Characteristics of the Confirmed Opioid-Related Adverse Events
| . | Age, y . | |||
|---|---|---|---|---|
| 2–5, n = 56 . | 6–11, n = 71 . | 12–17, n = 310 . | All Ages, n = 437 . | |
| Category of case, n (%) | ||||
| Probable, with symptoms | 33 (58.9) | 49 (69.0) | 190 (61.3) | 272 (62.2) |
| Probable, with intervention | 6 (10.7) | 0 (0.0) | 21 (6.8) | 27 (6.2) |
| Possible | 17 (30.4) | 22 (31.0) | 99 (31.9) | 138 (31.6) |
| Severity of outcome, n (%) | ||||
| Death | 1 (1.8) | 1 (1.4) | 1 (0.3) | 3 (0.7) |
| Hospitalization or opioid-related intervention and/or care escalation | 6 (10.7) | 5 (7.0) | 71 (22.9) | 82 (18.8) |
| ED visit onlya | 49 (87.5) | 65 (91.6) | 238 (76.7) | 352 (80.6) |
| Source of opioid,b n (%) | ||||
| Patient’s prescription | 54 (96.4) | 69 (97.2) | 264 (85.2) | 387 (88.6) |
| Other source | 2 (3.6) | 1 (1.4) | 10 (3.2) | 13 (3.0) |
| Source not indicatedc | 0 | 1 (1.4) | 36 (11.6) | 37 (8.5) |
| Circumstances of opioid use related to the adverse event,d n (%) | ||||
| Therapeutic use | 45 (80.4) | 67 (94.4) | 199 (64.2) | 311 (71.2) |
| Unintentional overdose | 9 (16.1) | 3 (4.2) | 19 (6.1) | 31 (7.1) |
| Abusee | 0 | 0 | 36 (11.6) | 36 (8.2) |
| Self-harm | 0 | 0 | 35 (11.3) | 35 (8.0) |
| Circumstances not indicated | 2 (3.6) | 1 (1.4) | 21 (6.8) | 24 (5.5) |
| Primary symptoms and/or signs of opioid toxicity,f n (%) | ||||
| Gastrointestinal | 19 (33.9) | 23 (32.4) | 92 (29.7) | 134 (30.7) |
| Neuropsychiatric | 13 (23.2) | 13 (18.3) | 94 (30.3) | 120 (27.5) |
| Dermatologic | 15 (26.8) | 21 (29.6) | 66 (21.3) | 102 (23.3) |
| CNS depression | 9 (16.1) | 7 (9.9) | 81 (26.1) | 97 (22.2) |
| Allergic | 10 (17.9) | 19 (26.8) | 48 (15.5) | 77 (17.6) |
| Respiratory depression | 1 (1.8) | 0 | 11 (3.6) | 12 (2.8) |
| Other | 0 | 5 (7.0) | 10 (3.2) | 15 (3.4) |
| . | Age, y . | |||
|---|---|---|---|---|
| 2–5, n = 56 . | 6–11, n = 71 . | 12–17, n = 310 . | All Ages, n = 437 . | |
| Category of case, n (%) | ||||
| Probable, with symptoms | 33 (58.9) | 49 (69.0) | 190 (61.3) | 272 (62.2) |
| Probable, with intervention | 6 (10.7) | 0 (0.0) | 21 (6.8) | 27 (6.2) |
| Possible | 17 (30.4) | 22 (31.0) | 99 (31.9) | 138 (31.6) |
| Severity of outcome, n (%) | ||||
| Death | 1 (1.8) | 1 (1.4) | 1 (0.3) | 3 (0.7) |
| Hospitalization or opioid-related intervention and/or care escalation | 6 (10.7) | 5 (7.0) | 71 (22.9) | 82 (18.8) |
| ED visit onlya | 49 (87.5) | 65 (91.6) | 238 (76.7) | 352 (80.6) |
| Source of opioid,b n (%) | ||||
| Patient’s prescription | 54 (96.4) | 69 (97.2) | 264 (85.2) | 387 (88.6) |
| Other source | 2 (3.6) | 1 (1.4) | 10 (3.2) | 13 (3.0) |
| Source not indicatedc | 0 | 1 (1.4) | 36 (11.6) | 37 (8.5) |
| Circumstances of opioid use related to the adverse event,d n (%) | ||||
| Therapeutic use | 45 (80.4) | 67 (94.4) | 199 (64.2) | 311 (71.2) |
| Unintentional overdose | 9 (16.1) | 3 (4.2) | 19 (6.1) | 31 (7.1) |
| Abusee | 0 | 0 | 36 (11.6) | 36 (8.2) |
| Self-harm | 0 | 0 | 35 (11.3) | 35 (8.0) |
| Circumstances not indicated | 2 (3.6) | 1 (1.4) | 21 (6.8) | 24 (5.5) |
| Primary symptoms and/or signs of opioid toxicity,f n (%) | ||||
| Gastrointestinal | 19 (33.9) | 23 (32.4) | 92 (29.7) | 134 (30.7) |
| Neuropsychiatric | 13 (23.2) | 13 (18.3) | 94 (30.3) | 120 (27.5) |
| Dermatologic | 15 (26.8) | 21 (29.6) | 66 (21.3) | 102 (23.3) |
| CNS depression | 9 (16.1) | 7 (9.9) | 81 (26.1) | 97 (22.2) |
| Allergic | 10 (17.9) | 19 (26.8) | 48 (15.5) | 77 (17.6) |
| Respiratory depression | 1 (1.8) | 0 | 11 (3.6) | 12 (2.8) |
| Other | 0 | 5 (7.0) | 10 (3.2) | 15 (3.4) |
These are confirmed cases from 1999 to 2011.
In 337 patients, symptoms associated with opioid toxicity were determined to be the main reason for the ED visit. In 15 patients, there was another reason for the visit, but opioid toxicity was part of the encounter.
The categories were mutually exclusive.
Medical records did not indicate the source; however, all these patients filled prescriptions for opioids.
The categories were mutually exclusive, on the basis of the following hierarchy: self-harm was greater than abuse, which was greater than unintentional overdose, which was greater than therapeutic use.
Records with signs and/or symptoms of abuse and/or opioid withdrawal.
Symptoms and signs were not mutually exclusive. See Supplemental Section 5 for lists of specific symptoms.