America's opiate epidemic is affecting children at rapidly increasing levels. The number of pediatric opioid hospitalizations requiring intensive care nearly doubled to 1,504 patients between 2012 and 2015, from 797 patients between 2004 and 2007, found a study published this month in Pediatrics.
Researchers also found peaks in children hospitalized for opioids between the ages 1 to 5 and then in 12 to 17 age groups. There were a total of 3,647 opioid-related hospitalizations in 31 hospitals from 2004 to 2015 and almost 43 percent of these children needed intensive care, according to data from the Pediatric Health Information System.
In the midst of an epidemic, the question turns to why opioids are still being prescribed in certain cases. Numerous papers show opiates are not more effective than other pain killers, but the amount of opiates prescribed has more than doubled from 2006 to 2016 in the United Kingdom where such prescriptions are much more limited and have gone up at least three-fold in the U.S. during the same time.
JAMA published a study last week that there was no significant difference in the reduction of severe chronic pain with opiates versus acetaminophen such as Tylenol or non-steroidal anti-inflammatory drugs such as Motrin or Celebrex for adults. Another JAMA study last fall found that for limb pain due to sprain or fracture giving acetaminophen mixed with ibuprofen was as effective as giving acetaminophen mixed with opiates.
Having opiates around the house is heavily correlated with injuries to young children thinking they are candy, and teens looking for adventure or suicide. What can be done to help these children? Home safety is paramount. Medications, no matter what the type, should be stored in child proof containers that are properly closed between uses, kept on high shelves, and preferably in locked cabinets. The children harmed between 1 and 5 years just eat what they find on tables, countertops, and even floors.
Prescription medications when you have finished using them should be discarded safely – unfortunately, hardly anyone does this. The 12 to 17 group, who are often experimenting, initially use what they find at home. In terms of safety, almost everything is dangerous if one takes too much. Acetaminophen is the number one cause of overdose death and permanent injury when taken in very large amounts.
Another issue we face is the number of newborns exposed to opioids in utero is rapidly growing. The national numbers are not clear because of inconsistent reporting rules from state-to-state. What is clear is that the numbers are most likely up about five times more than 20 years ago.
My teacher, Loretta Finnegan, MD, started at Jefferson University Hospital in the early 1970s, and she consistently diagnosed and treated newborns with what she labeled Neonatal Abstinence Syndrome. These are babies exposed to opiates in utero experience opiate withdrawal after birth. Some untreated newborns can have seizures or neurological damage. Death can occur in very rare cases. Since multiple drug use and the impurity of street drugs can cause much worse outcomes, she pioneered using opiate substitutes such as Methadone and finding safe, drug-free housing for the mothers while pregnant.
But not every newborn exposed to opiates withdraws. The State of Pennsylvania just published rules on reporting the birth of these babies, which can be interpreted in several ways. Some hospitals will be reporting just withdrawing babies and some will be reporting all babies exposed to opiates, and some will be reporting all children exposed to street drugs of any type.
These confusing rules are the norm nationally so exact exposure opiate exposure numbers in babies are hard to calculate, but the number is certainly increasing rapidly.
I cannot stress this enough. Doctors have to stop prescribing so many opioids, patients have to stop leaving unused opioids around the house, and patients have to stop thinking that only opiates can help their pain.