October 31, 2016 at 11:00 AM
Graphic images of a mom and dad passed out, mouths agape, in a car with their 4-year-old still strapped into the back seat. A video of a woman lying in a grocery-store aisle as a toddler in pink pajamas cries and shakes her. The police report of a 7-year-old who told her bus driver on the way back from school that she hadn't been able to wake her parents.
Such stories, circulated on social media in recent months, have highlighted the toll of the epidemic of opioid abuse on the youngest Americans. They have become a rallying cry for pediatricians calling for better psychological counseling and other supports to better protect the children of addicts.
But a new study, published in the journal JAMA Pediatrics on Monday, shows that the effects of the crisis on children go far beyond mental health. According to an analysis of discharge papers collected every three years from a representative sample of pediatric hospitals nationwide, 13,052 children were hospitalized for poisonings from opioid prescriptions of Oxycodone, Percocet, codeine and the like during six years between 1997 to 2012. Of those, 176 died.
Related: [Special Report — A new divide in American death: Drugs, alcohol, marketing and lax federal oversight are working to defy modern trends of mortality, perhaps most starkly among middle-age white women.]
The numbers show that hospitalizations for prescription opioid poisonings in children doubled during those years.
Report author Julie R. Gaither, an epidemiologist at the Yale School of Medicine who has also studied the injuries to children from firearms, drew parallels between the need to store guns safely and the need to make sure opioid pills are stored safely.
"These children are getting into their parents' or grandparents' medication. Opioids are now ubiquitous in millions of U.S. homes," Gaither said in an interview. "They are like guns — you have these dangerous things, and we need to keep [them] out of the hands of the most vulnerable."
With drugs now killing more people than guns and cars in the country, it was perhaps inevitable that the crisis would hit children in this way. But even Gaither was surprised by the numbers.
In the youngest group (age 1 to 4), 1,531 children were poisoned during the years studied, and the rate doubled over time. This suggests a carelessness or callousness by parents and other adults near them about keeping children away from the pills, she said. Gaither suggested that doctors should emphasize to any adults on opioids that they should have a safety plan to make sure the drugs are out of reach and are disposed of properly when they are finished with them.
In contrast, in children age 5 to 9 — when many children become able to differentiate between a potentially dangerous drug in a colorful casing and, say, candy — there were so few cases of poisonings that the study wasn't able to show any statistically significant trends except that it was pretty close to zero.
That may sound positive, but Gaither's data shows this is the only age not horribly affected by opioid poisonings. Starting at age 10, the rate of overdoses starts to climb until the teenage years, when the highest rate of poisonings occurs.
Gaither said that unlike in the toddler and preschool groups, where poisonings were probably accidental, the poisonings among youth older than 10 were primarily attributed to suicide or self-inflicted injury.
"These data underscore the dangers associated with the widespread availability of prescription opioids, particularly for adolescents at risk for depression," the study authors wrote.
On the surface, the numbers appear to show a positive trend among teens, in that the rate of poisonings is decreasing. But when Gaither and her co-authors separately analyzed poisonings in that age group for heroin or other illicit drugs, she found that the numbers rose in the same years, suggesting that as it became more difficult to get prescription drugs, teens may have switched to street drugs — a trend that happened at around the same time for adult users of opioids.
There are other parallels to the trend in adults. Most of the victims — 73.5 percent — are white, and slightly more than half (53 percent) are female. In their parents' generation, opioids have contributed to a surprising decline in life expectancy among white women.
"Keeping kids' hands off these pills should be pretty simple," Gaither said. "When it's complicated is when an adult is abusing them, and that interferes with how they can be a responsible parent." She said she hopes the stories in the news recently serve as a wake-up call to parents to seek help.