Here’s a news story from MSNBC http://www.msnbc.msn.com/id/27168078/ regarding an article we posted at the end of September from the Annals of Emergency Medicine about opiate abuse and resultant exposures in children.
By JoNel Aleccia
Health writer
updated 4:33 a.m. PT, Mon., Oct. 20, 2008
Nine-month-old Shayla Davidson was a sick little girl, and her mother had no idea why.
Pale, listless and barely breathing, the baby wouldn’t wake up one day last month, even when 25-year-old Nicolle Jones rushed her to an emergency room near Cincinnati.
Medical crews were stumped, too, until they noted that Shayla’s pupils were constricted, a tell-tale sign of opiate poisoning.
“They kept asking me, ‘Did she get ahold of any medicine?’” Jones recalled. “I said, ‘No.’”
In fact, Shayla had ingested medication, a single 60-milligram tablet of oxycontin, a powerful prescription painkiller.
But pediatric specialists at the Cincinnati Children’s Hospital and Medical Center wouldn’t know that until later, after they’d treated the child five times with a strong antidote and performed tests that linked Shayla’s life-threatening condition to the common drug her grandfather takes for back pain.
“I about fell on the floor when they told me,” said Jones, who lives with her parents in nearby Independence, Ky. “My dad keeps his medicines up high. We’re thinking he dropped it.”
Shayla’s fine now, but she’s also lucky, according to a recently released report from the nation’s poison control centers. It shows a rising tide of prescription drug use is threatening unintended users: young children who accidentally ingest the powerful painkillers.
Some 9,179 toddlers and kids under age 6 were exposed to widely prescribed drugs such as hydrocodone, oxycodone and methadone between January 2003 and June 2006, according to a report published online in September in the Annals of Emergency Medicine.
Exposures ranged from a pill snatched quickly from a kid’s mouth to actual ingestion, said Dr. Richard C. Dart, medical director for the Rocky Mountain Poison and Drug Center in Denver, and a co-author of the report.
‘One pill is enough’
Eight children died, 43 suffered life-threatening injuries or serious disabilities and 214 required prolonged medical treatment, all because they mistakenly took strong medications belonging to their parents, grandparents and other adults.
“For opioids, really, one pill is enough,” said Dart. “One pill can kill or at least cause major effects.”
The incidents represent a surge in injuries and near-misses that have made prescription drugs a top cause of child poisonings, second only to carbon monoxide poisoning, said Dart. The study, which used data from the Researched Abuse, Diversion and Addiction-Related Surveillance — RADARS — system, probably underestimates the extent of the problem, he added, because not all poison control centers participated and not all exposures are reported.
“Conservatively, you can say the number is twice that high and probably higher than that,” Dart said. “I knew we would find something, but I was stunned.”
The accidents have been fueled by skyrocketing rates of legal and illegal prescription painkiller use. There were 119 million prescriptions written for hydrocodone in the United States in 2007, up from 112 million in 2006, according to figures from IMS Health, a healthcare information and consulting company. Prescriptions for variations of oxycodone topped 38 million, up from 34 million a year earlier.
At the same time, about 5.2 million people aged 12 and older used prescription pain relievers for non-medical purposes in 2007, latest figures from the federal Office of Applied Studies showed.
Overall, deaths caused by unintentional drug poisonings spiked by nearly 70 percent between 1999 and 2004, according to a report last year from the federal Centers for Disease Control and Prevention, which attributed most of the increase to overdoses of prescription painkillers.
“I think what we’ve noticed over the years is that as the prescription opiate pain reliever base goes up — legitimately and illegitimately — more kids are getting into these pills,” said Dr. Randall Bond, medical director for the Cincinnati Drug and Poison Information Center.
Other drugs, such as heart medications, certain antidepressants and anti-malaria drugs are equally dangerous, Bond added. But they’re not nearly as common as the potent pain relievers.
Not necessarily neglect
About half of the opiate exposures occurred in what Dart described as “complicated” households, those with many adults living together or with histories of drug use or child neglect. The rest occurred in “competent” families with no signs of neglect or abuse, he added.
“For good families, if you have patient opioids in the household, you’d be surprised how fast a kid can get ahold of these,” Dart said.
Some of the children in the report drank liquid methadone stored in refrigerators. Others encountered dropped drugs while crawling or toddling, and still others got into a grandparent’s purse or suitcase and found untended bottles of pills.
“Those caps are only child-resistant,” Dart said. “They just slow down a child.”
Once a child ingests a strong painkiller, the effects can be quick — and deadly. The drugs generally act by depressing respiration, so a youngster affected may simply stop breathing.
In Shayla Davidson’s case, it was fortunate that her family noticed her behavior during the day. “If the child had gotten into it right before bed, she might never have woken up,” said Bond.
Nicolle Jones, Shayla’s mother, said her family always took precautions with medications, but they’ve made them even stronger. They keep the drugs in a locked cabinet and there’s a new hook on the bathroom door.
“Oh my God, my dad felt so bad that she got hold of one of his medicines,” Jones said. “It was a scary situation. I could have lost my baby.”
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