The number of deaths among young people from prescription and illicit opioid poisoning has nearly tripled in the past two decades, according to a US study
A cross sectional US study, using mortality data from the Centers for Disease Control and Prevention, has found that the mortality rate among American children and adolescents from opioid poisoning has increased nearly three-fold between 1999 and 2016.
During this 18-year period, 8986 children and teens died from prescription and illicit opioid poisoning.
Of these, 73.1% were male, and 88.1% were among adolescents aged 15 to 19 years, according to the study published in JAMA Network Open.
Across time, 80.8% of all paediatric deaths were unintentional, with 61.6% occurring outside of a medical facility.
Prescription opioids were implicated in 73% of deaths.
Rates of opioid poisoning deaths related to prescription opioids increased by 94.7% from 0.57 (95% CI, 0.49-0.66) to 1.11 (95% CI, 0.99-1.25).
There was also an alarming 404.8% rise in heroin-related deaths among adolescents aged 15 to 19 years.
The overall paediatric mortality rate in the US increased from 0.22 (95% CI, 0.19-0.25) to 0.81 (95% CI, 0.76-0.88) per 100,000, an increase of 268.2% (P for time effect <0.001).
Time trends revealed a steady linear increase among children aged 0 to 4 years and those aged 5 to 9 years.
A smaller fraction (6.7%) of opioid poisoning deaths were among children aged 0 to 4 years.
However among children younger than 5 years, a quarter (24.5%) of deaths were attributed to homicide, much higher than the 2.4% rate among all children and adolescents.
The researchers from the Department of Pediatrics at the Yale School of Medicine, US, said it is important to address deaths seen in the youngest children, “a highly vulnerable group for which the consequences of the opioid crisis have been somewhat overshadowed by opioid-related morbidity among neonates and older teens.
“We found that children aged 0 to 4 had the second-highest mortality rates overall as well as the largest increase in rates over time,” they said, pointing to the roles that abuse, neglect and parental opioid abuse may play in these deaths.
Study authors said the nature of unintentional poisonings is particularly relevant to recent initiatives that would increase the availability of naloxone in homes and communities, especially given the majority of paediatric deaths occur outside of a medical setting.
“These findings suggest that the opioid epidemic is likely to remain a growing public health problem in the young unless legislators, public health officials, clinicians, and parents take a wider view of the opioid crisis and implement protective measures that are paediatric specific and family centred,” they conclude.
Recent data from the Australian Institute of Health and Welfare (AIHW) shows that in 2016, the rate of emergency department presentations for opioid poisoning for Australians aged under 15 was 3.6 per 100,000.
However data on opioids deaths only provides numbers on the age group <25 years, which reveals a crude mortality rate of 0.7 per 100,000.
Across all ages in Australia, pharmaceutical opioids (for example, oxycodone, codeine, morphine) were more likely than illegal opioids to be involved in deaths and hospitalisations, similar to the US.
In 2016, the vast majority of opioid deaths across Australia were accidental (83%).
See the full JAMA Paediatrics article here (Open Access)