Summary Mirroring trends seen among adults, pediatric fentanyl deaths began to increase substantially in 2013, resulting in a more than 30-fold increase in mortality between 2013 and 2021. An increase that began in 2018 has led to a nearly 3-fold increase in deaths among older adolescents and a nearly 6-fold increase among children under 5 years of age. Across all age groups, annual deaths peaked in 2020 and 2021, suggesting that the COVID-19 pandemic exacerbated this public health crisis. |
In 2021, nearly 70,000 American adults suffered a fatal fentanyl overdose. Little is known about the extent to which the fentanyl crisis has affected the pediatric population since the opioid epidemic began nearly 25 years ago, and to our knowledge, no studies have reported on national trends in fentanyl poisonings among children. under 10 years old.
Methods
In this cross-sectional study, county-level vital statistical data from the US Centers for Disease Control and Prevention’s Wide Range Online Data for Epidemiologic Research (CDC WONDER) database were used. to identify opioid deaths between January 1, 1999 and December 31, 2021, among individuals under the age of 20 .
Consistent with previous research, deaths were examined by age category (<1, 1-4, 5-9, 10-14, and 15-19 years). Mortality rates were calculated per 100,000. International Statistical Classification of Diseases and Related Health Problems, 10th Revision, codes were used to identify the cause and manner of death.
Descriptive statistics were used to characterize deaths (per CDC WONDER policy, rates and counts of 9 deaths or less cannot be reported). Time trends were examined with Poisson regression. Analyzes were performed in SAS, version 9.4 (SAS Institute Inc) with a two-sided significance level of P < 0.05. This study was exempt from Yale School of Medicine Institutional Review Board approval due to the use of de-identified, publicly available data. This study followed the STROBE reporting guideline.
Results
Fentanyl was implicated in 5,194 of 13,861 (37.5%) fatal pediatric opioid poisonings between 1999 and 2021. Most deaths occurred among adolescents ages 15 to 19 (89.6%) and children ages 0 to 4 years (6.6%).
For all ages, 43.8% of deaths occurred at home and 87.5% were unintentional. Co-ingestion of benzodiazepines was implicated in 17.1% of deaths.
In 1999, approximately 5% of the 175 opioid deaths were from fentanyl. For 2021, 1,557 (94.0%) of 1,657 opioid deaths were attributed to fentanyl. Between 2013 and 2021, the mortality rate per 100,000 increased by 3,740.0%, from 0.05 (95% CI, 0.04-0.07) to 1.92 (95% CI, 1.82-2.01). ) (P < 0.001 for trend).
For adolescents aged 15 to 19 years , the mortality rate between 2018 and 2021 increased 289.8%, from 1.67 (95% CI, 1.49-1.84) to 6.51 (95% CI, 6 .16-6.85) (p < 0.001 for trend); among children 0 to 4 years old increased 590.0%, from 0.10 (95% CI, 0.06-0.15) to 0.69 (95% CI, 0.57-0.81) (p < 0.001 for trend). In 2021, fentanyl was responsible for the deaths of 40 infants and 93 children ages 1 to 4.
Pediatric opioid fatal poisonings stratified by fentanyl versus non-fentanyl, 1999-2021
In accordance with the reporting policies followed by the US Centers for Disease Control and Prevention Powerful Online Data for Epidemiologic Research, values that would allow retrospective calculation of 9 deaths or less (NR).
Discussion
Fentanyl is now the primary agent seen in the pediatric opioid crisis.
Mirroring trends seen among adults, pediatric fentanyl deaths began to increase substantially in 2013, resulting in a more than 30-fold increase in mortality between 2013 and 2021. A surge that began in 2018 has led to an increase a nearly 3-fold increase in deaths among older adolescents and a nearly 6-fold increase among children under 5 years of age. Across all age groups, annual deaths peaked in 2020 and 2021, suggesting that the COVID-19 pandemic exacerbated this public health crisis.
The main limitation of this research is that it relied on population-based death certificate data, including provisional data from 2021. The quality of this information depends on the accuracy and completeness of the investigations conducted at the time of death. .
The findings of this study suggest that the pediatric opioid crisis is changing in ways that will make it more difficult to combat. Common sense solutions (e.g., safe storage and disposal) are still needed to prevent pediatric exposure to opioids, but greater emphasis is needed on harm reduction strategies , including treatment of parents and adolescents. for opioid use disorder and improving access to naloxone in homes, which is where most pediatric fentanyl deaths occur.
