America’s opioid crisis has taken a top slot as a public health concern a little more than a year after the FDA approved Oxycontin for use among children

This article is more than 3 years old

This article is more than 3 years old

The incidence of American children overdosing on opioids increased dramatically between 1997 and 2012, including a two-fold increase among toddlers, a review of more than 13,000 hospital discharge records has found.



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Previous such studies have focused on overdose among adults, or overall poisonings of children.

“Not a lot of attention has focused on children, and because these drugs are so ubiquitous I knew children also had to be impacted by the opioid crisis,” said Julie Gaither, a researcher and registered nurse at Yale.

However, she said, “We see little about it really in the press, and little research has been done in this area.”

America’s opioid crisis has taken a top slot as a public health concern, infiltrating the 2016 presidential election a little more than a year after the US Food and Drug Administration (FDA) approved a powerful opioid, Oxycontin, for use among children.

Gaither’s research examined records concerning children from ages one to 19 who were hospitalized for opioid poisoning in three-year intervals between 1997 and 2012. During that time, 176 of the hospitalized children died.

The study found that over 15 years, as the popularity and prescribing of opioids increased, the number of children who were accidentally poisoned or adolescents who attempted to kill themselves also increased.

The most dramatic rise in poisonings was among the youngest children. Toddlers between one and four years old had more than twice the rate of poisonings from painkillers in 2012 as they did in 1997. On a population level, researchers estimated that meant 2.6 of every 100,000 toddlers would be poisoned by opioids, from less than one in 1997.

Most poisonings were accidental – probably from toddlers believing the pills were candy.

Among teens, the rise was also dramatic but was more likely to indicate attempts at intentional self-harm. Overdoses among adolescents from 15 to 19 years old rose by an estimated 176%, the population of teens hospitalized from opioid poisoning rising from 3.6 per 100,000 in 1997 to 10.1.

In the same age group, heroin overdoses increased by 161%. Poisoning from opioid abuse treatment soared – methadone overdoses increased by 950%.

In that time, the profile of children hospitalized for opioids also changed, growing significantly whiter and more male.

In 1997, researchers found that 34.7% of hospitalizations were of boys. That grew to 47.4%. The children were predominantly white, 73.5%, and the proportion who were on Medicaid or government health insurance for low-income families increased from 24.1% to 44% in 2012.

The new work, published in the Journal of the American Medical Association Pediatrics, adds to research that showed increases in overdose among children. Boston children’s hospital researchers found that overdose rates among children younger than 18 rose by 30% between 2001 and 2008. Poison center officials have also reported increases in opioid overdose among children.

Gaither emphasised the need for more tamper-resistant packaging and for greater care when storing such medications.

“You’ve got the childproof safety caps, but obviously more needs to be done to keep kids from getting into them,” she said.

Though Gaither’s research is some of the first to address opioid overdose among children, it is not the first to call on the industry to develop new packaging.

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A 2015 Johns Hopkins Universtiy report recommended researchers develop tamper-resistant packaging and more rigorously test it. Better packaging, the authors reasoned, would not only stop children from accidentally taking the drugs but would also help stop the diversion of prescription drugs to the black market.

A pill bottle that links doses to a phone app and website is being tested by the National Institutes of Health. Johns Hopkins developed a prototype bottle that links a patient’s fingerprint to dosing.

One small study showed that patients in opioid addiction treatment felt tamper-proof bottles dissuaded at least some from diverting their buprenorphine pills (better known by the brand name Suboxone) to the black market.

“Across the board, for all age groups, we need to limit exposure,” Gaither said. “We need to limit children getting their hands on these drugs – they may think they’re candy.

“Opioids are now ubiquitous in the US, and they’re in millions of American homes.”