Pediatric drug overdose mortality: contextual and policy effects for children under 12 years

Abstract

Background: We determine trends in fatal pediatric drug overdose from 1999 to 2018 and describe the influence of contextual factors and policies on such overdoses. Methods: Combining restricted CDC mortality files with data from other sources, we conducted between-county multilevel models to examine associations of demographic and socioeconomic characteristics with pediatric overdose mortality and a fixed-effects analysis to identify how changes in contexts and policies over time shaped county-level fatal pediatric overdoses per 100,000 children under 12. Results: Pediatric overdose deaths rose from 0.08/100,000 children in 1999 to a peak of 0.19/100,000 children in 2016, with opioids accounting for an increasing proportion of deaths. Spatial patterns of pediatric overdose deaths are heterogenous. Socioeconomic characteristics are not associated with between-county differences in pediatric overdose mortality. Greater state expenditures on public welfare (b=−0.099; CI:[−0.193,−0.005]) and hospitals (b=−0.222; CI:[−.437,−.007]) were associated with lower pediatric overdose mortality. In years when a Good Samaritan law is in effect, the county-level pediatric overdose rate was lower (b=−0.095; CI:[−0.177,−0.013]). Conclusions: Pediatric overdose mortality increased since 1999, peaking in 2016. Good Samaritan laws and investment in hospitals and public welfare may temper pediatric overdoses. Multi-faceted approaches using policy and individual intervention is necessary to reduce pediatric overdose mortality.

A Series of 8 Illicit Fentanyl Intoxication Deaths in Infants and Toddlers

“…As illicit fentanyl use increases, so does its presence in the home setting, which in turn increases the potential for infant exposure 10 . This has been described as an overlooked aspect of this opioid epidemic 11 .…”

“…As illicit fentanyl use increases, so does its presence in the home setting, which in turn increases the potential for infant exposure. 10 This has been described as an overlooked aspect of this opioid epidemic. 11 Each of these 8 children had initial presentations of being found unresponsive after being laid down to sleep or nap.…”

Application of postoperative analgesia with different doses of nalbuphine in children with cleft palate

“…From the pharmacokinetic point of view: for some drugs, such as codeine and tramadol, the metabolic difference of these drugs will change the level of active drugs exposed to children. In extreme cases, drug overdose can be fatal [20]. Nalbuphine may be a safe and effective analgesic drug for children after operation, and the secondary sedation may increased [21,22].…”

Physiologically based modeling reveals different risk of respiratory depression after fentanyl overdose between adults and children

“…1 However, while the opioid epidemic's impact on adolescents and adults has received substantial attention, its impact on young children has received less consideration. 2 In line with this, there is only sparse evidence concerning the exposure-response relationship between opioids and respiratory depression in children, 3 which is the primary cause of death in opioid overdose. 4 In 2019, the Society for Pediatric Anesthesia published a set of recommendations for the use of opioids in children during the perioperative period.…”

“…Between 1999 and 2016, the national pediatric mortality rate from prescription and illicit opioids increased nearly threefold 1 . However, while the opioid epidemic's impact on adolescents and adults has received substantial attention, its impact on young children has received less consideration 2 . In line with this, there is only sparse evidence concerning the exposure‐response relationship between opioids and respiratory depression in children, 3 which is the primary cause of death in opioid overdose 4 …”