The Underrecognized Toll of Prescription Opioid Abuse on Young Children
Study objective
The impact of prescription opioid abuse on young children is underrecognized and poorly documented. We hypothesize that poisoning of young children from prescription opioids occurs regularly in the United States and is associated with serious health events, including death.
Methods
Using data from poison centers participating in the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, exposures in children younger than 6 years, involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone (January 2003 to June 2006), were quantified and described.
Results
We identified 9,179 children exposed to a prescription opioid. The median age was 2.0 years (range newborn to 5.5 years), and 54% were boys. Nearly all exposures involved ingestion (99%) and occurred in the home (92%). Exposures to any opioid were associated with 8 deaths, 43 major effects, and 214 moderate effects. Of 51 patients who experienced a major effect or death, 35 were treated with naloxone: a beneficial response was documented in 34 patients. All 5 exposures to buprenorphine associated with a major effect were treated with naloxone, and a beneficial response was recorded in all 5. Nearly all exposures were to medications prescribed for adults in the household. The number of prescriptions filled for an opioid in an area correlated well with exposures in young children in the same area; children have access to household members' prescription drugs.
Conclusion
Young children are exposed to prescription opioids, typically prescribed for other patients, resulting in major health effects and death.
Supervising editor: Steven M. Green, MD
Dr. Green was the supervising editor on this article. Dr. Dart did not participate in the editorial review or decision to publish this article.
Author contributions: JEB and RCD conceived and designed the study and obtained funding through an unrestricted educational grant. The RADARS System Poison Center Investigators were responsible for collecting the data, performing quality control checks on the data, and commenting on the article. EC analyzed the data. Each author was responsible for drafting different sections of the article and contributed substantially to the revisions of the article as a whole. JEB takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Reckitt Benckiser Pharmaceuticals Inc., Richmond, VA, supported these analyses through an unrestricted educational grant but did not participate in the data collection, analysis, or preparation of the article. Denver Health—Rocky Mountain Poison & Drug Center (RMPDC) is a nonprofit public hospital that operates the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System. Data presented are from poison centers participating in this system. RADARS System is supported by several subscribers from the pharmaceutical industry.
Publication dates: Available online September 2, 2008.
PII: S0196-0644(08)01503-5
doi:10.1016/j.annemergmed.2008.07.015
© 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
