image: This graph shows children with Opioid Abuse/Dependence ED/YEAR. view more
Credit: AAP/Dr. Allareddy
CHICAGO - Showing the opioid epidemic knows no age limits, new research suggests more than 100 children test positive for opioid addiction or dependency each day in U.S. emergency departments.
The study abstract, "Opioid abuse in children: An emerging public health crisis," will be presented on Monday, Sept. 18, during the American Academy of Pediatrics (AAP) 2017 National Conference & Exhibition in Chicago. Researchers performed a retrospective analysis of the 2008-2013 data from the Nationwide Emergency Department (ED) Sample, the largest all-payer ED database in the United States.
They found the number of ED visits by patients age 21 and younger for any reason who were diagnosed with addiction or dependency on opioids - which include prescription painkillers as well as illicit drugs such as heroin -- rose from 32,235 in 2008 to 49,626 in 2013.
"It was very concerning to see that by the last year we studied, an average of 135 children each day were testing positive for opioid addiction or dependency in emergency departments," said Veerajalandhar Allareddy, MD, MBA, one of the abstract's authors and medical director of the pediatric intensive care unit at the University of Iowa Stead Family Children's Hospital. " In our opinion, this is a pediatric public health crisis," he said.
Allareddy said nearly one-third of the children were admitted as inpatients, regardless of cause, to the same hospital as the ED visit. Pediatric patients living in high-income households were more likely to be hospitalized rather than routinely discharged, the data show, while uninsured patients were less likely to be hospitalized.
This apparent income-based difference in the likelihood patients were to be hospitalized and potentially treated for their opioid addiction or dependency, Allareddy said, was among the many reason youth opioid addiction merits further study.
"This was intended to be an exploratory study," Allareddy said, "one that we hope will help alert the public, researchers, and policymakers of the need to fully define and address this important, emerging public health problem among children in the United States."
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Allareddy will present an abstract of the study, available below, between 5:10 and 6 p.m. in room S106 of McCormick Place West, 2301 S King Dr, Chicago.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.
Abstract Title: Opioid abuse in children: An emerging public health crisis
Introduction-Opioid abuse by adults is widely perceived as a major health hazard in the USA. National estimates of Opioid abuse by children are relatively unknown. We sought to estimate the burden of opioid dependence/abuse(OD/OA) in children who visited the emergency department (ED) for any cause in the United States. We hypothesize that there is an increasing trend of OD/OA in children who visited the ED during the study period. Methods-The Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All ED visits with diagnoses codes for Opioid dependence/abuse amongst those aged up to 21 years were selected. Demographic characteristics of this cohort were examined. Multivaraiable linear and logistic regression models were used to examine ED charges and disposition status following the ED visit. Results-During the study period, a total of 257,165 ED visits with OD/OA amongst those aged up to 21 years were made in the USA. The number of ED visits increased from 32,235 in year 2008 to 49,626 in year-2013. 88.3% of ED visits were made by those aged 18 to 21 years and 8.4% of ED visits were made by those aged 16 to 17years. Males comprised 56% of visits. Types of opioid dependence included: unspecified (N=79,787), continued (N=44,960), episodic(N=723) and in remission (N=3,948). Types of opioid abuse included: unspecified (N=111,219), continued (N=11,182), episodic(N=1,841) and in remission (N=4,913). Following an ED visit, 58.2% were discharged routinely and 31.4% were admitted as inpatients into same hospital as ED visit. All-cause mortality: 200 children died in the ED while 325 died following hospitalization. Predominant payers included Medicaid (27.1% of ED visits) and Private-insurance (41.4%). 24.8% were uninsured. About 92% of patients did not have any chronic-co-morbid condition. The mean ED charge per visit was $2,372 and the total ED charges across the entire USA during the study period was $505 million (in year-2013 $ value). The mean hospitalization charge was $25,356 and total hospitalization charges across the entire USA was $2 billion. Those with significantly higher ED charges included those diagnosed with an unspecified opioid abuse (p < 0.01), those aged 13 to 15years (p=0.04), those aged 16 to 17 years(p=0.01), females (p=0.04), those with co-morbid-conditions (p=0.03), and those residing in Western regions of USA (p < 0.01). Those aged up to 9 years (p < 0.01), those with an increasing co-morbid burden(p< 0.01), those residing in the Northeast/Midwest/Southern regions (p< 0.01), and those residing in high income households (p < 0.01) were more likely to be hospitalized as opposed to being routinely discharged from the ED. The uninsured were less likely to be hospitalized (p< 0.01). Conclusions-Opioid abuse is a major public health issue in children in United States. About 117 children test positive for opioid abuse or dependence every day across the Emergency Departments in the United States. There is an increasing trend in the use of opioids by children.