Drug overdoses and poisonings are a leading cause of death among children and adolescents in the United States, according to the Centers for Disease Control and Prevention (CDC). The crisis is exacerbated by an increasingly toxic illicit drug supply, including fentanyl and other potent synthetic opioids.
Addressing the pediatric overdose crisis requires a comprehensive approach that includes education on safe storage and disposal practices and promotion of naloxone accessibility. Whether in the emergency department or outpatient settings, pediatricians play a vital role in ensuring that families are informed and equipped to prevent overdoses and poisonings.
Safe storage and disposal
Unintentional opioid ingestions and overdoses have become more prevalent than intentional ones among youth ages 5-18. For children under 5, virtually all overdoses or ingestions are categorized as unintentional.
Thus, a robust prevention strategy starts with education on the safe storage and disposal of opioids. Parents and caregivers are encouraged to keep medications “up and away,” as advocated by the CDC.
For families with older children, storing medication in a lockbox is one way to minimize access, paralleling strategies used in firearm safety.
Safe disposal of unused medications includes utilizing drug take-back programs or mail-in or disposal by flushing when listed on the Food and Drug Administration’s approved flush list.
Naloxone prescriptions
When preventive measures are not sufficient and an opioid overdose occurs, intranasal naloxone remains a critical intervention to prevent fatal outcomes. Naloxone has become increasingly accessible through over-the-counter options, standing orders and distribution programs.
Pediatricians are uniquely positioned to enhance naloxone accessibility. The AAP recommends co-prescribing naloxone with opioids for acute pain management. Many states have enacted laws requiring prescribers and pharmacists to offer naloxone alongside opioid prescriptions.
Pediatricians should screen for substance use disorders using validated tools. Even if the patient screens negative, pediatricians may consider prescribing naloxone if the patient is at risk of overdose due to a condition like suicidal ideation, intoxication or disordered eating. A history of opioid use is known in only one-third of adolescents who overdose (Tanz LJ, et al. MMWR Morb Mortal Wkly Rep. 2022;71:1576-1582).
Other hazardous agents
While opioids represent a significant concern, other potentially hazardous agents such as beta-blockers, psychotropics and common household medications like acetaminophen and iron supplements also warrant attention.
Furthermore, the legalization of cannabis has introduced additional challenges for overdose prevention, evidenced by a 1,375% increase in reports of accidental ingestions among children ages 5 and younger from 2017-’21 (Tweet MS, et al. Pediatrics. 2023;151:e2022057761).
Safe storage and disposal are applicable to a range of medications and substances, including cannabis. When exposures do occur, America’s Poison Centers (1-800-222-1222) are a key resource for families and health care providers.
Prevention strategies for pediatricians
Following are strategies pediatricians can use to prevent and mitigate pediatric overdoses.
- Educate families on safe storage and disposal. Counsel parents and caregivers on safe medication storage practices to prevent accidental ingestions, especially in households with young children. Advise families on safe disposal methods for unused medications.
- Increase naloxone accessibility. Offer naloxone prescriptions alongside opioids for acute pain management and consider naloxone for patients at risk of overdose due to other conditions. Inform families about the availability of naloxone over the counter, via pharmacy standing orders and through distribution programs.
- Screen patients for substance use disorder. Use validated screening tools to screen patients for substance use disorders, and educate patients and families about fentanyl contamination in unregulated drug supplies.
- Put help at your fingertips. Educate parents about poison control centers and consider saving the hotline (1-800-222-1222) into cell phones.
Dr. Kelly is a member of the AAP Committee on Substance Use and Prevention. Dr. Lim is a post-residency training member of the AAP Section on Emergency Medicine.
