Medication Safe - Dr. Ben Tsutaoka

Article published in:

Annals of Emergency Medicine

 2008 Sep 5. [Epub ahead of print]

 http://www.annemergmed.com/article/S0196-0644(08)01503-5/abstract

Bailey JE, Campagna E, Dart RC; The RADARS System Poison Center Investigators.

Rocky Mountain Poison and Drug Center-Denver Health, Denver, CO.

ABSTRACT

STUDY OBJECTIVE: The impact of prescription opioid abuse on young children is underrecognized and poorly documented. We hypothesize that poisoning of young children from prescription opioids occurs regularly in the United States and is associated with serious health events, including death.

METHODS: Using data from poison centers participating in the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System, exposures in children younger than 6 years, involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone (January 2003 to June 2006), were quantified and described.

RESULTS: We identified 9,179 children exposed to a prescription opioid. The median age was 2.0 years (range newborn to 5.5 years), and 54% were boys. Nearly all exposures involved ingestion (99%) and occurred in the home (92%). Exposures to any opioid were associated with 8 deaths, 43 major effects, and 214 moderate effects. Of 51 patients who experienced a major effect or death, 35 were treated with naloxone: a beneficial response was documented in 34 patients. All 5 exposures to buprenorphine associated with a major effect were treated with naloxone, and a beneficial response was recorded in all 5. Nearly all exposures were to medications prescribed for adults in the household. The number of prescriptions filled for an opioid in an area correlated well with exposures in young children in the same area; children have access to household members’ prescription drugs.

CONCLUSION: Young children are exposed to prescription opioids, typically prescribed for other patients, resulting in major health effects and death.

The following is a story from the Los Angeles Times:

http://www.latimes.com/features/health/la-he-drugside15-2008sep15,0,150748.story

By Melissa Healy
Los Angeles Times Staff Writer

September 15, 2008

Prescriptions for painkillers — left over from surgeries, orthopedic injuries or dental work — frequently languish, unfinished, in family medicine chests.

Supplies of anti-anxiety medications, including the benzodiazepines known by their commercial names Xanax and Ativan, take up shelf space because they are prescribed for episodic use. And as a growing number of adults are diagnosed with ADHD, their stimulant medication often sits alongside that of their children with attention difficulties.

Unwittingly, parents who leave these medications unsecured and unmonitored are tempting their children — and their children’s friends — to try drugs they have heard and read about at school, in movies and on the Internet. In a teenager’s calculation, the price is right and the risks — of scoring the drugs at least — are low.

For parents, the antidotes to youthful rebellion and the impulse to dangerous experimentation may be complex and elusive. But making it harder for kids to lay hands on drugs with high addiction potential and growing allure among their friends, say experts, is quite simple:

Lock ‘em up. (No, not the kids. The drugs.)

“In total, nearly half the prescription drugs being abused by teens originate in the homes of passive pusher parents,” concluded National Survey of American Attitudes on Substance Abuse” released last month by Columbia University’s National Center on Addiction and Substance Abuse. CASA Executive Director James Califano called parents who fail to lock up prescription medications — or who fail to ask the parents of their kids’ friends to do the same — “problem parents.”

Experts also urge parents to dispose of prescription drugs that remain unused after their purpose has been served. The Office of National Drug Control Policy warns against flushing them down the toilet — which sends them into public water supplies — but recommends disposing of them in a coffee canister or other tightly closed opaque container, under coffee grounds or kitty litter to make exploration less appealing.

If prescription medications need to be retained for future use, experts say parents should keep an inventory of them and secure them, either under lock and key or by keeping them where a curious child won’t find them.

The stakes are high — not only for teens and young adults but for their younger siblings. The Centers for Disease Control and Prevention reported recently that deaths from drug use among people age 15 to 24 doubled from 1999 to 2004 — with the overwhelming majority involving prescription painkillers. Last week, the Annals of Emergency Medicine reported 9,147 cases of accidental ingestion of opiates by children under 6 — for whom such medications can be lethal even at very small doses — in a 3 1/2 -year period starting January 2003. In eight cases, death was the result.

The authors — a trio of University of Colorado Medical School researchers — believe the “poisoning of young children from prescription opioid occurs regularly,” and suggests the number of children who actually found and took pain pills left out is probably much higher, since they only surveyed a portion of U.S. poison control centers to gather their data.

“The word is getting out to teens and their parents that prescription medications are dangerous when used improperly, but plenty of risk remains,” says Dr. Linda Lawrence, president of the American College of Emergency Physicians. “Adults need to monitor closely all medications in the house, and apply the same sense of caution that they would to any potentially dangerous substance.”