Opioid poisonings are sending more kids than ever to the hospital

 As opioid prescriptions have soared in the last two decades, so have the number of children and teens hospitalized for drug poisoning, a new study finds -- pointing to the need for more awareness and change, local addiction experts say.

"This is really, really tragic," Deb Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania, said of the findings. "It makes the point we have to be doing a much more enhanced job of physician education on the use of these drugs."

The study, published Monday online in JAMA Pediatrics, examined the U.S. hospital-discharge records of 13,502 patients ages 1 to 19. It found admissions for prescription opioid poisonings in the group rose by 165 percent from 1997 to 2012, the last year available.

"Opioid presentation has increased dramatically in the last two decades," said lead author Julie R. Gaither, a postdoctoral fellow at the Yale School of Medicine.
The findings, Gaither said, are "a reflection of what has been going on in the population," as opioids have become among the most widely prescribed medications in the United States and a fixture in medicine cabinets.

While the growth of poisoning, especially among very young children, suggests undersecured medication in the home, research cited by the Yale authors also shows that pediatric patients, particularly adolescents, are now frequently prescribed opioid medication for routine pain relief.

The study's numbers suggest that too many people don't realize the risk these drugs present, Beck said.

The Yale researchers as well as Philadelphia-area experts called for better prevention efforts, more public education, and more stringent prescribing guidelines.

Terri Randall, an attending psychiatrist with Children's Hospital of Philadelphia, said the study, while not surprising, was distressing.

"It helps reinforce that this is a major problem, and we need to address it," Randall said.

The most vulnerable population, she said, "is the very young."

The study is based on information from the federal Kids' Inpatient Database for 1997, 2000, 2003, 2006. 2009, and 2012, which reflects children covered by private insurance as well as Medicaid. It reflects 176 deaths during those six years, Gaither said.

While the majority of deaths occurred in older teens, young children showed the highest rate of increase in hospitalizations — 205 percent from 1997 to 2012.
Prescription-opioid poisoning, including methadone poisoning, among teens ages 15 to 19 jumped 176 percent, hitting 10.17 per 100,000 children.

The study also looked at intent. Only 16 poisonings of children under 10 from the six years reviewed were attributed to attempted suicide.

For older children and teens, there were marked increases in poisonings linked to attempted suicide — they climbed 140 percent among 15- to 19-year-olds. Accidental prescription-opioid poisonings were up, too. However, for older teens, suicide attempts exceeded accidental poisonings, according to the study.
"These data underscore the dangers associated with the widespread availability of prescription opioids, particularly for adolescents at risk for depression," the study states.

Heroin poisoning for these older teens was examined separately by the researchers. Hospital admissions for heroin in this age group grew 161 percent, to a rate of 2.51 per 100,000 children.

The study authors said this increase, coupled with a slight recent decrease for prescription-opioid hospitalizations for the older teens, "is consistent" with prescription-drug abuse being a precursor to heroin use, as it often is with adults.

And as with the opioid epidemic in adults, the majority of the children in this study were white -- 73.5 percent. Nearly half were covered by private insurance, although the number covered by Medicaid increased over the 16-year study period.