Study reveals sources of opioid poisoning among children

A dog’s pain medication, a grandparent’s pill organizer, even a discarded tissue: Rutgers Health research reveals they’re all potential sources of opioid poisoning for young children.

Researchers at the New Jersey Poison Control Center examined 230 cases of opioid exposure in children ages 1 month to 6 years over a five-year period. Their findings in the Journal of Pediatrics show how children access these dangerous drugs.

“We’re seeing this in our clinical practice,” said Diane Calello, the medical director of the poison control center and senior author of the study. “I’ve seen too many kids in my practice at University Hospital who have gotten severely poisoned because they got opioids in their house.”

An overwhelming majority of exposures (97%) were unintentional. More than 91% occurred in the child’s home, and 84.3% resulted in the child being admitted to a health care facility.

While many cases involved a child accessing a parent’s medication, the study uncovered several unexpected sources of exposure. Grandparents’ medications were implicated in 17.4% of cases, highlighting what the researchers described as an often-overlooked risk factor: exposure to older adults who may not be as vigilant as parents about securing their medications.

Another significant risk came from pet medications, which were involved in 4.3% of cases. Children sometimes accessed these opioids directly and sometimes accessed pet medication that had been mixed with food, such as peanut butter, and then left out.

Children ages 2 and under accounted for 80% of all exposures. Kids in this age group face particularly high risk because of their exploratory behavior and inability to distinguish between safe and dangerous substances.

The study drew data from reports to the New Jersey Poison Control Center between January 2018 and December 2022. Researchers manually extracted and analyzed information from the center’s database, focusing on single opioid exposures in young children.

While prescription opioid pills were the most common source of danger, the study uncovered other scenarios. Children accessed used fentanyl patches, illicit drug paraphernalia and even opioid residue left on discarded items such as tissue paper and cotton balls.

The study highlights the importance of proper medication storage and disposal, Calello said.

“One opioid pill could actually kill a 2-year-old,” she said. “And yet, a parent who may take that opioid pill every day may not realize that even though it’s very familiar to them, it is deadly.”

The study authors said there is a need for more comprehensive education about the dangers of opioids in the home. Calello suggested it should include grandparents and anyone who might bring medications into a home where children are present.

One potential solution is increasing access for parents and caregivers to naloxone, a medication that can reverse opioid overdoses, Calello said.

“I’ve seen several cases of young children where I thought that if this mom or dad had naloxone with them, they could have given it, and this child may have had a better outcome,” she said.

Looking forward, the study team is preparing to publish data on how children nationwide are exposed to opioids. Those figures show more pediatric exposures to illicit opioids and medications for treating opioid addiction.

Calello added that she hopes to study the effects of distributing naloxone more widely to parents.

“That would be a good next step,” she said. “It could make a big difference.”