Youth Opioid Deaths Nearly Tripled Over Past Two Decades
Surge partially attributable to increased prevalence of synthetic opioids
Nearly 9,000 youth died from opioid poisonings, with the mortality rate increasing nearly threefold in the past two decades, according to a retrospective study.
The overall pediatric mortality rate from prescription and illicit opioid poisonings rose 268.2% — increasing from 0.22 per 100,000 (95% 0.19-0.25) in 1999 to 0.81 per 100,000 (95% CI 0.76-0.88) in 2016 (P for time effect<0.001), reported Julie Gaither, PhD, MPH, RN, of Yale School of Medicine in New Haven, Connecticut, and colleagues.
Opioid-related deaths were most common amongst teenagers, and the mortality rate for adolescents ages 15-19 increased by 252.6% across the study period, they wrote in JAMA Network Open.
However, all age groups experienced a rise in rates over time, with mortality rates among the youngest children ages 0-4 rising by 225.0%, the authors noted.
“The primary thing is that we need to consider — public health officials, legislators, clinicians, and parents — is how everyone is affected in the home when an adult brings an opioid into the house,” Gaither told MedPage Today, adding that this includes administering safety recommendations and disposal instructions based on who is in the home along with opioid prescriptions.
Although differing in magnitude, pediatric mortality rates followed a similar temporal and drug use pattern as adult opioid-related mortality rates, with pediatric mortality rates demonstrating a steady linear increase until roughly 2008, the authors reported.
Gaither said that similar to adult trends, after a brief plateau from 2012 to 2014, youth mortality rates rose again starting around 2014, when regulations tightened around opioid prescriptions, and a surge in synthetic opioid deaths occurred.
Although prescription opioids are primarily driving the epidemic, the introduction of drugs like illicitly manufactured fentanyl likely contributes to an increased number of children who are exposed, with nearly one third of teen deaths in this study attributed to synthetic opioids since 2014, Gaither noted.
“With our data, we were not able to distinguish between what was pharmaceutical fentanyl and what was illicitly manufactured fentanyl, and no study is able to do that because you cant look at that, but these are likely illicitly manufactured drugs,” Gaither said. “That’s very troubling that teens are getting hold of these illegal drugs that are 50 to 100 times more potent than heroin.”
In this study, researchers analyzed cross-sectional data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to determine the number of poisonings from prescription and illicit opioids across the study period. Deaths were identified using ICD-10 codes.
Overall, 8,986 youth died from opioid poisonings across the study period, with 7,921 (88.1%) deaths involving teenagers ages 15-19, 605 (6.7%) involving children ages 0-4 and 364 (4.1%) involving children ages 10-14. The majority of deaths occurred in non-Hispanic white children (79.9%) and in boys (73.1%), the researchers reported.
In teens ages 15-19, the authors found that heroin was responsible for 1 in 4 deaths (23.6%) and from 1999 to 2016, the rate of fatal heroin overdoses increased by 404.8%, while the rate of prescription opioid deaths in this age group increased by 94.7%. Additionally, synthetic opioids resulted in an increased mortality rate of 2,925% within this age group.
Most deaths in this study were unintentional, with just 5% attributed to suicide and 2.4% to homicide. Gaither said further research should investigate the circumstances in which these deaths occur, and if parental opioid abuse is contributing to them.
Additionally, many deaths took place outside of a medical setting, with 38% of youth dying at home. Just 10.4% of deaths occurred in inpatient settings and 24.1% in emergency departments. Gaither said this suggests these deaths likely occur suddenly and take place before emergency services can reach a child who has been exposed to opioids.
Because this study relies on data from death certificates, it is possible that some deaths are misclassified in terms of the cause and manner of death, the authors reported. Researchers also noted that this study is limited because they were not able to determine the circumstances of death, as well as whether deaths involved pharmaceutical or illicitly manufactured fentanyl. It’s possible, therefore, that the number of deaths found across the study period could be underestimated, they reported.