Yale researchers have uncovered startling data about the number of children and adolescents (younger than age 20) dying from opioid poisoning.
The general belief—until the Yale team delved into it—was that children and adolescents rarely die from ingesting illicit and prescription opioids.
But the researchers found that most studies had looked at deaths related to hospitalizations or emergency department visits—not deaths occurring outside hospitals.
Adding the deaths outside hospitals brought the average yearly death total to nearly 500—far more than had been expected; meaning that over the 18-year span of the study, ending in 2016, opioid deaths claimed the lives of almost 9,000 children and adolescents. Almost 8,000 of the deaths occurred among adolescents (aged 15 to 19), and just over 600 among children aged 0 to 4 years.
The findings were especially grim among children younger than age 5. Tragically, almost one death in four in this highly vulnerable group was due to homicide.
The study results were published in the December issue of JAMA Network Open.
Study Focus, Design, and Data Source
Led by Julie R. Gaither, PhD, MPH, the investigators looked at deaths in children per year from opioid poisonings. This was a retrospective analysis of data from the WONDER database, which compiles information from all death certificates from the National Center for Health Statistics. The team used the Multiple Causes of Death file to identify poisonings.
Summarized below are data gathered over the study period.
Deaths Among All Children and Adolescents, No. (%)
| Unintentional | Homicide | Suicide | Undetermined |
|---|---|---|---|
| 7,263 (80.8) | 219 (2.4) | 445 (5.0) | 1,061 (11.8) |
In particular, the authors noted that the under-5 group was “highly vulnerable.” This group had “the second-highest mortality rates overall,” and “the second-largest increase in rates over time.”
Many deaths in this age group were due to homicide or to unintentional harm.
Deaths Among Children Younger Than 5 Years, No. (%)
| Unintentional | Homicide | Undetermined |
|---|---|---|
| 230 (38) | 148 (24.5) | 227 (37.5) |
Additional findings:
- Mortality rates rose by 252.6% in adolescents aged 15 to 19 years, and by almost as much—225.0%—in children aged 0-4 years
- In infants, 34.5% of deaths were categorized as homicides—the highest percentage so categorized for any age group
- In all age groups, 10.4% died in the inpatient setting, and 24.1% in the emergency department—but the largest proportion—38.0%—died at home
Again, the last finding—most deaths occurring outside a medical setting—helps to explain the original widely held, but incorrect, belief that the young rarely die from ingesting opioids.
The authors pointed to the need for further research “to determine what roles abuse, neglect, and parental substance abuse—specifically, opioid abuse—play in these deaths.”
Current Practices
Policies and practices in the opioid field have focused on adults, but the Yale team pointed out that this needs to change, and steps need to be taken to protect young children. For example, it’s easy to open the foil wrappers of Suboxone and Duragesic—products that are potentially lethal to a young child.
The Bottom Line
For the under-5 age group, the authors foresee a public health problem that is likely to grow “unless parents, legislators, public health officials, and clinicians—including physicians who prescribe opioids to adults—begin to take a wider view of what is a systemic crisis.” The authors call for something better than ”isolated solutions that fail to account for how entire families and communities are affected by adult opioid use.”
Reference
Gaither JR, Shaban ova V, Leventhal JM. US National trends in pediatric deaths from prescription and illicit opioids, 1999-2016. Original Investigation / Pediatrics. JAMA Network Open. 2018;1(8);e186558. doi:10.1001/jamanetworkopen.2018.6558.