Martin Thomas C, Rocque Michael A
Department of Pediatrics, Eastern Maine Medical Center, 489 State Street, Bangor, ME 04402, USA.
Curr Drug Saf. 2011 Feb 1;6(1):12-6. doi: 10.2174/157488611794480034.
To assess the effect of recent availability (due to more home use) of methadone and buprenophine has had on the accidental and non-accidental misuse by children.
A retrospective review of all pediatric (< 18 years old) admissions for methadone or buprenorphine ingestion at Eastern Maine Medical Center (EMMC) from September 1, 1999 to August 31, 2009 was performed. Data recorded included age, sex, accidental or non-accidental ingestion, source of drug, ward or pediatric intensive care unit (PICU) admission, treatment given and length of hospital stay. Relation to pediatric emergency department (ED) visits, general pediatric ward admissions and patients on opioid maintenance treatment in the area was also assessed.
There were 22 children (12 female) admitted for methadone (10, 46%) or buprenorphine (12, 54%) ingestion, with ingestions tripling in the later five year period compared with the earlier five years. The trend was statistically significant, unrelated to pediatric ED visits or ward admissions but statistically related to number of patients on opioid maintenance treatment in the region. Of the 22 children with ingestion, six (27%) were adolescents (mean age 15.2 years) and ingestion was intentional (three suicide, three recreational) and 16 were infants or toddlers (mean age 21.6 months) whose ingestions were accidental. The drug source was family and friend (18, 82%) or unknown (four, 18%). There were six patients admitted to the ward and 16 patients (74%) admitted to the PICU. Two patients had observation only, seven had anticipatory intravenous (IV) line placement, nine patients were given IV line and naloxone (bolus + IV infusion), and four patients required endotracheal intubation, IV placement and naloxone. There were no fatalities and mean hospital stay was one to seven days, mean 2.3 days. All families were referred to family services.
Accidental and non-accidental ingestion of methadone and buprenorphine by children is increasing in proportion to increased clinical use and availability. Health providers should be aware of this increased risk and be able to provide appropriate treatment and family support.
评估近期美沙酮和丁丙诺啡可及性增加（因家庭使用增多）对儿童意外和非意外滥用情况的影响。
对1999年9月1日至2009年8月31日期间缅因州东部医疗中心（EMMC）收治的所有因摄入美沙酮或丁丙诺啡的儿科（<18岁）患者进行回顾性研究。记录的数据包括年龄、性别、意外或非意外摄入、药物来源、病房或儿科重症监护病房（PICU）收治情况、给予的治疗以及住院时间。还评估了与儿科急诊科（ED）就诊、普通儿科病房收治情况以及该地区接受阿片类药物维持治疗患者的关系。
有22名儿童（12名女性）因摄入美沙酮（10名，46%）或丁丙诺啡（12名，54%）入院，后五年的摄入量是前五年的三倍。该趋势具有统计学意义，与儿科ED就诊或病房收治情况无关，但与该地区接受阿片类药物维持治疗的患者数量具有统计学相关性。在22名摄入药物的儿童中，6名（27%）为青少年（平均年龄15.2岁），摄入为故意行为（3例自杀，3例娱乐性），16名是婴儿或幼儿（平均年龄21.6个月），摄入为意外。药物来源为家人和朋友（18名，82%）或不明（4名，18%）。6名患者入住病房，16名患者（74%）入住PICU。2名患者仅接受观察，7名患者预先放置静脉（IV）导管，9名患者给予静脉导管和纳洛酮（推注+静脉输注），4名患者需要气管插管、静脉置管和纳洛酮。无死亡病例，平均住院时间为1至7天，平均2.3天。所有家庭均被转介至家庭服务机构。
儿童意外和非意外摄入美沙酮和丁丙诺啡的情况随临床使用和可及性增加而增多。医疗服务提供者应意识到这种风险增加，并能够提供适当的治疗和家庭支持。
