Opioid-Related Adverse Effects A Growing Problem for US Children

Opioid-associated problems have become increasingly prevalent in children, according to 2 study abstracts recently presented at the American Academy of Pediatrics 2017 National Conference.

Between 2003 and 2012, hospitalization of infants, children, and teens who experienced adverse reactions to opioids increased more than half, according to one study abstract at the conference.¹ Researchers analyzed hospital stays of children aged 1 month to 17 years from data from 2003, 2006, 2009, and 2012 taken from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Kids’ Inpatient Database.

The frequency of opioid withdrawal has more than doubled since 2003, study author Jessica Barreto, MD, noted in a press release.² The researchers documented opioid-related problems in 16.6 children per 10,000 discharges, and determined that the prevalence increased from 13.3 per 10,000 discharges in 2003 to 20.8 per 10,000 discharges in 2012.

Opioid withdrawal affected 3.1% of hospitalized children. Other adverse effects included constipation (12.5%), altered mental status (10.5%), urinary retention (2.3%), cardiac arrest (1%), and anaphylaxis (0.75%). According to the abstract, adverse effects were reported highest in white children each year.

“For the past two decades, doctors have been increasingly recognizing and treating pain in children. Unfortunately, the efforts to improve pain management in children have led to a significant rise in the use of opioids both within hospitals as well as in the outpatient setting," Dr. Barreto told Pharmacy Times. "While these medications are valuable in providing pain relief, there are various developmental factors that place children at higher risk of toxicity. Further studies on the safety and efficacy of opioid use in children and alternate pain medications with less toxicity and addiction potential are urgently needed. In the meantime, judicious use of opioid medications for the treatment of pain and monitoring for their side effects is crucial."

In a separate abstract presented at the conference, research highlighted an increasing number of children who test positive for opioid addiction and dependency in US emergency departments. The analysis included data from the 2008-2013 data from the Nationwide Emergency Department Sample.³

The researchers noted that the number of pediatric patients who were diagnosed with opioid addiction or dependency after visiting an emergency department for any reason increased by more than half during that time. Additionally, nearly one-third of the children were admitted as inpatients to the same hospital as the ED visit. Patients living in high-income households were more likely to be hospitalized, while uninsured patients were less likely to be hospitalized.

“This was intended to be an exploratory study,” Veerajalandhar Allareddy, MD, MBA, one of the abstract authors, said in a press release, “one that we hope will help alert the public, researchers, and policymakers of the need to fully define and address this important, emerging public health problem among children in the United States.”⁴

In this video from PainWeek 2017, Jeremy Adler, MS, PA-C, co-owner of Pacific Pain Medicine, discusses the pharmacist's role in combating the opioid abuse epidemic.

Reference

• Barreto J. Adverse Effects from Opioid Use in Hospitalized Children in the United States: a 9-year trend from 2003 to 2012 [Abstract]. Presented at: American Academy of Pediatrics 2017 National Conference & Exhibition. September 16-19, 2017. Chicago.
• Study Suggests Increase in Adverse Effects Due to Use of Opioids in Hospitalized Children [news release]. Chicago. AAP’s website. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Study-Suggests-Increase-in-Adverse-Effects-Due-to-Use-of-Opioids-in-Hospitalized-Children.aspx. Accessed September 18, 2017.
• Allareddy V, Rampa S. Opioid abuse in children: an emerging public health crisis in the United States [Abstract]. Presented at: American Academy of Pediatrics 2017 National Conference & Exhibition. September 16-19, 2017. Chicago.
• Study Finds Increasing Number of Children Arrive at Emergency Departments Addicted to Opioids [news release]. Chicago. AAP’s website. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Study-Finds-Increasing-Number-of-Children-Arrive-at-ED-Addicted-to-Opioids.aspx. Accessed September 18, 2017.