SickKids-led research determines predictors of severe outcomes following opioid intoxication in children and youth

An international research collaboration led by scientists at The Hospital for Sick Children (SickKids) has identified predictors of severe outcomes following opioid intoxication in children and youth amid the ongoing opioid epidemic. Worldwide, more than 350,000 lives are lost every year with rising cases of paediatric opioid intoxications which can occur through accidental ingestion, as well as intentional use of these substances. To improve understanding regarding the impact of opioid intoxication on children and youth, the American College of Medical Toxicology approached experts at SickKids to lead a study on the effects of the opioid epidemic on children and youth, and to establish a dedicated registry.

Published on March 25, 2022 in Clinical Toxicology, the five-year study collected data on 165 children and youth who presented with opioid intoxication at 50 medical centres in the U.S., Canada and Thailand. The researchers found that children and youth with an opioid intoxication who have been exposed to fentanyl and those over the age of 10 had 3.6 and 2.6 higher odds of intensive care unit (ICU) admission or in-hospital death, respectively.

First-of-its-kind international study establishes database of paediatric opioid intoxications

Led by Dr. Yaron Finkelstein, Staff Physician, Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology at SickKids, and Dr. Neta Cohen, research fellow at SickKids, the research team designed the study to have a medical toxicologist dispatched to each paediatric patient enrolled at a participating centre. For each enrolled patient, the toxicologist would gather high-quality data from the bedside, including specific types and amounts of substances ingested, as well as directly manage their care.  

“This is a key public health concern, however, the downstream effect of the opioids crisis on children has not received enough attention. The support for this study was amazing with many renowned toxicology researchers and centres participating,” notes Finkelstein, Senior Scientist, Child Health Evaluative Sciences at SickKids. “By collecting real-time data, we were able to get the most accurate information about types and amounts of opioid ingested to inform the determination of specific risk factors for this population.”

Between 2000 and 2015, the proportion of deaths attributable to prescribed or illicit opioids in Canada nearly tripled, with the greatest increase documented in individuals aged 15 to 24 years. Children and youth represent a unique population of concern within the opioid epidemic, with toddlers and adolescents at higher risk for opioid-related morbidity. Toddlers are prone to accidental ingestion of opioids and often experience severe acute toxicity because they have not been previously exposed to such substances. Adolescents, however, are more likely to have had previous exposure to opioids or exposure to multiple, frequently unknown substances at the same time, both of which often make opioid toxicity challenging to manage.  

Findings to help inform strategies to reduce the risk of severe outcomes for children and youth

The researchers hope that this information helps opioid management programs to employ these predictors and reduce the risk of severe outcomes for children and youth. For example, if adults with children in their home are prescribed an opioid, their health-care provider should consider also co-prescribing and educating on naloxone, an opioid antidote, in the event of an accidental ingestion by the child.

“Such efforts to mitigate poor outcomes should also include improving education about these risks, updating health-care provider prescribing practices and policies - such as dispensing smaller pill amounts, discussion of safe storage and leftover discard, co-prescribing of an antidote, particularly when there are children in the household, and informing regulations for improved packaging of opioids,” says Finkelstein.

The SickKids team has already been approached by other regions across the world to set up similar toxicology research projects, and to employ this international research network to study other important areas in paediatric toxicology. Finkelstein adds, “I’m particularly proud of the strong collaboration and the leadership role that our team at SickKids played in designing and orchestrating this international research initiative. These findings will greatly support our collective efforts in addressing and mitigating the ongoing impacts of the opioid epidemic on children globally.”