Young children of mothers prescribed opioids at increased risk of overdose

TORONTO —Children of women prescribed an opioid painkiller face a nearly 2.5-fold higher risk of being hospitalized for opioid overdose than children whose mothers don’t receive these drugs, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (SickKids).

The dramatic increase in the prescribing of opioids such as codeine and oxycodone over the past two decades in North America has been associated with a marked increase in fatal overdoses. New research shows that young children of women prescribed these painkillers are also at risk of opioid overdose.

“With the increase in opioid prescribing and availability of these drugs in North American homes,  it's critical to understand how this may impact children,” says Dr. Yaron Finkelstein, lead author of the study, staff physician in Paediatric Emergency Medicine, and Clinical Pharmacology and Toxicology, associate scientist at SickKids and adjunct scientist at ICES. “Prescribers, pharmacists and parents should be cognizant of this risk and take measures to prevent overdoses, such as dispensing smaller opioid quantities, considering alternatives to opioids for pain relief, and emphasizing the importance of secure storage and disposal of unused opioids.”

In the study, published today in Pediatrics, the researchers looked at children under age 10 whose mothers’ prescriptions were covered under Ontario’s publicly-funded provincial drug plan and who were treated in the emergency department, hospitalized or died of opioid overdose between 2002 and 2015.  They found that young children are at a nearly 2.5-fold risk of severe overdose, often resulting in hospital stays, if their mothers were prescribed opioid medications, compared with those whose mothers were prescribed non-opioid medications for pain.  Information about opioid prescription to fathers was not available and could not be included in the study.

The researchers identified 103 children who were 10-years-old or younger with an opioid overdose and 412 children with no opioid overdose, and compared the likelihood that their mothers received an opioid or a non-steroidal anti-inflammatory drug such as ibuprofen before the overdose episode. Half of the children who presented to hospital with an opioid overdose were two-years-old or younger, and one in 10 of the overdoses involved infants younger than 12 months. Nearly 40 per cent of the children were admitted to hospital, including 13 who were treated in critical care units.

“For some opioids, a single tablet is enough to kill a child,” says Dr. David Juurlink, study author and senior scientist at ICES. “It’s important that parents and grandparents understand the importance of keeping these drugs out of the hands of young children.”

“Overdose risk in young children of women prescribed opioids,” was published today in Pediatrics.

Author block: Yaron Finkelstein, Erin M. Macdonald, Alejandro Gonzalez, Marco LA Sivilotti, Muhammad M. Mamdani, and David N. Juurlink, for the Canadian Drug Safety and Effectiveness Research Network (CDSERN).

This project is an example of how SickKids and ICES are contributing to making Ontario Healthier, Wealthier and Smarter www.healthierwealthiersmarter.ca.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized child and family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca. Follow us on Twitter (@SickKidsNews) and Instagram (@SickKidsToronto).

For further information please contact:
Deborah Creatura
Media Advisor, ICES
deborah.creatura@ices.on.ca
(o) 416-480-4780 or (c) 647-406-5996

Suzanne Gold
The Hospital for Sick Children (SickKids)
suzanne.gold@sickkids.ca
416-813-7654, ext. 202059