University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, 13123 E 16th Ave B251, Aurora, CO 80045, United States; Rocky Mountain Poison and Drug Safety, Denver Health Hospital Authority, 777 Bannock St MC 0180, Denver, CO 80204, United States.
Rocky Mountain Poison and Drug Safety, Denver Health Hospital Authority, 777 Bannock St MC 0180, Denver, CO 80204, United States.
Drug Alcohol Depend. 2020 Jun 1;211:107924. doi: 10.1016/j.drugalcdep.2020.107924. Epub 2020 Mar 13.
Our objective was to describe trends and deaths in young children associated with opioid analgesics.
Analysis of pediatric exposures using the RADARS System Poison Center Program from July 1, 2010 through December 31, 2018. Cases involving a child < 6 years, with an exposure to one or more opioids: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tramadol. Poisson regression was used to model the shape of the time response curve.
48,560 cases were identified, median age 2 years (IQR 1.4, 2.0), 52.4 % male. The most commonly involved opioid was hydrocodone (32.5 %); buprenorphine and methadone had the highest exposure rates when adjusted for dispensed prescriptions (0.84 and 0.73 per 10,000 prescriptions). There were 28 deaths, methadone being the most commonly involved opioid (16). Exposures decreased significantly accounting for population (from 8.39 to 4.19 exposures per 100,000 children) and per prescription (from 0.33 to 0.25 exposures per 10,000 prescriptions). After adjustment for prescriptions, the exposure rate for hydromorphone and fentanyl increased over the study period, while buprenorphine had the greatest decrease in exposure rate. Among 28 deaths, 11 (39 %) were known or suspected to have been exposed, but medical care was not sought or was delayed.
Pediatric opioid exposure rates by prescription and population decreased from July 2010 through December 2018. However, with over 48,000 exposures and 28 deaths, the opioid epidemic continues to impact young children. Many exposures including deaths were preventable. Continued improvements in prevention require a multifaceted approach.
我们的目的是描述与阿片类镇痛药相关的幼儿趋势和死亡情况。
使用 RADARS 系统毒理中心计划，对 2010 年 7 月 1 日至 2018 年 12 月 31 日期间的儿科暴露情况进行分析。病例涉及年龄<6 岁的儿童，接触一种或多种阿片类药物：丁丙诺啡、芬太尼、氢可酮、氢吗啡酮、美沙酮、吗啡、羟考酮、羟吗啡酮和曲马多。采用泊松回归对时间响应曲线的形状进行建模。
共确定了 48560 例病例，中位年龄为 2 岁（IQR 1.4，2.0），男性占 52.4%。最常涉及的阿片类药物是氢可酮（32.5%）；丁丙诺啡和美沙酮的处方调整后暴露率最高（每 10000 张处方 0.84 和 0.73 张）。有 28 例死亡，美沙酮是最常涉及的阿片类药物（16 例）。暴露率显著下降，占人口（从每 100000 名儿童 8.39 次暴露降至 4.19 次）和每处方（从每 10000 张处方 0.33 次暴露降至 0.25 次）。调整处方后，氢吗啡酮和芬太尼的暴露率在研究期间有所增加，而丁丙诺啡的暴露率下降最大。在 28 例死亡中，有 11 例（39%）已知或疑似暴露，但未寻求或延迟医疗。
从 2010 年 7 月至 2018 年 12 月，按处方和人口计算的儿科阿片类药物暴露率有所下降。然而，有超过 48000 例暴露和 28 例死亡，阿片类药物流行仍在影响幼儿。许多暴露包括死亡都是可以预防的。要继续改进预防措施，需要采取多方面的方法。
