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Buprenorphine exposures increasing among US children, teens
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United States poison control centers received reports of 11,275 exposures between 2007 and 2016, according to researchers. Most of these exposures occurred in children aged younger than 6 years and were accidental; however, over three-quarters of adolescent exposures were intentional.
Researchers said 12% of these intentional exposures in teenagers involved a suspected suicide attempt.
“From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000,” Gary A. Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital, told Infectious Diseases in Children. “From 2007 to 2010, buprenorphine exposure rates among children increased more than 200%, which is likely attributable to the increasing number of buprenorphine prescriptions dispensed.”
The researchers noted that in 2016, the AAP suggested the use of buprenorphine in adolescents with severe opioid use disorder. Because of the likelihood of increasing pediatric and adolescent exposures, Smith and colleagues assessed the number of incidents in which U.S. poison control centers were contacted for children aged 19 years or younger from 2007 to 2016.
The researchers observed an exposure rate of 6.4 per 1,000,000 in 2007. This rate increased by 215.6% by 2010 (20.2 per 1,000,000). A 42.6% drop was observed between 2010 and 2013 (11.6 per 1,000,000), but this rate increased again by 8.6% in 2016 (12.6 per 1,000,000).
Smith and colleagues said that most exposures occurred in children aged younger than 6 years (86.1%). These exposures were generally unintentional (89.2%) and were related to one substance (97.3%). However, children in this age group who were exposed to one substance were approximately two times more likely to be admitted to the hospital or have serious adverse outcomes compared with teenagers.
Although adolescents accounted only for 11.1% of exposures reported to poison control centers, 77.1% of these exposures were intentional. Over one-quarter of these exposures included multiple substances (27.7%). When teens were exposed to multiple substances, the likelihood of hospital admission was nearly five times higher and serious adverse outcomes were nearly three times more likely compared with exposure to buprenorphine alone.
“Safe storage of all opioids, including buprenorphine, is crucial. Parents and caregivers who use buprenorphine need to store it safely: up, away and out of sight. A locked cabinet is best,” Smith said. “Health care providers should inform caregivers of young children about the dangers of exposure and provide instructions on proper medication storage and disposal. Additionally, teenagers should receive information regarding the risks of substance abuse and misuse. The percentage of exposures attributable to suspected suicide in this age group highlights the need for access to mental health services.” – by Katherine Bortz
Disclosures: Post reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Jason M. Kane, MD, MS, FAAP, FCCM
This is not the first study to show these data, but it is the latest study to show how a medication designed and prescribed to help adults with narcotic or opioid addiction ends up poisoning children, mostly unintentionally. This particularly affects those who are most vulnerable based on their young age.
This added burden we are putting on the health care system is entirely preventable. These are children who would not need medical care if not for the fact that they were poisoned by medications that were not designed to be taken by them.
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Post S, et al. Pediatrics. 2018;doi:10.1542/peds.2017-3652.
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