​New research: Additional measures needed to curb opioid exposure in children

The number of pediatric intensive care unit (PICU) admissions for opioid overdoses doubled between 2004 and 2015, despite continuing efforts to curb misuse of the addictive painkillers among adults, according to a new study by researchers from the University of Chicago Medicine published in the journal Pediatrics.

The study uses a national sample of 31 children’s hospitals to assess trends both in pediatric opioid-related admissions and in the resources required for each case. The study, titled “Opioid-Related Critical Care Resource Utilization in U.S. Children’s Hospitals,” is the first national study to examine how often children end up in critical care from ingesting opioids. It was published in the April 2018 edition of Pediatrics.

"The U.S. opioid crisis has been devastating to children and families,” said lead author Jason Kane, MD, associate professor of pediatrics at UChicago Medicine’s Comer Children’s Hospital. "Prescription drug poisonings are the leading cause of injury-related deaths in the nation. We found that the rate of hospitalization and PICU admission for pediatric opioid ingestions is actually increasing, which makes this issue even more alarming."

"What concerns us is the rate that PICU admissions are increasing over time, which is in contrast to adult data that suggest we have reached a plateau in hospitalization for opioid overdose."

According to the U.S. Department of Health and Human Services (HHS), roots of the nation’s opioid epidemic date back to the 1990s, when doctors began prescribing more opioids based on pharmaceutical companies' claims that patients would not become addicted. The increased prescriptions led to greater overall misuse and, ultimately, increased morbidity related to overdose.

The researchers found nearly one percent (or 3,647 cases) of the more than 4 million children’s hospital admissions in their study between 2004 and 2015 was due to opioid-related conditions. The majority of these patients were ages 12-17, but a third of patients were younger than 6.

Although 12 percent of pediatric hospital admissions required PICU care, an alarming 43 percent of those children admitted to the hospital with opioid ingestion required treatment in the PICU.

In 2016, the year data is most recently available from the HHS, 11.5 million adults and children were reported to have misused opioids and about 116 people died each day from related overdoses. The HHS survey also found the epidemic cost the U.S. economy $504 billion that year alone.

Kane and fellow researchers hypothesized that critical care resource use in PICUs has increased along with opioid-related admissions. Resources in PICUs that help treat overdose include medications (vasopressors) that work to increase low blood pressure, mechanical ventilators to assist with breathing, and naloxone (a drug that blocks opiate receptors in the nervous system).

In the study, one-third of children admitted to the PICU required respiratory support with a mechanical ventilator and artificial airway, and 20 percent of the children required an infusion of a vasopressor medication to maintain normal blood pressure in the face of life-threatening low blood pressure.

"As more opioids are being prescribed in the community, children are becoming ‘second victims’ of the opioid epidemic."

The researchers suggest that additional measures need to be taken to prevent opioid exposure to children. They identified a key difference between pediatric and adult opioid-related hospitalizations: Methadone and other opioids were greater contributors to pediatric hospitalization. In contrast, a comparable study found that heroin was the key driver of adult hospitalizations. Adult heroin users tend to have other related issues that lead to an increased cost in their care.

"What concerns us is the rate that PICU admissions are increasing over time,” said Kane, “which is in contrast to adult data that suggest we have reached a plateau in hospitalization for opioid overdose. As more opioids are being prescribed in the community, children are becoming ‘second victims’ of the opioid epidemic. Additionally, PICU beds are a limited commodity. There are roughly 4,100 PICU beds available nationwide, compared to nearly 80,000 adult ICU beds. Every time a child is placed in a PICU bed with an entirely preventable condition such as an exploratory ingestion of opioids, that PICU bed is no longer available for a child with critical illness that is not preventable. These opioid ingestions should be viewed as entirely preventable."