At least a quarter of children in the United States who died from opioid poisoning between 2004 and 2020 were victims of prior abuse or neglect, a new Yale study finds, and over two-thirds of 10- to 17-year-olds who suffered fatal poisonings had a history of substance use.
The findings, say researchers, will inform strategies to prevent opioid poisoning deaths in the future by identifying when and where interventions should take place.
"When most people think about the opioid epidemic, they don't take into account that it's something that's affecting individuals of all ages," said Julie Gaither, an assistant professor of pediatrics at Yale School of Medicine and lead author of the study published Nov. 1 in the journal Pediatrics.
While pediatric opioid poisonings were largely attributed to prescription opioids at the start of the U.S. opioid crisis, which began about 25 years ago, fentanyl has become increasingly implicated in recent years. Between 1999 and 2021, nearly 14,000 children died from an opioid poisoning.
In many cases, the circumstances behind pediatric opioid-related deaths are not well understood, which limits the implementation of effective interventions, say researchers.
"In the large datasets we tend to work with as researchers, we only get a broad sense of what's happening," said Gaither, who is also an assistant professor of epidemiology at Yale School of Public Health. "You don't get a sense of what happened in the home or what led to the death."
To get more detailed information about fatal pediatric opioid poisonings, Gaither and her team turned to the National Fatality Review-Case Reporting System, which collects information from child death review teams - multidisciplinary groups established in every U.S. state to investigate child deaths.
The researchers found that across nearly 1,700 children aged 0 to 17 years who died from opioid poisonings between 2004 and 2020, most poisoning incidents occurred in the child's home (65%) or at the home of a relative, friend, or foster parent (23%). And the majority of poisonings (92%) involved a prescription opioid. While most of the deaths were attributed to accidental ingestion, among children aged 0 to 4 years, 34% of deaths were attributed to homicide, which could include intentional exposure to opioids or criminal neglect on the part of the caregiver.
"These findings aligned with those of previous studies," said Gaither. "But I was surprised to find that across all four age groups - 0 to 4, 5 to 9, 10 to 14, and 15 to 17 - 25% to 33% of children had a history of maltreatment. And over 25% of all children had a primary caregiver with a history of substance use."
Substance use was also common among adolescents, the researchers found, with 42% of 10- to 14-year-olds and 73% of 15- to 17-year-olds having a history of substance use.
Together, these more nuanced details regarding pediatric opioid-related deaths highlight areas where interventions could be most effective, the researchers said. For instance, health care providers should offer information about opioid storage, misuse, and disposal to better protect children in their homes, said the researchers. And all prescription opioids should come in child-proof packaging, which is currently not the case.
Additionally, naloxone (sold under the brand names Narcan and Evzio) can rapidly reverse an opioid poisoning and needs to be more easily accessible to parents, said Gaither.
"It's a drug that's safe and effective for children of all ages, even infants," she said. "It would be great if when people picked up prescriptions for opioids, pharmacists offered naloxone as well."
Similarly, expansion of opioid use disorder treatment is urgently needed for both adults and adolescents, the researchers noted.
"Opioids are a risk for children and teens, including very young children, and we need to be taking the precautions that we do with any other substance that can harm a child," said Gaither. "We need to spend a lot more time and energy thinking about how we can help families protect themselves and prevent these deaths from happening because they're true tragedies."
