National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012

Abstract

Importance: National data show a parallel relationship between recent trends in opioid prescribing practices and hospitalizations for opioid poisonings in adults. No similar estimates exist describing hospitalizations for opioid poisonings in children and adolescents.

Objective: To describe the incidence and characteristics of hospitalizations attributed to opioid poisonings in children and adolescents.

Design, setting, and participants: Retrospective analysis of serial cross-sectional data from a nationally representative sample of US pediatric hospital discharge records collected every 3 years from January 1, 1997, through December 31, 2012. The Kids' Inpatient Database was used to identify 13 052 discharge records for patients aged 1 to 19 years who were hospitalized for opioid poisonings. Data were analyzed within the collection time frame.

Main outcomes and measures: Poisonings attributed to prescription opioids were identified by codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. In adolescents aged 15 to 19 years, poisonings attributed to heroin were also identified. Census estimates were used to calculate incidence per 100 000 population. The Cochran-Armitage test for trend was used to assess for changes in incidence over time.

Results: From 1997 to 2012, a total of 13 052 (95% CI, 12 500-13 604) hospitalizations for prescription opioid poisonings were identified. The annual incidence of hospitalizations for opioid poisonings per 100 000 children aged 1 to 19 years rose from 1.40 (95% CI, 1.24-1.56) to 3.71 (95% CI, 3.44-3.98), an increase of 165% (P for trend, <.001). Among children 1 to 4 years of age, the incidence increased from 0.86 (95% CI, 0.60-1.12) to 2.62 (95% CI, 2.17-3.08), an increase of 205% (P for trend, <.001). For adolescents aged 15 to 19 years, the incidence increased from 3.69 (95% CI, 3.20-4.17) to 10.17 (95% CI, 9.48-10.85), an increase of 176% (P for trend, <.001). In this age group, poisonings from heroin increased from 0.96 (95% CI, 0.75-1.18) to 2.51 (95% CI, 2.21-2.80), an increase of 161% (P for trend, <.001); poisonings involving methadone increased from 0.10 (95% CI, 0.03-0.16) to 1.05 (95% CI, 0.87-1.23), an increase of 950% (P for trend, <.001).

Conclusions and relevance: During the course of 16 years, hospitalizations attributed to opioid poisonings rose nearly 2-fold in the pediatric population. Hospitalizations increased across all age groups, yet young children and older adolescents were most vulnerable to the risks of opioid exposure. Mitigating these risks will require comprehensive strategies that target opioid storage, packaging, and misuse.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Weighted National Estimates of Temporal Trends in Hospitalizations for Prescription Opioid Poisonings Stratified by Age Category

Error bars indicate 95% CI (P for trend, <.001 for all ages). Estimates for 5- to 9-year-olds do not meet the criteria for statistical reliability and thus are not shown.

Figure 2.. Weighted National Estimates of Temporal Trends in Prescription Opioid Poisonings by Intent in the Group Aged 15 to 19 Years

Error bars indicate 95% CI (P for trend, <.001 for poisonings attributed to accidental and suicidal intent).

Figure 3.. Weighted National Estimates of Temporal Trends in Hospitalizations for Illicit vs Prescription Opioid Poisonings in the Group Aged 15 to 19 Years

Error bars indicate 95% CI (P for trend, <.001 for poisonings attributed to heroin and prescription opioid drug use).