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Fatal opioid poisoning in children skyrockets
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Fatal opioid poisoning in children skyrockets

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Shivani Modi, PharmD

Young child crawling on floor and putting pills in mouth.

Opioid poisoning is the leading cause of fatal poisoning in young children, according to new research published March 8, 2023, in Pediatrics.

Researchers wanted to investigate and understand the factors that contribute to fatal poisoning in the pediatric population. Using data from the National Fatality Review Case Reporting System, the research team analyzed factors related to poisoning among children ages 5 years and younger from 2005 to 2018.

During the study period, 731 poisoning-related cases were reported in children. Among all the cases reported, over three-fifths of poisoning fatalities occurred in a child’s home and approximately one-third occurred while they were supervised by an adult other than a biological parent. In 2018, researchers found that opioid poisonings accounted for over half of all poisoning fatalities in children.

Overall, opioid poisoning-related death rates have increased from 24% in 2005 to 52% in 2018, according to the findings.

These children were exposed to illicit opioids such as heroin and fentanyl as well as opioids used in medication-assisted treatments like methadone and buprenorphine.

Researchers found that OTC pain, cold, and allergy medications also contributed greatly to deaths in this population. They found that 74% of poisoning-related fatalities for children 2 years and younger were due to OTC pain medications. In the pediatric population, poisoning prevention is critical.

Parents and caregivers must take appropriate measures such as using correct dosing and administration to prevent adverse outcomes.


In addition to appropriate labeling on OTC medications, pharmacists and clinicians can help by counseling parents and caregivers on correct dosing and techniques to administer OTC medications to children.

Pharmacists can counsel parents and caregivers on home safety, including storing medications in the original container and/or cabinets, off-label use of OTC medications, and the importance of using age-appropriate and weight-based dosing that can prevent fatal poisoning.

Pharmacists should be trained to recognize opioid overdose symptoms, such as altered mental status or respiratory depression, and indications for the use of naloxone. Pharmacists should also have strategies in place to mitigate such complex situations and identify early signs to provide comprehensive education to parents and caregivers.

Preventing fatal opioid poisoning requires that pharmacists and other health care professionals ensure the safety of patients through counseling and education about the dangers of opioids.

In addition, pharmacists should offer community interventions and resources if parents and caregivers demonstrate a lack of understanding due to contributing social determinants of health.


Findings from the study are in line with previous studies that demonstrate increased rates of pediatric deaths related to opioid poisoning.

Earlier studies showed opioids, antihistamines, and sympathomimetics as common agents that contributed to fatal opioid poisoning in children. Authors of the study also note that policymakers and programmatic initiatives should focus on the types of opioids circulating during the ongoing epidemic as it relates to children living with adults.

In this study, researchers emphasize that despite the precautions and measures taken by the regulatory agencies to have improved labeling on OTC products as well as unit dose packaging to reduce fatal opioid poisoning, this does not include all medications such as prescription drugs and opioids. They said that further interventions need to be put in place to reduce poisoning in the pediatric population, and strategies should be developed to educate all health care professionals as well as parents and caregivers.

“A subset of our study population demonstrated factors associated with child abuse, including history of previous maltreatment, illness or disability, or sibling placement,” the authors wrote. “Other familial and community factors, including substance use disorder, poverty, and social inequities, have been identified as associated factors. Further research is needed to elucidate the role of these social factors in fatal poisoning to inform individual- and community-level safety interventions.”



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