Last April, Dr. Sarah Kohl (Chartiers/McMurray Division) wrote that we were at the center of an epidemic:

Fact: Pennsylvania is one of the top states for deaths due to heroin overdoses. Addiction to narcotics cuts across all walks of life — moms, dads, grandparents, co-workers, teens; every person in our community is at risk.

Fact: Right now if you live in Pennsylvania you are more likely to die from a drug overdose than to be killed in a car accident. This is frightening!

Fact: We cannot arrest our way out of this crisis. It’s too big and too complex.

 

Yesterday we looked at data which clearly shows the depth of this public health crisis: 52,000 Americans died from a drug overdose in 2015. Of those, 33,091 (63%) involved a prescription opioid medication or heroin. Dr. Kohl clued us in to how addiction starts:

Most addictions start with a trip to the doctor or ER for an accident or injury. People incorrectly assume that prescription pain medicines are safe and non-addicting. When over-prescribed they become addicted. Eventually they are unable to purchase pills and move on to a cheaper source: heroin.

 

A new report just published in Pediatrics this week says that of Americans who seek health care due to pain, 20% are prescribed opioid painkillers by the treating physician. In fact, the researchers tell us that 80% of all synthetic opioid medications worldwide are prescribed in the United States:

From 1999 to 2010, opioid sales in the United States quadrupled, and in 2012, an estimated 259 million prescriptions for opioid medications were written. This rapid increase stemmed from concerns raised in the 1990s that physicians were not adequately treating patient pain. As a result, pain management guidelines were revised to favor more liberal prescribing of opioid medications.

 

It shouldn’t be surprising that the opioid epidemic has trickled down to the pediatric population with terrible health consequences. Between 2000-2015, U.S. poison control centers received nearly 190,000 calls about opioid exposure among children under 20. That averages out to almost 12,000 calls per year, 32 calls per day, one call every 45 minutes. All age groups were affected, says Robert Ferris, and 175 children died over that 16 year period:

The youngest children — groups into the ages 0-5 years in the study — typically ingested the medicines accidentally, often because the medicines were left out on a counter, improperly stored or because the child began digging through a parent’s purse or bag.

The middle group, comprised of children ages 6-12, usually ingested medicines prescribed for them in excessive doses, again by accident.

Teenagers, though, usually ingested the medicines intentionally. Attempted suicide was the most common motivation, followed by recreational use.

 

Maggie Fox reviewed the study and found that 25% of high school seniors already had occasion to experience opioids — medically from prescriptions, and, more commonly, non-medically as a result of experimentation, abuse, or an attempt to commit suicide. Only in the latter case is poisoning intentional:

“Unintentional poisonings are now the leading cause of injury-related mortality in the United States. Among teenagers aged 15 to 19 years, there was a 91 percent increase in fatal poisoning from 2000 to 2009, which was mostly attributable to an increase in prescription drug overdoses,” the team wrote.

With 22 percent of teens suffering from a mental health disorder severe enough to cause impairment or distress, it’s a problem, the team pointed out.

 

For very young children (0-5 years), accidental ingestion of buprenorphine (a drug like methadone, used to treat opioid addiction) was a significant source of opioid poisoning and serves as a reminder for adults to keep all medicines out of sight, out of reach, and locked away from everyone — infants, children, teenagers, other adults.

 

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