Children under 5 increasingly fall victim to opioid epidemic, study finds


The number of young children in the U.S. who have died from opioid overdoses has increased significantly, according to a new study of accidental poisonings of children 5 and younger.

The study, published Wednesday in the journal Pediatrics, looked at a national database and found 731 children age 5 and younger among the poison-related deaths. between 2005 and 2018. Some of the children were poisoned by over-the-counter pain, cold and allergy medications, but the largest number of fatal poisonings by far were from opioids.

The trend worsened over time. In 2005, opioids accounted for 24.1% (seven of 29) of substances contributing to child deaths, compared to 52.2% (24 of 46) in 2018.

“It’s really striking to see, looking at this data, how different the ratios were between 2005 and 2018,” said study co-author Dr. Christopher Gaw, a fellow at the Children’s Hospital of Philadelphia whose research focuses primarily on childhood injury and poisoning.

The number of fatal poisonings in this age group had fallen since the Poison Prevention Packaging Act was passed in 1970, when more difficult-to-open waterproof packages became the standard for many drugs, other studies have shown.

Gaw believes that people’s preferences for certain drugs have changed and that this has had an impact on the number of deaths.

In the late 1990s and early 2000s, prescription opioids were the drug of choice. As guidelines tightened and more doctors and dentists became aware of the opioid epidemic, they prescribed fewer opioids, so people turned to things like heroin and fentanyl.

Drugs used illegally, such as fentanyl, which is 100 times stronger than morphine and can kill quickly, do not come in waterproof packaging.

The new study builds on work that has shown a steady increase in the number of children killed by opioids, alongside an increase in deaths among adults. Drug overdose deaths have increased fivefold since 1999, according to the US Centers for Disease Control and Prevention, and nearly 75% of the 91,799 overdose deaths in 2020 involved an opioid.

Drug safety initiatives to reduce the number of opioids in circulation have helped reduce opioid use to some extent, but the initiatives cannot address the illegal drug trade, research shows.

The new study can’t explain how the young victims took drugs, but it does offer some details about the circumstances under which these deaths occurred.

Child protective services departments had open files on 97 of the children who died. There was a documented history of child abuse in 153 of the cases, and almost a third of those who died with a history of abuse were under the age of one.

More than two-fifths of the children who died were infants, under the age of one.

Over 65% of deaths occurred at home. Almost a third were under the supervision of someone who was not their biological parent.

Of the cases in which the conditions were recorded, more than 40% of the deaths were accidental overdoses. Just under 18% were considered deliberate poisonings.

Researchers in the new study pulled records for all children 5 years and younger from the National Case Review System, a database of death records from 40 US states in which a variety of interdisciplinary teams review child deaths within their jurisdictions. America’s poison centers keep their own data on childhood poisoning deaths and have found similar trends.

“What we tend to see at the poison center level is that opioids are associated with more childhood deaths than other substances,” said Kate Brown, clinical director of the American Association of Poison Control Centers, who was not involved in the new research. .

Brown has also seen a decrease in exposure to prescription opioids such as hydrocodone and oxycodone and an increase in exposure to fentanyl. Additionally, there has been an increase in children being poisoned by opioid withdrawal medications such as methadone.

“Most of the time, when kids are exposed, it’s accidental,” Brown said. People can keep prescriptions in easy-to-open pill organizers instead of waterproof baby bottles. They may even keep them loose in a pocket, as many of these medications are for pain. A pill could then be dropped into the open, where small children could easily find it.

Gaw says most of these young victims probably find drugs as they explore the world around them.

“That’s how children, when they grow and develop, move around. They explore their environment. They like to put things in their mouths,” he said.

Gaw said it’s important for health care providers to remind caregivers that the best way to keep children safe is to focus on preparedness and prevention.

“Try to keep dangerous substances, whatever they are, out of sight, out of sight, out of children’s minds, preferably behind a locked cupboard,” he said.

If you have unused medicine, you can take it to a pharmacy or other safe disposal site instead of throwing it in a bin.

Gaw encourages all caregivers to keep the poison control number handy: (800) 222-1222.

He hopes his study will prompt service providers to educate parents about the dangers of drugs. He also wants to see wider availability of naloxone, the opioid antidote, also known as Narcan. It is safe for children and can reverse an overdose.

In February, two independent advisory panels for the US Food and Drug Administration voted unanimously to make naloxone nasal spray available over the counter to increase access. The FDA commissioner has considered these recommendations and could make a decision any day.

Gaw said it’s also important for health systems to continue to find ways to limit the number of opioids in a young child’s environment. And if adults with substance use disorders get help, he says, the child will be helped, too.

“It’s incredibly sad, but I think it’s important to really highlight it because we don’t want children to be forgotten in this epidemic because they’re also at risk,” Gaw said. “Their danger is related to the larger world they are in.”

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