News & Commentary

Opioids Killing More Children


The pediatric opioid-related mortality rate increased 268% between 1999 and 2016, according to a study published in JAMA Network Open by Yale researchers.

Prescription and illicit opioid poisonings totaled 8,986 in that 17-year period, with 7,921 deaths (88%) among those aged 15 to 19. Among people in their late teens, 3,050 deaths (39%) involved one or more other substances, such as alcohol, antidepressants, cocaine, and benzodiazepines.

“What began more than two decades ago as a public health problem primarily among young and middle-aged white males is now an epidemic of prescription and illicit opioid abuse that is taking a toll on all segments of U.S. society, including the pediatric population,” according to lead author Julie R. Gaither and her colleagues. “Millions of children and adolescents are now routinely exposed in their homes, schools, and communities to these potent and addictive drugs.”

For all those under 20, 7,263 deaths (81%) were unintentional, 445 (5%) were suicides, and 219 (2%) were homicides. For those aged 15 to 19, 6,755 (85%) were unintentional, and 381 (5%) were suicides.

For children younger than age 5, 230 (38%) of the overdose deaths were unintentional and 148 (25%) were homicides. The manner of death could not be determined in 227 (38%) of the cases.

“The underrecognition of the risks that prescription and illicit opioids pose to children and adolescents is reflected in the current policies and practices in place in the United States today,” the study states. “Of the hundreds of state and federal initiatives enacted to contain the opioid crisis, nearly all focus on adults.”

The researchers mention the lack of childproof packaging for long-acting opioids that can harm small children with even minimal exposure. Suboxone (the combination form of buprenorphine and naloxone), a medication used to treat opioid addiction, and Duragesic (the transdermal pain patch of fentanyl), come in foil wrappers that can be easily opened, they point out.

Even when these concerns appear to be addressed, the solution seems questionable. Suboxone, for instance, is no longer sold as a pill. Good. But now it comes in “brightly colored film strips.” Not so good.

“These findings suggest that the opioid epidemic is likely to remain a growing public health problem in the young unless legislators, public health officials, clinicians, and parents take a wider view of the opioid crisis and implement protective measures that are pediatric specific and family centered,” say Gaither and colleagues.

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