Pediatric Opioid-Related ICU Admissions Nearly Doubled in 10 Years

Veronica Hackethal, MD

March 05, 2018

Children's admission to a pediatric intensive care unit (PICU) for opioid overdoses nearly doubled between 2004 and 2015, highlighting the broad-ranging impact of the current opioid crisis in the United States, a new study shows.

The study, published online today in Pediatrics, is the first to evaluate the effect of the opioid epidemic on pediatric critical care.

Efforts to contain the opioid epidemic have largely failed. Opioid-related deaths have doubled since 2000, while prescriptions for methadone have skyrocketed. A recent analysis by the Council of Economic Advisors estimated that the societal costs of opioid overdose total about $504 billion, or 2.8% of the 2015 US gross domestic product.   

"The increasing number of adult drug prescriptions is strongly associated with rising pediatric exposures and poisonings; young children are at the greatest risk for exposure, with substantial health care use and morbidity specifically associated with opioid ingestions," write Jason Kane, MD, MS, associate professor of pediatrics and interim chief of the Section of Critical Care at the University of Chicago Medicine Comer Children's Hospital, Illinois, and colleagues.

Opioids now cause the majority of drug poisonings in children under age 6 years, the authors note. Young children like to explore, which makes them particularly vulnerable to accidental opioid ingestions. Children may have access to these drugs when adults in their households are being treated with methadone for opioid addiction or are abusing opioids.

"Current efforts to reduce prescription opioid use in adults have not curtailed the incidence of pediatric opioid ingestion, and additional efforts are needed to reduce preventable opioid exposure in children," the authors stress.

The researchers analyzed the Pediatric Health Information System database, which houses data on about 20% of pediatric hospitalizations in the United States, to identify pediatric hospitalizations and PICU admissions related to opioid ingestions between 2004 and 2015.

Of 3647 opioid-related pediatric admissions across 31 tertiary care children's hospitals between 2004 and 2015, 0.09% were for opioid-related conditions. Of these, 42.9% required PICU care, with an overall mortality of 1.6%. 

The rate of opioid-related admissions was 6.7 per 10,000 admissions in 2004 and 10.9 in 2015 (P < .001), while the rate of opioid-related PICU admissions rose from 24.9 per 10,000 PICU admissions to 35.9 (P < .001).

A sobering one third of opioid-related admissions were for children under age 6 years, and 19.5% of these were admitted for methadone ingestion.

Methadone also accounted for 9.8% of admissions among children aged 12 to 18 years, whereas heroin accounted for 4.4% of admissions in this age group.

Among PICU admission, 37.0% required ventilator support and 20.3% required vasopressors. While the need for these interventions decreased over time, the sheer increase in number of opioid-related PICU admissions means that the absolute number of these interventions increased over time.

Likewise, costs per PICU admission decreased over time, but the total financial burden on the healthcare system increased as a result of the large increase in hospitalizations and PICU admissions. 

"To develop and implement effective prevention, mitigation, and intervention policies, we must understand the true costs of this epidemic," writes Sheryl Ryan, MD, from Penn State Health Children's Hospital, Milton S. Hershey Medical Center, Pennsylvania, in an accompanying comment.

She emphasizes the importance of implementing evidence-based programs that decrease the abuse of illicit substances among teens, several of which are highly effective.

Pediatricians also need to engage in such programs and take part in fighting the opioid epidemic in the United States. "Findings from the work by Kane et al‍ highlight the need for pediatricians to engage in this critical work to combat the ongoing opioid crisis in our country," she concludes.

Bartlett reports serving as a consultant member of the CVS Caremark National Pharmacy and Therapeutics Committee. Ryan has disclosed no relevant financial relationships

Pediatrics. Published online March 5, 2018. Full text, Editorial

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