Adults are not the only ones in the United States whose lives have been horribly and adversely affected by the overprescribing and misuse in recent years of prescription opioid painkillers — drugs like OxyContin, Percocet and Vicodin.
Children and adolescents have also been caught up in this tragic epidemic, and not just because their addicted parents are overdosing on the drugs (sometimes right in front of them).
Opioid poisonings are harming many children directly, as a disturbing study published Monday in the journal JAMA Pediatrics makes clear. It found that thousands of U.S. children were hospitalized for prescription opioid overdoses and poisonings during a recent 16-year period. Furthermore, the rate of such poisonings rose almost twofold during that time frame.
“Our findings mirror those we’ve seen in adults, and it really illustrates that this is a systemic problem that affects individuals across the lifespan,” said Julie Gaither, the study’s lead author and an epidemiologist and postdoctoral researcher at Yale University, in a video released with the study.
Gaither and her colleagues urge stronger public health interventions, including tougher consumer-product regulations and tighter practice guidelines for physicians, to protect children across all age groups, but particularly those that this study found most vulnerable: young children and older adolescents.
Looking for trends
For the study, the Yale researchers analyzed 16 years of data (1997-2012) from a national database of hospital discharge records for children and adolescents, aged 1 to 19.
The 1997 date is important because it was a year after OxyContin had come on the market. Its manufacturer, Purdue Pharma, had begun marketing the drug aggressively to doctors for the treatment of chronic pain, saying it was less addictive than other prescription painkillers alreayd in use. (That claim was false, which the company acknowledged a decade later when it and several of its executives pled guilty to misleading the public about the drug’s risk and paid $634.5 million in fines. By this time, however, sales of the drug had climbed to over $1 billion a year — and would total $35 billion by 2015. And the sales of other prescription opioids had also skyrocketed.)
The Yale researchers were looking not only for trends in pediatric hospitalizations for prescription opioid poisonings, but also for trends in heroin and methadone overdoses among the older teens (those aged 15 to 19). As the researchers note, individuals who become addicted to prescription opioids often go on to use heroin, and methadone is an opioid used to treat drug addiction. (Methadone is also responsible for a disproportionate number of drug poisonings, despite the fact that it’s prescribed infrequently.)
The researchers identified 13,052 cases of children and adolescents hospitalized for opioid poisonings. They also found that 176 of the children (1.3 percent) died during those hospitalizations.
The trend line was alarming. During the 16 years of the study, hospitalizations from opioid poisonings rose by 165 percent, from 1.40 to 3.71 per 100,000 children.
Although rates increased across all age groups, “the highest incidence for each year of the study occurred among the oldest children, the 15- to 19-year-olds,” said Gaither. “But we were surprised to find that the greatest increase over time actually occurred among the youngest children, those 1 to 4 years of age.”
Opioid poisonings among toddlers jumped 205 percent (from 0.86 to 2.62 per 100,000 children). Among teens aged 15 to 19, such poisonings rose 176 percent (from 3.69 to 10.17 per 100,000).
Heroin and methadone, too
Heroin overdoses among older teens also climbed significantly — 161 percent (from 0.96 to 2.51 per 100,000) — while overdoses in this age group from methadone jumped a stunning 950 percent (from 0.10 to 1.05 per 100,000).
The data also revealed that most of the children hospitalized due to opioid poisoning were white (73.5 percent) and covered by private insurance (48.8 percent). The proportion of children insured by Medicaid grew significantly, however, from 24.1 percent in 1997 to 44 percent in 2012.
The Medicaid finding may be a reflection of the widening of the prescription opioid epidemic across all socioeconomic groups, say the researchers.
The link with self-harm
Gaither and her colleagues also looked for the intent behind the poisonings — in other words, at whether the poisonings were the result of an accidental overdose or an attempt to commit suicide.
They found 16 cases of opioid poisoning attributed to suicide or attempts at self-inflicted injury among children younger than 10. And among children older than 10 years, most of the opioid poisonings were attributed to suicide or self-inflicted injury.
“These data underscore the dangers associated with the widespread availability of prescription opioids, particularly for adolescents at risk for depression,” the researchers write. (Many teens with depression are believed to self-medicate with prescription opioids.)
But accidental poisonings among teens advanced at a faster pace than that of suicide attempts — a finding that suggests pills are not being stored safely in many homes.
Limitations and implications
The study has several important limitations. The database used by the researchers is susceptible to miscoding and omission errors, and does not offer “a full clinical picture behind the poisonings,” said Gaither. Also, the study ended with 2012 data. The number and rate of opioid poisonings among children may have changed since then.
Still, these findings are disturbing. According to the Centers for Disease Control and Prevention (CDC), doctors write more than 260 million prescriptions for opioid painkillers in 2012 — enough for every American adult to have a bottle of pills.
Overdoses from opioids — prescription painkillers and heroin — killed more than 47,000 Americans in 2014, about 1½ times more than 33,000 Americans who died in traffic accidents that year, the CDC reported earlier this year.
“The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction and provide support and treatment to those who suffer from opioid use disorders,” CDC director Dr. Tom Frieden said at that time.
Sadly, our children need that support and treatment, too.