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Young infants frequently receive overdose amounts of narcotics
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DENVER — Dosage amounts of narcotic drugs dispensed by pharmacies are often incorrect, with the youngest infants receiving at least twice the expected dose 20% of the time, according to findings presented here at the Pediatric Academic Societies' Annual Meeting 2011.
The researchers found that 4.1% of all children received an overdose amount. In fact, the youngest children had the greatest chance of receiving an overdose, according to lead researcher William T. Basco Jr., MD, MS, associate professor and director of the division of general pediatrics at the Medical University of South Carolina.
“Our goal was to determine the magnitude of overdosing for this high-risk drug class in a high-risk population, and these results are concerning,” Basco said in a press release.
The researchers reviewed Medicaid data from 2000-2006 for outpatients from South Carolina. The investigators identified the top 19 narcotic-containing drugs, including drugs like codeine and hydrocodone, prescribed for children aged 0-36 months. For each prescription, the expected daily dose of the narcotic component was calculated by utilizing CDC growth chart data to impute the weight of each child as the 97th percentile based on age and gender.
From Medicaid pharmacy files of paid, filled prescriptions, the researchers then calculated the dose per day as dispensed (observed dose). The observed dose dispensed was compared with expected daily dose, calculating frequency of overdose — which the researchers defined as the observed dose dispensed greater than expected dose — and the excess amount dispensed per drug and by age group.
There were 149,791 prescriptions analyzed for narcotic-containing preparations to children aged 0-36 months; the mean age of subjects receiving a narcotic was 18.2 months. Overall, 14.9% of the prescriptions contained an overdose quantity dispensed. Among prescriptions with an overdose, the average excess amount dispensed was 53% more than expected. An association between younger age and higher frequencies of overdose was observed.
For example, 61.1% of infants aged 0-2 months who received a narcotic received an overdose quantity, compared to 35% of infants aged 3-5 months old, 17.1% of infants aged 6-11 months old and 8% of children aged 12 months or older (P<.0001).>
The excess amount dispensed was also inversely related to age, with infants aged 0-2 months who received an overdose quantity receiving 90% more than expected, compared with 53% for infants aged 3-5 months, 36% for infants aged 6-11 months, and 34% for children aged 12 months or older (P<.05). infants="" aged="" 0-2="" months="" were="" dispensed="" at="" twice="" the="" expected="" quantity="" —="" and="" sometimes="" more="" than="" twice="" the="" expected="" quantity="" —="" 20%="" of="" the="" time.="" infants="" aged="" 3-5="" months="" received="" ≥twice="" the="" expected="" quantity="" 3.8%="" of="" the="" time,="" infants="" aged="" 6-11="" months="" received="" that="" quantity="" 1.5%="" of="" the="" time,="" and="" children="" aged="" 12="" months="" or="" older="" received="" greater="" than="" or="" equal="" to="" double="" doses="" at="" a="" 0.2%="" rate="">P<.05).>
About 40% of children aged younger than 2 months received an overdose amount compared with 3% of children older than 1 year. For the average child who had an overdose quantity dispensed, the amount of narcotic drug dispensed was 42% greater than would have been expected.
“Almost one in 10 of the youngest infants ages 0-2 months received more than twice the dose that they should have received based on their age, gender and a conservative estimate of their weight,” Basco said. “Since we know that parents have difficulty measuring doses of liquid medication accurately, it is critical to strive for accurate narcotic prescribing by providers and dispensing by pharmacies.”
The researchers concluded that narcotic prescribing to infants and young children is a high-risk scenario that requires better controls on prescribing, dispensing and standardization of concentrations to ensure appropriate dosing.
Disclosures: Dr. Basco reports no disclosures.
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