番茄社区

ORLANDO -- Roughly one in four opioid poisonings involve children and adolescents, and these poisonings have become more severe and life-threatening in recent years, a researcher said here.

The retrospective analysis of 753,592 opioid poisoning cases reported to the National Poison Data System from 2005 until 2018 revealed that 207,543 (27.5%) involved children and adolescents younger than age 19 years, reported Megan Land, MD, of Emory University in Atlanta.

Also, nearly one in 10 children and adolescents who overdosed on opioids were admitted to a critical care unit (CCU) between 2015 through 2018 and, during the same time period, more than one in five opioid overdoses involved an attempted suicide, she said in a presentation at the Society of Critical Care Medicine congress.

She told 番茄社区 that around 50% of the poisonings appeared to involve accidental ingestions in younger children, and the remaining poisonings were associated with intentional drug use in adolescents.

"What we saw in the poison control database is two peak age distributions for opioid poisoning," Land said. "One peak occurred in toddlers, around the ages of 0 to 4 years, and we saw another peak in 15- to 19-year-olds."

She added that a particularly troubling finding in the adolescent data was the high percentage of teens who were using opioids to attempt suicide.

"The stark rise in suicide as an intent was a really eye opening part of the study for me," she said.

The study used data on opioids ingestion in children and teens through age 18 years collected from 55 poison control centers.

Trends over three time periods (2005-2009, 2010-2014, and 2015-2018) were assessed using the Cochran-Armitage Trend Test. The researchers used multivariable logistic regression analysis to calculate the adjusted odds of variables associated with having at least one pediatric ICU intervention.

A total of 207,543 opioid poisonings involving children were reported during the period, which represented 27.54% of the total reported opioid poisonings (n=753,592).

During the period, the percentage of patients admitted to a CCU increased for each time group studied from 6.6% in 2005-2009, to 8.5% in 2010-2014, and 9.6% in 2015-2018.

The probability of having a moderate effect or major effect increased by 0.55% (0.51%-0.58%) and 0.11% (0.10%-0.13%) per year, respectively.

Overall mortality due to opioid poisoning was 0.21%, but deaths increased over each of the three time periods studied (0.18%, 0.20% and 0.28%, respectively), as did suicidal intent as a poisoning cause (13.9%, 15.3%, 21.2%, respectively).

Among those admitted to a pediatric ICU, 88.15% received at least one treatment, and 14.38% required pediatric ICU admission.

The use of CPR increased from 1.31% in the 2005-2009 time period to 3.18% between 2015-2018.

"By far the most common drugs reported were standard opiate pills likely to be in medicine cabinets, such as oxycodone, codeine, and tramadol. These are medications that someone might get for a sprained ankle or [after] surgery," Land said. "But the drugs that were most dangerous were the illicit or synthetic opiates heroin, fentanyl, and methadone. "

Land said efforts to raise awareness about the dangers of having prescription opioids in the home seem to be having an impact, but the magnitude of that impact on child poisonings is being reduced by the increased availability of illicit opioids.

"The proportion of kids that are having opioid poisonings is actually starting to decline," she said. "There is a lot of effort around [opioid] -- making sure that those pills aren't sitting around in peoples homes. These efforts are helping both adults and children.

"But what we are also seeing is that, even though the the overall number of poisonings is declining, the proportion of kids suffering really severe consequences from these poisonings is going up," Land added.

In a written statement, co-author Jocelyn Grunwell, MD, PhD, also at Emory, called for policy initiatives "to better identify children with mental health issues and help them and their families get services to prevent suicide attempts."

She noted that, "parents, pediatricians, teachers, coaches, counselors, everyone who interacts with children and adolescents needs to be aware of the risk of self-harm, misuse and abuse of opioids, and restrict access to them in the home."

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