The number of young children in the United States who have died from opioid overdoses has risen dramatically, according to a new study of accidental poisonings of children 5 and younger.
The study, published Wednesday in the journal Pediatrics, examined a national database and found 731 children ages 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 by far the highest number of fatal poisonings came from opioids.
The trend has worsened over time. In 2005, opioids accounted for 24.1% (seven of 29) of substances contributing to childhood deaths, compared to 52.2% (24 of 46) in 2018.
“It’s really striking, looking at this data, how different the proportions were between 2005 and 2018,” said study co-author Dr Christopher Gaw, a research associate at Children’s Hospital. of Philadelphia whose research focuses primarily on pediatric injuries and poisoning.
The number of fatal poisonings in this age group had declined since the Poison Prevention Packaging Act was passed in 1970, when harder-to-open child-resistant packaging became the norm for many many drugs, according to other studies.
Gaw thinks people’s preferences for particular drugs have changed and that has had an impact on the number of deaths.
In the late 1990s and early 2000s, prescription opioids were the drug of choice. As the guidelines got stricter and more doctors and dentists became aware of the opioid epidemic, they were prescribing less opioids, so people were turning to things like heroin and fentanyl.
Illicit drugs like fentanyl, which is 100 times stronger than morphine and can kill quickly, are not packaged 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 adult deaths. 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.
Medication safety initiatives aimed at reducing the number of opioids in circulation have helped reduce opioid use to some extent, but the initiatives cannot combat the illicit drug trade, the research found.
The new study cannot explain how the young victims obtained the drugs, but it does offer some details about the circumstances in which these deaths occurred.
Child Protective Services departments had open cases for 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 less than a year old.
More than two-fifths of the children who died were infants under the age of one.
More than 65% of deaths occurred at home. Almost a third were under the supervision of someone who was not their biological parent.
Of the cases with documented circumstances, more than 40% of deaths were accidental overdoses. Just under 18% were considered intentional poisonings.
Researchers for the new study extracted the records of all children ages 5 and under from the National Fatality Review-Case Reporting System, a database of death records from 40 US states in which various interdisciplinary groups review any child death within their jurisdiction. The US Poison Centers keep their own data on pediatric poisoning deaths and have found similar trends.
“What we tend to see at the poison control center level is that opioids are associated with the most cases of pediatric deaths compared to other substances,” said Kait Brown, clinical chief executive of the American Association. of Poison Control Centers, which was not involved in the new research.
Brown also noticed a drop in exposures to prescription opioids like hydrocodone and oxycodone and an increase in exposures to fentanyl. Additionally, there has been an increase in the number of children being poisoned by opioid abstinence medications like methadone.
“Most of the time when children are exposed, it’s accidental,” Brown said. People can store their prescriptions in easy-to-open pill boxes instead of childproof bottles. They may even keep them loose in a pocket, as many of these drugs are for pain. A pill could then fall out into the open, where small children could easily find it.
Gaw says most of these young victims likely find drugs while exploring the world around them.
“So kids, when they grow and develop, they move. They explore their environment. They love to put things in their mouths,” he said.
Gaw said it’s important for healthcare 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 the minds of children, preferably behind a locked cupboard,” he said.
If you have unused medicine, you can take it to a pharmacy or another safe place rather than throwing it in a trash can.
Gaw encourages all caregivers to keep the poison control number handy: (800) 222-1222.
He hopes his study will inspire providers to educate parents about the risks posed by the drugs. He also wants to see greater availability of the opioid antidote naloxone, also known as Narcan. It is safe for children and can reverse an overdose.
In February, two independent advisory boards of the US Food and Drug Administration voted unanimously to make naloxone nasal spray available over-the-counter to increase access. The FDA commissioner took these recommendations into consideration and could make a decision at any time.
Gaw said it’s also important that healthcare 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 get help too.
“It’s incredibly sad, but I think it’s important to really highlight this because we don’t want children to be forgotten in this outbreak because they’re also at risk,” Gaw said. “Their risk is related to the larger world they find themselves in.”