CATES: Opioid poisonings in children increasing

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

Almost every nurse I know who has worked in the Emergency Department for a few years, has had a situation with a patient that has made it very hard emotionally for them to care for similar patients. For most of those people, myself included, it’s a pediatric death.

Some of them are accidents, some of them are abuse or neglect, and some are illnesses. With rare exception, they are all things that could have been prevented. That is why a study published this week by the Children’s Hospital of Philadelphia (CHOP) about opioid poisonings really caught my attention.

Researchers at CHOP found the US rate of fatalities in kids under age 5 from opioid poisoning has doubled since 2005. Opioid poisonings cause more than half of the poisoning deaths in kids under age 5. I hope those statistics distress you as much as they do me. Opioid poisonings, especially in kids under age 5, can be prevented and we need to do everything we can to turn these statistics around.

Opioids include both legally and illegally obtained prescription drugs like oxycontin, hydrocodone, codeine, morphine, meperidine, hydromorphone, and fentanyl and street drugs like heroin. The major cause of death from opioids is respiratory depression.

Normally, the brain senses the amount of carbon dioxide and oxygen in the blood and triggers breathing based on those levels. That is why we normally breathe faster with exercise. Our use of oxygen increases, so those levels go down, and muscle cells working harder increases the carbon dioxide waste products in our blood. The brain senses those things and tells our lungs to increase our respiratory rate and depth, which gets rid of more carbon dioxide and brings in more oxygen. Conversely, we tend to breathe slower as we sleep because we aren’t using as much energy, and the brain senses that we make less carbon dioxide and need less oxygen, so it slows our breathing.

In an opioid poisoning, the brain stops sending those signals to breathe to the lungs to a point where breathing is either very, very slow or stops altogether. That means carbon dioxide levels increase and oxygen levels decrease to a point where cells, especially in the brain, which is very oxygen hungry, start to die. According to the National Institutes of Health (NIH), irreversible brain damage can happen when a person’s brain has been without oxygen for as little as 4-5 minutes. Death depends on the person, but usually occurs within 20 minutes without oxygen.

In this study, researchers found between 2005 and 2018, there were 731 poisoning deaths in kids under age 5 in the US. 40% of those were in kids under age 1, and 65% of them occurred in the home. 1/3 of the deaths happened when someone other than a parent was supervising the child. In 2005 opioids accounted for 24.1% of poisoning deaths, but by 2018, they accounted for 52.5%.

The statistics for Texas aren’t any better than the U.S. statistics. According to the Texas Department of State Health Services (TX DSHS), in 2020, the most recent year Texas has published data, 25 kids under 17 died related to opioid poisonings. In the 10 years before that, the highest number I could find was in 2014 at 22. Most years were less than 15. The statistics by county, unfortunately were not broken down by age, but 15 people died in Ector County in 2020 related to opioid poisoning, and statistically its likely some of those were kids.

As I was looking at the TX DSHS graphs on opioid poisonings one thing really struck me. In every single graph, from the overalls to the break downs by age, race, and sex is the last 10 years have shown a very sharp increase in opioid poisonings in every category. Experts believe this increase is related to the upsurge in fentanyl abuse in the last decade.

That is why prevention is so very important. If you have opioids in your home, keep them out of reach of children, many experts are recommending they be kept under lock and key. Make sure all medicines are out of reach and stored in child resistant packaging if you have children in your home. Teach kids that medicines can be dangerous if not taken under adult supervision. Finally, speak to your children about recreational drug use and the dangers that behavior can pose to both their physical and mental well-being. Unfortunately, that is a conversation that now needs to happen in kids in elementary school—junior high and high school are too late.

It is only with a concerted effort of prevention by all of us that we can stop these deaths from happening, and the lives of these children are far too important for us not to make that effort.