Opioids Most Common Substance in Young Children’s Fatal Poisonings

Opioids were the most common substance contributing to fatal poisonings among children age 5 years and younger in recent years, researchers reported.

Examination of 731 poisoning-related fatalities from 2005 to 2018 in young kids reported to the National Fatality Review-Case Reporting System (NFR-CRS), showed that opioids were involved in 346 of the fatal cases (47.3%).

Additionally, the proportion of fatal cases involving opioids trended upward over the study period, said Christopher Gaw, MD, MBE, of the Children’s Hospital of Philadelphia, and colleagues. In 2005, opioids were involved in 24.1% of the fatal poisonings, increasing to 52.2% in 2018.

“These data highlight the increasing impact of the opioid epidemic on children and is in line with previous studies, which have described increasing rates of pediatric opioid exposures and death,” the researchers wrote in Pediatrics. “Initiatives focused on reducing opioid prescribing and diversion were likely associated with a transient reduction in pediatric mortality in the early 2010s.”

“In the past decade, children have been exposed to new opioid sources, such as heroin, fentanyl, and opioids used in medication-assisted treatment (e.g., methadone, buprenorphine), which have reversed previous public health gains,” the team continued. “As the types of opioids circulating during the current epidemic continue to evolve, policy and programmatic initiatives should focus on children in addition to adults.”

In an email to MedPage Today, Gaw noted that many toxic substances can harm children, but said “it is truly striking how just one class of substances was implicated so frequently in child poisoning deaths.”

“These findings provide additional supporting evidence of how the opioid epidemic has not spared our nation’s infants or young children,” he added.

The researchers explained that although regulatory changes have improved the safety of over-the-counter (OTC) medications, a substantial proportion of pediatric fatalities are still associated with OTC medications. In their study, OTC medications for pain, cold, and flu were involved in 14.8% of fatalities (108 of the total).

In addition, the researchers said, although certain medication safety initiatives have shown promise in reducing poisonings — such as the adoption of unit dose packaging — such approaches do not address illicit opioids or all prescription opioids.

Prevention of fatal pediatric poisonings thus requires a multifaceted approach of caregiver education and community-level interventions, particularly among communities facing socioeconomic disparities, the investigators emphasized.

“Further study is needed to improve our understanding of how infants and young children can be harmed by specific types of opioids and routes of opioid exposure,” the researchers wrote. “First responders and clinicians should maintain a high level of suspicion for opioid intoxication among children with altered mental status or respiratory depression; opportunities exist to improve both provider and community familiarity with the indications for and use of naloxone.”

For their study, the investigators acquired data from 40 states participating in the NFR-CRS, analyzing demographic, supervisor, death investigation, and substance-related variables using descriptive statistics.

Among the findings were that:

• Other or unspecified illicit drugs contributed to 14.2% of fatalities (104 of the total)

• Other or unspecified OTC or prescription drugs contributed to 9.7% (71)

• Carbon monoxide contributed to 6.4% (47)

Additionally, Gaw and colleagues reported, 42.1% of the 731 deaths occurred among infants, and nearly two-thirds occurred at home.

Of the 581 cases for which information on child protective services involvement was available, 16.7% had a documented open case at the time of death, the researchers found.

Limitations of the study, the team said, included that the NFR-CRS does not capture all fatal poisonings.