M 14: Pediatric Opioid Exposures and Poisonings: Prevalence and Characteristics
PhD Candidate, Department of Pharmacotherapy and Outcomes Science
Virginia Commonwealth University School of Pharmacy United States
Among different drugs involved in pediatric exposures, opioids are an important class due to a rise in their medical and nonmedical use. This study examined the prevalence and characteristics of pediatric opioid exposures and poisonings.
We examined closed cases of children < 18 years with a suspected opioid exposure in the National Poison Data System (NPDS). Opioid exposures were characterized based on clinical factors and socio-demographics. Prevalence rates were standardized by the age-adjusted U.S. Census population estimates.
We identified 83,418 children exposed to an opioid over the five-year period (January 1, 2010 to December 31, 2014). More than half of them experienced poisoning i.e., an exposure that resulted in clinical effects. About 61.2% of these children were <= 5 years old, over 90% of exposures occurred at home and involved ingestion. Nearly half of the exposures involved a single-substance opioid, the majority involving tramadol, oxycodone, buprenorphine, codeine or hydrocodone. About 73.4% of exposures were unintentional (i.e., accidental) and 18.8% resulted from a therapeutic error. One-fourth of exposures involved co-ingestants or multiple opioid and non-opioid products. Nearly 33.4% of the children had at least one related clinical effect including neurological, cardiac and respiratory effects, 11% had a moderate-to-severe outcome (including death) and 8.5% were admitted to critical care following an opioid exposure. About 6.4% were treated with naloxone.
The total prevalence rate of opioid exposures was found to be 22.6 per 100,000 children. The annual prevalence rate of opioid exposures decreased from 2010 to 2014 (25.5 to 20 per 100,000 children, respectively). The prevalence rate was higher among children <= 5 years (42.4 per 100,000 children) compared to those 6 to 12 years and 13 to 17 years (6.1 and 22.2 per 100,000 children, respectively).
Generalized linear mixed model showed a statistically significant yearly trend. The number of opioid exposures decreased from 2010 to 2014 after adjusting for random effects of states. In multivariable regression, older age, non-accidental intent, and involvement of a single substance opioid, rather than a combination product, were found to be significantly associated with severe outcome (which included moderate outcome, major outcome or death), following an opioid exposure in children (p<0.05).
Pediatric opioid exposures and poisonings still continue to occur. While the prevalence of pediatric opioid exposures and poisonings has declined over time, the magnitude of the annual decreases has been low. Our results suggest that opioid exposures are more prevalent in younger children and are mostly unintentional in nature. Younger children may gain access to opioids belonging to others at home. This can lead to an opioid exposure and poisoning, resulting in negative health outcomes. Development of educational efforts and targeted prevention strategies that are age-specific is warranted. Further analyses will identify the economic burden associated with opioid exposures and poisonings in children.
Other author information: Norman V. Carroll, BS, MS, PhD (Professor, Virginia Commonwealth University, Richmond, VA)