Hospitalization for prescription opioid poisoning among U.S. children and teens nearly doubled during a recent 15-year period, and grew especially dramatically among children under 4, according to a study published Monday in the journal JAMA Pediatrics.
Using a database of millions of hospital discharges, the researchers estimated that 2,918 patients aged 1 to 19 were hospitalized for prescription opioid poisonings in 2012, up from 1,049 in 1997. Most hospitalizations occurred among teens 15 to 19. But the rate of hospitalization grew fastest among the youngest children: for every 100,000 children aged 1 to 4, 2.62 children were hospitalized for prescription opioid poisonings in 2012, compared to 0.86 in 1997 – a 205 percent increase. Hospitalizations among those 1 to 4 rose from 133 in 1997 to 421 in 2012, the researchers estimated.
Lead author Julie R. Gaither, an epidemiologist and postdoctoral fellow at the Yale School of Medicine, said she and her team weren’t surprised to see an increase in opioid-related hospitalizations among older teens during a period when overall prescribing rates for the drugs skyrocketed.
But they did not expect to see such a large increase among toddlers and preschoolers. Gaither said it reflects how vulnerable young children are, and how ubiquitous the drugs are in society.
“Opioids are in millions of American homes now, and so children are increasingly exposed to them,” she said. She noted that other research suggests most drug poisonings in young children occur after they get into medication prescribed to someone else in the home.
Gaither’s team used a database of pediatric hospitalizations that releases records every three years; their study spanned the period from 1997 to 2012, with records for six of the years. They used medical coding to identify cases in which children or teens were hospitalized for prescription opioid poisoning and to identify whether the cause was classified as intentional or accidental. They excluded infants under age 1 because they wanted to capture cases that involved self-administration of the medication.
Girls were more likely to be hospitalized than boys, although the gap narrowed over time; in 1997, only 34.7 percent of the poisonings occurred in boys, but that rose to 47.4 percent in 2012. Nearly three-quarters of hospitalizations involved white children and teens, while just under half were covered by private insurance.
Among those older than 10, the poisonings were most likely to be categorized as the result of a suicide attempt or self-inflicted injury, rather than accidental.
“These data underscore the dangers associated with the widespread availability of prescription opioids, particularly for adolescents at risk for depression,” the authors wrote.
Nationally, prescription opioids dispensed dropped slightly from 2011 to 2013, and the study also found a small decline in hospitalization rates for prescription opioid poisonings in young people from 2009 to 2012. But that was the result of a drop in hospitalizations among teens aged 15 to 19 – and hospitalizations for heroin overdoses rose for that age group during the same period. Gaither said that’s a sign of teens switching to heroin, rather than a decline in opioid use overall.
Gaither said the findings point to a need to pay better attention to how the opioid crisis affects children and teens – and to recognize that it impacts people of all ages.
“It’s really across the lifespan,” she said. “Children are born addicted to narcotics because their mothers are taking them. They affect the elderly, and everyone in between.”
She said it also suggests the need for better storage, packaging and labeling to keep the drugs away from young children. Doctors who prescribe opioids could also ask if there is a child in the home and, if so, advise the patient to ensure the child can’t access the medications.
Because many adults misusing opioids are parents, Gaither – who has previously studied opioid use in adults and injuries in children – said there’s also a need to focus on the impact on children of growing up in families dealing with substance abuse.
Connecticut legislators, aiming to reduce the availability of prescription opioids that can be misused, passed a law earlier this year that limits initial prescriptions for opioids to seven days or less, although there are exceptions for cases in which the prescriber deems a longer supply necessary. That provision took effect July 1.