Opioids Linked to Nearly Half of Pediatric Poisoning Deaths

Data from the National Fatality Review-Case Reporting Systems (NFR-CRS) links opioids to nearly half of pediatric poisoning deaths. That makes opioids the leading cause of poisoning fatalities among infants and young children, the American Academy of Pediatrics (AAP) says in a new study in Pediatrics.

The study focused on deaths in children five and younger between January 1, 2005, and December 31, 2018. The data showed that 731 fatalities across 40 states were attributed to “poisoning, overdose, or acute intoxication.”

The researchers note that 42.1% of the cases analyzed were in infants under one year old, with over 65% happening in the child or infant’s home. Additional insight suggests that nearly 16.7% of children who died due to poisoning were in the middle of an open child protective services case.

In addition to data on the children and location of death, researchers collected information on the supervision surrounding these preventable fatalities, noting that 32.2% of deaths occurred when the child was cared for by someone other than the biological parents.

Beyond situational demographics, the study focused heavily on the substance contributing to death, finding that 47.3% of the deaths, 346 out of 731, were associated with an opioid. Over-the-counter pain, cold, and allergy medications were the second most common source of pediatric poisoning fatalities, accounting for 14.8% of deaths.

In addition to analyzing the proportion of deaths caused by opioids, researchers also examined what proportion of the substances associated with poisoning were opioids. Of the 29 substances linked to fatal child poisoning in 2005, seven were opioids, accounting for 24.1%. By 2018, that number had risen to 52.2%, with 24 of the 46 substances linked to fatalities being opioids.

This data suggests that the widespread impacts of opioids and opioid use spreads far beyond addiction in adolescents, teenagers, and adults, affecting even the youngest patient populations. While opioids have multiple indications for use, comprehensive prevention strategies are necessary to minimize addiction and accidental poisoning.

One proposed solution is to co-prescribe Narcan (naloxone), a medication that can sometimes reverse the fatal effects of an opioid. New York, Virginia, Vermont, Arizona, Florida, Ohio, Rhode Island, Washington, California, New Mexico, and New Jersey have already enacted co-prescribing laws.

While varying in specificity, the laws allow patients prescribed opioid medication for pain management to obtain naloxone. In an interview with PharmaNewsIntelligence, Caroline Collins, Senior Behavioral Health Implementation Specialist at Sunwave, noted that getting naloxone easily has reduced the number of opioid-related deaths.

Beyond the potentially life-saving utility of naloxone, co-prescribing offers an additional opportunity for clinicians and healthcare providers to relay educational information to patients. Whether that is how to use naloxone, where to store opioids, or addiction resources, educational efforts can potentially alter the current rates of opioid-related death.

However, AAP researchers note in the study that “[p]revention of fatal pediatric poisonings requires a multifaceted approach involving caregiver education, as well as community-level interventions, particularly among communities facing socioeconomic disparities.”

“Further work is warranted in improving the capture of fatal child poisonings and characterizing the ecological factors associated with these cases,” they state.

Focusing on pediatric poisoning, having naloxone at home when an opioid is in the house, understanding how to use it properly, and education on storing opioids safely are invaluable tools for preventing pediatric poisoning.