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Opioid Mortality on the Rise in US Children
Veronica Hackethal, MD
Most data on US opioid-related deaths come from adults, but a recent study shows pediatric opioid deaths are on the rise at an alarming rate.
Despite increasing awareness and aggressive public health measures, the opioid epidemic continues to claim thousands of lives in the US alone. However, most data on opioid-related deaths in the US come from adults with one population being overlooked: children. Pediatric opioid deaths are increasing at an alarming rate. Exactly how many children are dying each year from opioids and how are those rates changing? Click through the slideshow below for information from the first nationwide study on pediatric opioid deaths. The results may just change both the medical and public perception of the opioid crisis.
Opioid Deaths in US Children. Most data on US opioid-related deaths come from adults, however, the epidemic is increasingly affecting children. Around 5000 children aged <6 years were seen for opioid exposure in the ED from 2010 to 2013.1 Pediatric hospitalizations for opioid poisoning almost doubled between 1997 and 2012.2
First Nationwide Study of Pediatric Opioid Deaths.3 The first nationwide study of pediatric opioid deaths was a cross-sectional study using CDC mortality data from 1999 to 2016. The study found that 8986 children aged <20 years died in the US from opioid poisoning with 73.1% being male, 88.1% aged 15-19 years, 6.7% aged 0-4 years, and 79.9% non-Hispanic whites. The overall pediatric mortality rate from opioids increased by 268.2% (P<.001).
Pediatric Opioid Deaths Highest in Older Teens, Very Young. Rates of opioid death increased substantially across all age groups (0-4, 5-9, 10-14, and 15-19 yrs) over time with the largest changes among oldest and youngest children. In children aged 15-19 years, opioid deaths increased 253% and in children aged 0-4 years, deaths increased 225%.
Black Children and Girls Increasingly Affected. Among black children, opioid deaths increased 390% and in girls, opioid deaths increased 323%.
Most Opioid Deaths Unintentional, Occur Outside Hospital. Overall, 81% of opioid deaths among children were unintentional, 5% were due to homicide, and 2.4% due to suicide. The highest suicide risk was in those aged 15-19 years, but 85% were unintentional. Homicide was notable in the very young with 24.5% in those aged <5 years and 34.5% in those aged <1 year. Across all age groups, most deaths occured outside the hospital with 10.4% in inpatients; 28% in the ED, other outpatient setting, or dead on arrival; and 38% at home.
Death from Synthetic Opioids, Heroin High in Older Teens. Death rates in those aged 15-19 years increased for synthetic opioids (2925%), heroin (405%), and prescription opioids (94.7%). Synthetic opioids caused about 1 in 3 deaths in this age group with almost half occurring between 2014 and 2016. Heroin caused 1 in 4 deaths in this age group as well.
Clinical and Public Health Implications:
- Gains in fighting prescription opioids eroded by increase in heroin, illicit fentanyl
- Risks of opioids under-recognized in children due to public health initiatives solely focused on adults and lack of childproof packaging
- Rise in methadone/buprenorphine use for adult opioid use disorders will likely increase pediatric exposure
- High infant homicide rate, but more research is needed on the role of abuse, neglect, parental substance abuse
Take Home Points:
- From 1999-2016, ~9000 US children died from opioids; pediatric opioid-related mortality rate increased almost 3-fold
- Highest mortality rates among those aged 15-19 years and 0-4 years
- Most deaths among male, non-Hispanic whites aged 15-19 years
- Opioid-related deaths increased at faster rates among black children and girls
- Most deaths labeled unintentional or happened outside the hospital
- Gains in fighting prescription opioids eroded by increase in heroin, illicit fentanyl
References:
1. Lovegrove MC, Weidle NJ, Budnitz DS. Trends in emergency department visits for unsupervised pediatric medication exposures, 2004-2013. Pediatrics. 2015;136:e821-e829.
2. Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016;170:1195-1201.
3. Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatric deaths from prescription and illicit opioids, 1999-2016. JAMA Netw Open. 2018;1:e186558.