Young children are increasingly victims of opioid epidemic, study finds
The number of young children in the US who have died from opioid overdoses has risen sharply, according to a new study on accidental poisonings in children 5 and older.
The study, published Wednesday in the journal Pediatrics, looked at a nationwide database and found 731 children 5 and younger among the poison-related deaths between 2005 and 2018. Some of the children were poisoned by painkillers, cold and over-the-counter allergy. , but the largest number of fatal poisonings by far was 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 surprising to see, looking at this data, how different the proportions were between 2005 and 2018,” said study co-author Dr. Christopher Gaw, an associate fellow at the Children’s Hospital of Philadelphia, whose research primarily focuses on pediatric injuries and poisoning.
The number of fatal poisonings in this age group has been declining since the Poison Prevention Packaging Act was passed in 1970, when packages that are more difficult for children to open became standard for many drugs, other studies have shown.
Gaw thinks that people’s preferences for particular 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 became stricter and more doctors and dentists became aware of the opioid epidemic, they prescribed fewer opioids, so people turned to things like heroin and fentanyl.
Illicit drugs like fentanyl, which is 100 times stronger than morphine and can kill quickly, don’t come in childproof 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 quintupled 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 illicit drug trade, research shows.
The new study can’t explain how the young victims got the drug, but it does provide some details on 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 cases, and nearly a third of those who died with a history of abuse were less than one year old.
More than two-fifths of the children who died were infants, less than one year old.
More than 65% of deaths occurred at home. Nearly a third were under the supervision of someone who was not their biological parent.
Of the cases in which the circumstances were documented, more than 40% of the deaths were accidental overdoses. Just under 18% were considered intentional poisonings.
Researchers in the new study pulled records for all children age 5 and older from the National Fatality Review System, a database of death records from 40 US states in which a variety of interdisciplinary teams review any child fatality within their jurisdiction. America’s poison centers keep their own data on pediatric poisoning deaths and have found similar trends.
“What we tend to see at the poison center level is that opioids are associated with the most pediatric deaths compared to other substances,” said Kait Brown, clinical managing director of the American Association of Poison Control Centers. which was not included in the new research.
Brown has also seen a decrease in exposure to prescription opioids like 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 child-resistant bottles. They can even keep them loose in a pocket, since many of these medications are for pain. A pill could then fall into space, where small children could easily find it.
Gaw says most of these young victims probably find drugs while exploring the world around them.
“So children, as 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 hazardous substances, whatever they are, out of reach, out of sight, out of mind of children, preferably behind a locked cabinet,” he said.
If you have unused medication, you can take it to a pharmacy or other safe place instead of throwing it in the trash.
Gaw encourages all caregivers to keep the poison control number handy: (800) 222-1222.
He hopes his study will encourage providers to educate parents about the dangers of drugs. He also wants to see more widespread 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 committees to the US Food and Drug Administration voted unanimously in favor of making naloxone nasal spray available over the counter to increase access. The FDA commissioner has taken these recommendations into consideration and may make a decision any day.
Gaw said it’s also important that health systems 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, too.
“It’s incredibly sad, but I think it’s important to really highlight 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.”