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Original Investigation
December 2016

National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012

Author Affiliations
  • 1Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
  • 2Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut
  • 3Biomedical Informatics/Research Service, Veterans Affairs Connecticut Healthcare System, Department of Veterans Affairs, West Haven, Connecticut
  • 4Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
  • 5Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Pediatr. 2016;170(12):1195-1201. doi:10.1001/jamapediatrics.2016.2154
Key Points

Question  How has the prescription opioid epidemic affected pediatric hospitalization rates in the United States?

Findings  This retrospective analysis of 13 052 national hospital discharge records found that pediatric hospitalizations for opioid poisonings increased nearly 2-fold from 1997 to 2012. Hospitalization rates were highest in older adolescents, but the largest percentage increase in hospitalizations over time occurred among the youngest children (toddlers and preschoolers).

Meaning  Reducing pediatric opioid exposure and misuse will require a combination of public health interventions, policy initiatives, and consumer-product regulations.

Abstract

Importance  National data show a parallel relationship between recent trends in opioid prescribing practices and hospitalizations for opioid poisonings in adults. No similar estimates exist describing hospitalizations for opioid poisonings in children and adolescents.

Objective  To describe the incidence and characteristics of hospitalizations attributed to opioid poisonings in children and adolescents.

Design, Setting, and Participants  Retrospective analysis of serial cross-sectional data from a nationally representative sample of US pediatric hospital discharge records collected every 3 years from January 1, 1997, through December 31, 2012. The Kids’ Inpatient Database was used to identify 13 052 discharge records for patients aged 1 to 19 years who were hospitalized for opioid poisonings. Data were analyzed within the collection time frame.

Main Outcomes and Measures  Poisonings attributed to prescription opioids were identified by codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. In adolescents aged 15 to 19 years, poisonings attributed to heroin were also identified. Census estimates were used to calculate incidence per 100 000 population. The Cochran-Armitage test for trend was used to assess for changes in incidence over time.

Results  From 1997 to 2012, a total of 13 052 (95% CI, 12 500-13 604) hospitalizations for prescription opioid poisonings were identified. The annual incidence of hospitalizations for opioid poisonings per 100 000 children aged 1 to 19 years rose from 1.40 (95% CI, 1.24-1.56) to 3.71 (95% CI, 3.44-3.98), an increase of 165% (P for trend, <.001). Among children 1 to 4 years of age, the incidence increased from 0.86 (95% CI, 0.60-1.12) to 2.62 (95% CI, 2.17-3.08), an increase of 205% (P for trend, <.001). For adolescents aged 15 to 19 years, the incidence increased from 3.69 (95% CI, 3.20-4.17) to 10.17 (95% CI, 9.48-10.85), an increase of 176% (P for trend, <.001). In this age group, poisonings from heroin increased from 0.96 (95% CI, 0.75-1.18) to 2.51 (95% CI, 2.21-2.80), an increase of 161% (P for trend, <.001); poisonings involving methadone increased from 0.10 (95% CI, 0.03-0.16) to 1.05 (95% CI, 0.87-1.23), an increase of 950% (P for trend, <.001).

Conclusions and Relevance  During the course of 16 years, hospitalizations attributed to opioid poisonings rose nearly 2-fold in the pediatric population. Hospitalizations increased across all age groups, yet young children and older adolescents were most vulnerable to the risks of opioid exposure. Mitigating these risks will require comprehensive strategies that target opioid storage, packaging, and misuse.

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