Divisions of Emergency Medicine, and
Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-2887. Epub 2017 Feb 20.
Over the past 20 years, the prescribing of opioids has increased dramatically in North America, with parallel increases in opioid addiction, overdose, and associated deaths. We examined whether young children of women prescribed opioids were at increased risk of opioid overdose.
We conducted a population-based, nested case control study in Ontario, Canada, between 2002 and 2015. We identified children aged ≤10 years, whose mothers received publicly funded prescriptions for an opioid or a nonsteroidal antiinflammatory drug (comparator analgesic) in the preceding year. Cases were children who presented to hospital for or died of opioid overdose. Each case was matched with 4 controls with no opioid overdose. The primary outcome was the risk of opioid overdose.
We identified 103 children who presented to the hospital with opioid overdose and matched them with 412 controls. Half of the children with opioid overdose were <2 years old. Compared with controls, children with an opioid overdose were far more likely to have a mother who received a prescription opioid (unadjusted odds ratio, 2.41; 95% confidence interval, 1.68-3.45) and who was prescribed antidepressants. The most commonly implicated overdose opioids were codeine (53.4%), oxycodone (32.0%), and methadone (15.5%).
Young children of mothers prescribed opioids are at a markedly increased risk of overdose. Physicians, pharmacists, and parents should take measures to mitigate the risk of opioid-related harm to children, such as prescribing smaller quantities, emphasizing the importance of secure medication storage, and the prompt disposal of unused opioids.
在过去的 20 年中，北美地区阿片类药物的处方量大幅增加，同时阿片类药物成瘾、过量用药和相关死亡人数也相应增加。我们研究了接受阿片类药物处方的女性的年幼子女是否有更高的阿片类药物过量风险。
我们在加拿大安大略省进行了一项基于人群的嵌套病例对照研究，时间范围为 2002 年至 2015 年。我们确定了年龄≤10 岁的儿童，其母亲在过去一年中接受了公共资金支付的阿片类药物或非甾体抗炎药（对照性镇痛药）处方。病例为因阿片类药物过量而到医院就诊或死亡的儿童。每个病例都与没有阿片类药物过量的 4 名对照者相匹配。主要结局是阿片类药物过量的风险。
我们共确定了 103 名因阿片类药物过量到医院就诊的儿童，并与 412 名对照者进行了匹配。一半的阿片类药物过量儿童年龄<2 岁。与对照组相比，阿片类药物过量的儿童的母亲更有可能接受阿片类药物处方（未调整的优势比，2.41；95%置信区间，1.68-3.45），且更有可能接受抗抑郁药物处方。最常见的阿片类药物过量药物为可待因（53.4%）、羟考酮（32.0%）和美沙酮（15.5%）。
接受阿片类药物处方的母亲的年幼子女发生药物过量的风险显著增加。医生、药剂师和家长应采取措施，降低儿童因阿片类药物相关伤害的风险，如开具较小剂量的药物、强调安全储存药物的重要性以及及时处理未使用的阿片类药物。
