Close to 9,000 children and teens in the United States died from opioid poisonings over the last two decades, representing a nearly three-fold increase in mortality rates, Yale researchers said. These findings illustrate how the opioid epidemic continues to evolve and harm children even as efforts to confront the crisis through treatment and limits on opioid prescribing ramp up, they said.

The study was published in JAMA Network Open.

While the high opioid overdose death rate among adults has been widely reported, it is unclear how many children die each year from prescribed and illegal opioids. To quantify the impact on young people, Yale researchers collected and analyzed mortality data from the Centers for Disease Control and Prevention covering the years 1999 through 2016.

Over the 18-year period, the research team found that nearly 9,000 children died from poisonings from either prescription or illicit opioids. While a prior estimate of pediatric opioid deaths that focused only on hospitalizations put the annual death toll at approximately 30 deaths per year, the current study, which includes deaths in all settings, shows that the yearly total is closer to 500, the researchers noted. Nearly 40% of children died at home.

“While there was a decline in the death rates in 2008 and 2009 that corresponded with a decrease in prescribing trends, the rates are going up again,” said lead author Julie Gaither. “It’s due to a rise in heroin and synthetic opioid use among teens.”

The children most at risk are older teens, who represent 88% of those who died from opioids during the period studied. But the research team found that even very young — children under age 5 — were not spared. About one-quarter of those deaths were due to homicides, the researchers reported, noting that further research is needed to understand what roles abuse, neglect, and parental substance abuse — including opioid abuse — play in these deaths.

The study also highlights how other subgroups of children are increasingly harmed by the opioid crisis. “This is still a problem that affects whites and males mostly, but that is changing. Death rates among females, blacks, and Hispanics are rising rapidly,” Gaither noted.

The findings show that despite efforts to contain the crisis among adults, not enough has been done to address the impact of opioids on children and families. For example, childproof packaging for prescription opioids used for addiction treatment, such as Suboxone, could go a long way toward protecting children, said Gaither. Methadone, a drug used to help adult opioid users reduce cravings, is also implicated in a disproportionate number of pediatric opioid deaths, she notes.

“As the United States is working more aggressively to treat opioid addiction, we need to consider how children and adolescents are affected by that,” she said. “We need to start looking at communities and families as a whole and how everything is interrelated.”

Other Yale authors are Veronika Shabanova and John Leventhal.

The study was supported by grants from the National Center for Advancing Translational Sciences, National Institutes of Health.