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Pediatric opioid exposures decreased with unit-dose packaging
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Transitioning to unit-dose packaging of combination opioids, such as buprenorphine-naloxone, decreased accidental pediatric exposures by nearly 80%, according to findings published in Pediatrics.
“Prior to unit-dose packaging, there were 20.57 pediatric unintentional exposures involving a combination buprenorphine-naloxone product per 100,000 prescriptions dispensed,” George Sam Wang, MD, from the department of pediatric emergency medicine at Children’s Hospital Colorado, pediatric medical toxicology at Denver Health’s Rocky Mountain Poison and Drug Center and assistant professor of pediatrics at the University of Colorado Anschutz Medical Campus, told Infectious Diseases in Children.
“After unit-dose packaging, the rate decreased to 4.36,” he continued. “This is almost an 80% decrease in relative exposures.”
To assess whether unit-dose packaging of buprenorphine-naloxone contributes to accidental exposures that present to pediatric poison centers, the researchers conducted an observational surveillance study in which unintentional exposures were identified within the Researched Abuse, Diversion and Addiction-Related Surveillance System Poison Center Program. Information on children younger than 6 years of age who unintentionally consumed buprenorphine-naloxone products was included in this analysis.
The timing of the introduction of unit-dose packaging of these products were also examined, with Wang and colleagues examining three time periods. These time frames were split from the first quarter of 2008 to the fourth quarter of 2010 (pre-unit-dose packaging), the first quarter of 2011 to the fourth quarter of 2012 (transition period) and the first quarter of 2013 through the fourth quarter of 2016 (post-introduction).
Over the course of the study period, 6,217 accidental exposures to buprenorphine-naloxone products were reported. Before the introduction of unit-dose packaging, the rate of pediatric accidental exposure was 20.57 exposures per 100,000 prescriptions administered. During the transition to unit-dose packaging, this rate fell to 8.77 exposures per 100,000 prescriptions administered.
The rate of pediatric accidental exposures to these combination medications dropped even further, with 4.36 accidental exposures reported per 100,000 prescriptions administered. According to the researchers, this decrease represented an 78.8% relative decrease in unintentional exposures since unit-dose packaging was introduced (95% CI, 76.1%-81.3%).
“Unit-dose packaging has played a great role in reducing unintentional pediatric exposures,” Wang said. “However, it is still important to counsel caregivers who use buprenorphine to properly store them to prevent encounters in the first place. Small dose exposures in children can lead to hospitalization and even death.”– by Katherine Bortz
Disclosures: The Researched Abuse, Diversion and Addiction-Related Surveillance System is supported by subscriptions from pharmaceutical manufacturers, government and nongovernment agencies for surveillance, research and reporting services. The RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado. Denver Health retains exclusive ownership of all data, databases and systems. Subscribers do not participate in data collection nor do they have access to the raw data. Indivior is a RADARS System subscriber. Scientists from Indivior reviewed the draft manuscript for proprietary information; however, all final decisions were made by the RADARS System. Wang reports receiving royalties from UpToDate for authorship contributions; the other authors report no relevant financial disclosures.
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