Yaron Finkelstein1,2,3,4, Erin M Macdonald4, Alejandro Gonzalez4, Marco L A Sivilotti5,6, Muhammad M Mamdani4,7,8, David N Juurlink4,9,10. 1. Divisions of Emergency Medicine, and yaron.finkelstein@sickkids.ca. 2. Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. 4. The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. 6. Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada. 7. Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada. 8. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada. 9. Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, Ontario, Canada; and. 10. Departments of Medicine, Paediatrics and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
Abstract
BACKGROUND AND OBJECTIVE: Over the past 20 years, the prescribing of opioids has increased dramatically in North America, with parallel increases in opioid addiction, overdose, and associated deaths. We examined whether young children of women prescribed opioids were at increased risk of opioid overdose. METHODS: We conducted a population-based, nested case control study in Ontario, Canada, between 2002 and 2015. We identified children aged ≤10 years, whose mothers received publicly funded prescriptions for an opioid or a nonsteroidal antiinflammatory drug (comparator analgesic) in the preceding year. Cases were children who presented to hospital for or died of opioid overdose. Each case was matched with 4 controls with no opioid overdose. The primary outcome was the risk of opioid overdose. RESULTS: We identified 103 children who presented to the hospital with opioid overdose and matched them with 412 controls. Half of the children with opioid overdose were <2 years old. Compared with controls, children with an opioid overdose were far more likely to have a mother who received a prescription opioid (unadjusted odds ratio, 2.41; 95% confidence interval, 1.68-3.45) and who was prescribed antidepressants. The most commonly implicated overdose opioids were codeine (53.4%), oxycodone (32.0%), and methadone (15.5%). CONCLUSIONS: Young children of mothers prescribed opioids are at a markedly increased risk of overdose. Physicians, pharmacists, and parents should take measures to mitigate the risk of opioid-related harm to children, such as prescribing smaller quantities, emphasizing the importance of secure medication storage, and the prompt disposal of unused opioids.
BACKGROUND AND OBJECTIVE: Over the past 20 years, the prescribing of opioids has increased dramatically in North America, with parallel increases in opioid addiction, overdose, and associated deaths. We examined whether young children of women prescribed opioids were at increased risk of opioid overdose. METHODS: We conducted a population-based, nested case control study in Ontario, Canada, between 2002 and 2015. We identified children aged ≤10 years, whose mothers received publicly funded prescriptions for an opioid or a nonsteroidal antiinflammatory drug (comparator analgesic) in the preceding year. Cases were children who presented to hospital for or died of opioid overdose. Each case was matched with 4 controls with no opioid overdose. The primary outcome was the risk of opioid overdose. RESULTS: We identified 103 children who presented to the hospital with opioid overdose and matched them with 412 controls. Half of the children with opioid overdose were <2 years old. Compared with controls, children with an opioid overdose were far more likely to have a mother who received a prescription opioid (unadjusted odds ratio, 2.41; 95% confidence interval, 1.68-3.45) and who was prescribed antidepressants. The most commonly implicated overdose opioids were codeine (53.4%), oxycodone (32.0%), and methadone (15.5%). CONCLUSIONS: Young children of mothers prescribed opioids are at a markedly increased risk of overdose. Physicians, pharmacists, and parents should take measures to mitigate the risk of opioid-related harm to children, such as prescribing smaller quantities, emphasizing the importance of secure medication storage, and the prompt disposal of unused opioids.
Authors: Jacqueline A Carrico; Katharine Mahoney; Kristen M Raymond; Shannon K McWilliams; Lena M Mayes; Susan K Mikulich-Gilbertson; Karsten Bartels Journal: Ann Fam Med Date: 2020-03 Impact factor: 5.166
Authors: Michael S Toce; Kenneth Michelson; Joel Hudgins; Michele M Burns; Michael C Monuteaux; Florence T Bourgeois Journal: JAMA Pediatr Date: 2020-10-01 Impact factor: 16.193