Why Efforts to Curb Opioid Use Haven’t Translated to the Pediatric Population

Current efforts to reduce prescription opioid use in adults have not curtailed the incidence of pediatric opioid ingestions, and it is critical that clinicians continue to work to address this issue, according to a new study.

The study, recently published in Pediatrics, reviewed 4.1 million admissions to 31 different hospitals.  Of those, 3,647 patients were admitted for opioid related conditions. 

Kane

“The study was done to specifically understand the pediatric ICU (PICU) resource utilization that pediatric patients were consuming as a result of the national opioid epidemic,” says lead author Jason Kane, an associate professor of pediatrics and critical care at Comer Children's Hospital in Chicago. “Although that number may seem small, remember that all of these should be considered entirely preventable.”

Even more disturbing is that the number of children admitted to the hospital for opioid-related admissions nearly doubled between 2004 and 2015, according to Kane. Although only 12% of the 4.1 million patients reviewed required ICU care, almost half (43%) of the children with opioid exposure needed the PICU, which is the most expensive area for care in the hospital.

“These children are quite sick,” Kane says. “Just over 40% of the children admitted to the hospital for opioid ingestion require ICU care. That is extremely taxing to the medical system where there is a relative shortage of ICU beds available. Additionally, the patients who require the ICU demand high-cost technology and medications with one out of three patients needing artificial mechanical ventilation and one out of five patients required cardiovascular support with vasopressors.”

Between 2004 and 2015, there has been a 39% increase in hospital admissions for opioid overdoses and a 35% increase in the rate of ICU admissions, according to Kane. Nearly 20% of the youngest children (those less than 6 years) were admitted because of ingestion of methadone, a drug often used to treat opioid addiction in adults.  It is worth it to note that from 2000 to 2007, U.S. Drug Enforcement Agency data showed a 559% increase in prescriptions for methadone which likely represent the source of these pediatric exploratory ingestions in infants.

According to Kane, the median cost per PICU admission was just under $5,000 per patient ($4,931) and the cost of care has decreased over time which likely reflects improvements in efficiency in caring for these children as hospital length of stay has decreased. 

“It is important to note that 66.5% of the youngest children in this study were covered by Medicaid,” he says. “Thus, any reduction in state-based Medicaid payments or funding could have a profound impact on the ability for hospitals to recuperate the costs of care associated with opioid ingestions.”

These findings also point to a strain on healthcare resources, according to Kane. There are roughly 4,200 pediatric intensive care unit beds in the United States, while adults have 80,000 intensive care unit beds.

“Therefore, every time you put a youngster in a PICU bed, you’re utilizing an exceptionally restricted asset,” he says.  “What’s more, on the off chance that we fill our PICU beds with patients who have altogether preventable conditions, we won’t have the capacity to give those beds to patients who really require them for inescapable medicinal conditions.”