How prescription opioids harm little kids

You can add preschoolers to those at risk from prescription opioids. @NightshiftMD explains why and how to put a stop to it.
Between 2000 and 2015, U.S. Poison Control Centers received 188,000 calls for advice about a child who had been exposed to a prescription opioid. (iStock)

The opioid crisis has mostly affected teenagers and adults.  Now, a new study just published online in the journal Pediatrics finds that pre-schoolers are also at risk. 

The study comes from two impeccable sources in the U.S.:  the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children's Hospital.  Researchers analysed records of phone calls to poison control centers across the U.S.  Poison control centers are the places that parents, doctors and nurses call when a child or an adult has swallowed something potentially harmful.  They keep records of those calls.  Between 2000 and 2015, U.S. Poison Control Centers received 188,000 calls for advice about a child who had been exposed to a prescription opioid.  

That works out to 32 calls per day across the U.S., or one every 45 minutes.

Thirty per cent of the calls concerned teenagers. Sixty per cent were children less than 5 years of age.  Of the 188,000 reports, just under 30 per cent were for the opioid drug hydrocodone, which is sold under the brand name Vicodin.  Hydrocodone pain relievers are not available in Canada.  Eighteen per cent of the calls to poison control centers were for oxycodone – which is sold in Canada under brand names such as OxyContin and Percocet.  Seventeen per cent of the calls were for the opioid drug codeine, which is found in Tylenol #3.  

Young kids under the age of five weren't trying to get high or harm themselves.  These exposures were described as accidental in that they happened to curious kids who found the drugs by exploring the medicine cabinet or other location where the drugs were stored.  

Among teens, more than two thirds were intentional exposures by teens trying to get high or to harm themselves.  This is circumstantial evidence, but during the 16-year period of the study, there was a 50 per cent increase in the rate of suspected suicides linked to prescription opioid pain relievers.  

The consequences depended on the age of those exposed to opioids.  Although some preschoolers required medical attention, none had serious outcomes.  Compared to the younger kids, the teens were more likely to require hospitalisation.

The bottom line is the these kids got their hands on opioids that were prescribed by a doctor or other prescriber to another member of the household.  The opioid crisis has been chalked up to over-prescribing by doctors and other health-care providers.  A recent study concluded that ER physicians like me start the ball rolling with the first prescription.

Surgeons also play an important role.  A study published last week in the Annals of Surgery looked at the prescribing habits of surgeons following operations such as partial mastectomy for breast cancer, gall bladder removal, and hernia repair.  They found that patients took just 28 per cent of the opioids surgeons prescribed to them. That means 72 per cent of the opioids prescribed likely ended up sitting in the medicine cabinet waiting to be pilfered.

That drugs aren't locked up but are sitting in the medicine cabin or on the night table ready to be taken is not an accident but abject carelessness.  

The study I just talked about advised surgeons to cap the number of pills they prescribe to between five and 10 for less painful operations and up to 15 for the rest.  Just doing that resulted in a 53 per cent drop in the number of pills prescribed, and would almost certainly reduce the number of unused pills in the medicine cabinet.  Prescribing guidelines by the Centers for Disease Control have begun to reduce the total number of opioid prescriptions in the U.S.  New guidelines are starting to show up in B.C. and other parts of Canada, but it's too soon to gauge the impact.

If you don't require opioids, don't take them.  If you do, keep them away from others.


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