a retrospective, cross-sectional analysis of a nationally representative sample of U.S. pediatric discharge records. They grouped children into four age categories: 1 to 4 years, 5 to 9 years, 10 to 14 years and 15 to 19 years.

The researchers used the Kids’ Inpatient Database (active from 2006 to 2012) to cull 13,052 discharge records for opioid poisoned children hospitalized between 1997 and 2012; attributable diagnostic ICD-9-CM codes 965.00 (opium), 965.02 (methadone) and 965.09 (other opiates and narcotics) alerted Gaither and colleagues to opioid-related hospitalizations. ICD-9-CM code 965.01 (heroin) was restricted to patients aged 15 to 19 years.

An annual rate of incidence for opioid poisoning-related hospitalizations per 100,000 children within the study group increased 165% from 1.4 (95% CI, 1.24-1.56) in 1997 to 3.71 (95% CI, 3.44-3.98) in 2012. The oldest age group experienced the highest increase in the 16-year period of hospitalizations due to opioid poisonings (176%; P < .001) and children aged 5 to 9 years had the lowest increase. Hospitalized children were predominantly white (73.5%; 95% CI, 72%-75%) and covered by private insurance (48.8%; 95% CI, 48%-50%), though hospitalized Medicaid insured patients increased from 24.1% in 1997 to 44% in 2012. During the 6 years of the Kids’ Inpatient Database, 176 children died during hospitalization from opioid poisoning (1.3%; 95% CI, 1.1%-1.6%). In addition, poisonings associated with suicide or self-inflicted injury increased by 140% (P < .001) and accidental poisonings increased by 303% (P < .001) in adolescents aged 15 to 19 years.

“Although poisonings attributed to suicide or self-inflicted injury among those aged 15 to 19 years exceeded those attributed to accidental poisonings across all time points, accidental poisonings increased at a more rapid rate, 3-fold from 1997 to 2012,” the researchers wrote. “Increasing rates of prescription opioid misuse and abuse, rather than therapeutic errors or adverse effects among adolescents prescribed opioids for pain management, are likely driving these trends in accidental poisonings.” – by Kate Sherrer

Disclosure: Gaither reports receiving funding from grant F31DA035567. Please see the full study for a list of all other researchers’ financial disclosures.

Hospitalizations from opioid poisonings more than doubled in children and adolescents during the last two decades, according to recent study findings.

“The increased availability of these medications has resulted in an unprecedented rise in opioid addiction and nonfatal overdoses,” Julie R. Gaither, PhD, MPH, from the department of epidemiology and public health at Yale School of Medicine, and colleagues wrote. “ED visits for opioid-related indications have risen substantially in children and adults during the past two decades; ED visits for prescription opioid overdose, abuse and misuse now rival those for illicit drugs, including heroin and cocaine.

Julie R. Gaither

“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.”

To determine the trends in hospitalizations associated with opioid poisonings in children and adolescents, Gaither and colleagues conducted a retrospective, cross-sectional analysis of a nationally representative sample of U.S. pediatric discharge records. They grouped children into four age categories: 1 to 4 years, 5 to 9 years, 10 to 14 years and 15 to 19 years.

The researchers used the Kids’ Inpatient Database (active from 2006 to 2012) to cull 13,052 discharge records for opioid poisoned children hospitalized between 1997 and 2012; attributable diagnostic ICD-9-CM codes 965.00 (opium), 965.02 (methadone) and 965.09 (other opiates and narcotics) alerted Gaither and colleagues to opioid-related hospitalizations. ICD-9-CM code 965.01 (heroin) was restricted to patients aged 15 to 19 years.

An annual rate of incidence for opioid poisoning-related hospitalizations per 100,000 children within the study group increased 165% from 1.4 (95% CI, 1.24-1.56) in 1997 to 3.71 (95% CI, 3.44-3.98) in 2012. The oldest age group experienced the highest increase in the 16-year period of hospitalizations due to opioid poisonings (176%; P < .001) and children aged 5 to 9 years had the lowest increase. Hospitalized children were predominantly white (73.5%; 95% CI, 72%-75%) and covered by private insurance (48.8%; 95% CI, 48%-50%), though hospitalized Medicaid insured patients increased from 24.1% in 1997 to 44% in 2012. During the 6 years of the Kids’ Inpatient Database, 176 children died during hospitalization from opioid poisoning (1.3%; 95% CI, 1.1%-1.6%). In addition, poisonings associated with suicide or self-inflicted injury increased by 140% (P < .001) and accidental poisonings increased by 303% (P < .001) in adolescents aged 15 to 19 years.

“Although poisonings attributed to suicide or self-inflicted injury among those aged 15 to 19 years exceeded those attributed to accidental poisonings across all time points, accidental poisonings increased at a more rapid rate, 3-fold from 1997 to 2012,” the researchers wrote. “Increasing rates of prescription opioid misuse and abuse, rather than therapeutic errors or adverse effects among adolescents prescribed opioids for pain management, are likely driving these trends in accidental poisonings.” – by Kate Sherrer

Disclosure: Gaither reports receiving funding from grant F31DA035567. Please see the full study for a list of all other researchers’ financial disclosures.