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Original Investigation
Impact of Policy on Children
July 13, 2020

Association of State-Level Opioid-Reduction Policies With Pediatric Opioid Poisoning

Author Affiliations
  • 1Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Harvard Medical Toxicology Program, Boston Children’s Hospital, Boston, Massachusetts
  • 3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
  • 4Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program (CHIP), Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. Published online July 13, 2020. doi:10.1001/jamapediatrics.2020.1980
Key Points

Question  Are state-level opioid-reduction policies associated with a decrease in opioid poisoning in children and adolescents?

Findings  In this interrupted time series analysis of 338 476 opioid poisonings among children younger than 20 years, implementation of a prescription drug monitoring program and a pain clinic legislation was associated with immediate and sustained reductions in rates of opioid poisoning.

Meaning  This study found that state-level opioid-reduction policies may reduce pediatric opioid poisoning.

Abstract

Importance  Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies.

Objective  To examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.

Design, Setting, and Participants  This interrupted time series analysis used data from the National Poison Data System (NPDS), a database of poisoning information reported to poison control centers across the US. Individuals younger than 20 years who experienced poisoning associated with 1 or more prescription opioids from January 1, 2005, to November 30, 2017, were included. The analysis focused on 3 widespread policy interventions: the prescription drug monitoring program (PDMP), pain clinic legislation, and opioid prescribing guidelines. Data analysis was performed from January 30, 2020, to March 30, 2020.

Exposures  Any opioid poisoning in individuals younger than 20 years that was reported to the NPDS.

Main Outcomes and Measures  Opioid poisoning rates per million person-months before and after implementation of each of the 3 policies, overall and stratified by age (≤4 years, 5-9 years, 10-14 years, and 15-19 years).

Results  A total of 338 476 opioid poisoning incidences in children and young adults were reported to the NPDS within the study period. Of this study population, the mean (SD) age was 9.74 (7.15) years, and 179 011 (52.9%) were female. The implementation of a PDMP was associated with a reduction in the monthly rate of opioid poisoning in children and adolescents (–0.07 per million person-months; 95% CI, –0.09 to –0.04) in the postimplementation period. This reduction was observed for all age groups except for the 10- to 14-year age group (−0.03 per million person-months; 95% CI, −0.05 to 0.00). Pain clinic legislation was associated with an immediate reduction in opioid poisoning (–6.22 per million person-months; 95% CI, –8.98 to –3.47). This association was statistically significant across all ages except for the 4 years or younger group. Analysis of the association of implementation of opioid prescribing guidelines was limited because of insufficient follow-up data and did not show an immediate or monthly change in the rate of opioid poisoning.

Conclusions and Relevance  Results of this study suggest that certain state-level opioid-reduction policies were associated with decreases in pediatric opioid exposures across age groups. Further examination of the underlying mechanisms of these associations, including age group–specific outcomes, may expand and strengthen policies that reduce opioid poisoning, misuse, and overdoses in children and adolescents.

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