Children with mothers prescribed opioids more likely to overdose

1. Children aged ≤10 years who had overdosed on opioids were more than 2 times more likely to have a mother with opioid prescriptions than one with prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs). 

2. Codeine, methadone, and oxycodone were the top 3 maternal opioid prescriptions implicated in pediatric opioid toxicity.

Evidence Rating: 3 (Average) 

Study Rundown: Legal prescription opioid use for chronic pain in North America has increased significantly over the past two decades. Previous work has demonstrated that increasing rates of adult drug use, prescription medications in particular, are related to increasing rates of unintentional poisonings in young children. The specific implications of parental prescription opioid use on children in the home remains unclear. In this study, researchers sought to better characterize the link between maternal prescription opioid use and pediatric opioid overdose in Ontario, Canada. Rates of opioid overdose in children whose mothers had prescriptions for opioids (cases) were compared to rates of opioid toxicity in those whose mothers had NSAID prescriptions (controls). Results indicated that children whose mothers had been prescribed opioids in the past year had greater than two fold increased risk of overdose than children whose mothers were taking NSAIDs. Codeine, methadone and oxycodone were the 3 prescription opioids most frequently responsible for overdose. One limitation of this study is the lack of data on prescription use for fathers or others living in the household, a potentially important source of exposure. Furthermore, the population studied only included those covered by the provincial drug plan, and did not include information on opioid overdose in children of families that do not received subsidized medications. These findings have implications for the role physicians and pharmacists play in educating parents on proper storage and handling of potentially toxic medications.

Click to read the study, published today in Pediatrics

Relevant reading: Leftover Prescription Opioids After Minor Procedures: An Unwitting Source for Accidental Overdose in Children

Study Author, Dr. Yaron Finkelstein, MD, FACMT, talks to 2 Minute Medicine: Professor of Pediatrics, Pharmacology and Toxicology, University of Toronto, Staff physician, Senior Associate Scientist, Hospital for Sick Children, Adjunct Scientist, Institute of Clinical Evaluative Sciences, Toronto

“The CDC has recently defined prescription opioids misuse as the worst drug epidemic in history, based on ~250,000 deaths over the past two decades and roughly 7,000 emergency department daily visits in the United States. With the increase in opioid prescribing and availability in North American homes, it is critical to understand how this may impact children, and specifically determine the potential downstream effect of parental opioids prescribing on their children.”

In-depth [retrospective case-control study]: In this study, cases were defined as children who 1) presented to the hospital for or died in the prehospital setting from opioid overdose, 2) had mothers that received either opioids or NSAIDs in the previous year, and 3) were aged ≤10 years. Each case was randomly matched with 4 controls with similar age (within 6 months) and sex that did not experience opioid overdose. Researchers utilized various national healthcare-related reporting registries to identify the 103 cases, which were matched with 412 controls using the Ontario Public Drug Benefit Database. This database includes information on prescriptions for residents who receive subsidized medications under Ontario’s provincial drug plan. NSAIDs were chosen as the reference exposure due to similarities in prescription indications (ie analgesia for chronic pain). Children >10 years were excluded to avoid inclusion of overdoses related to intentional misuse of opioid drugs. General characteristics, including age, income quintiles, additional prescription drug use, and co-morbid psychiatric disorders, of cases and controls were compared. Results indicated that maternal opioid prescription (particularly codeine, oxycodone and methadone) in the previous year increased the risk of pediatric opioid overdose more than two-fold, compared to mothers with NSAID prescriptions (OR, 2.41; 95% CI, 1.68-3.45). The average age of child opioid overdose was 2 years, with 1 in 10 opioid overdoses occurring in infants <12 months, suggesting some of the overdoses may have been related to caregiver neglect or malice, rather than unintentional medication ingestion. Mothers of the children in the case cohort were also found to have higher rates of concurrent antidepressant prescriptions, though there were no statistically significant differences in comorbid psychiatric disorders or other prescription drug use between mothers in the 2 groups.

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