Published: Jun 3, 2013 | Updated: Jun 3, 2013

By Nancy Walsh , Staff Writer, MedPage Today

Action Points

• Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly among children 0 to 5 years old.
• Rates of emergency department visits were highest for events related to hypoglycemics and beta-blockers, whereas serious injuries and hospitalizations occurred most frequently with opioids and hypoglycemics.

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Adult prescription drugs in the home pose a significant risk of poisoning and causing serious injury to children, a review of national data found.

Of all prescription drug ingestions that resulted in a visit to the emergency department (ED), the most common were oral anti-diabetes medications, at 60.3%, and beta-blockers, at 59.6%, according to Lindsey C. Burghardt, MD, of Children’s Hospital Boston, and colleagues.

In addition, 26.3% of exposures to opioids resulted in serious injury, as did 19.5% of ingestions of hypoglycemics, the researchers reported online in Pediatrics.

Despite the introduction of child-proof caps on medicine bottles and other protective efforts, at least 70,000 U.S. children are seen in the ED each year for suspected poisoning — and the numbers are rising along with the increase in prescription drug use among adults.

To determine the scope of the problem and to see whether pediatric poisoning and adult prescription drug use correlated, Burghardt and colleagues analyzed data from the National Poison Data System and the National Center for Health Statistics for the years 2000 through 2009.

Children were grouped according to age: 5 and younger, 6 to 12, and 13 to 19, and the analysis was limited to four common drug classes.

During the 10-year study, there were 62,416 pediatric exposures to opioids, 49,075 to beta-blockers, 39,693 to lipid-lowering medications, and 38,485 to oral hypoglycemics, with all classes showing increases over time (P<0.001).

For instance, among children younger than 5, ingestions of opioids significantly increased each month by 0.09 per million, while for teens 13 to 19, the monthly increase was 0.04 per million.

There also were apparent associations between medication use among adults and childhood poisonings.

For each 1% increase in the number of adults with prescriptions for opioids, there were corresponding significant increases of 1.53 poisonings per million children under age 5 and 0.74 per million children ages 13 to 19.

Similar patterns were seen for each 1% increase in adult prescriptions for hypoglycemics, beta-blockers, and lipid-lowering drugs across all age groups, the researchers found.

The increases in poisonings were most apparent in the month after the prescription was given or renewed, and particularly in the youngest children, when these significant increases per million children occurred:

• Hypoglycemics — 0.49
• Lipid-lowering agents — 0.46
• Beta-blockers — 0.68
• Opioids — 1.86

The researchers then performed a Granger analysis, which is a statistical technique that can suggest causality of an exposure and an event over time, and found positive associations in more than half of the possible age group-exposure combinations.

For example, the Granger analysis affirmed causality for adult opioid prescriptions or renewals in children 5 and under (F=2.20, P<0.05), among those 6 to 12 (F=6.42, P<0.001), and those ages 13 to 19 (F=4.31, P<0.001).

A total of 17.5% of cases resulted in serious injury, the researchers reported. Rates of serious injury were 19.5% for hypoglycemics, 9.8% for beta-blockers, and 8.8% for lipid-lowering agents.

Serious injuries also were most common among older children, ranging from 29.5% after ingestion of lipid-lowering drugs to 40.5% with opioids.

More than one-third of children seen in the ED for drug poisoning were admitted to the hospital, with admission being most common after exposure to hypoglycemics (49.4%) and opioids (35%).

“Increasing rates of adult drug prescriptions are strongly associated with increases in drug exposures and poisonings among children and appear to be a direct cause of exposures and poisonings,” Burghardt and colleagues wrote.

“Our work suggests that even though these programs may be effective, child exposures and poisonings continue to be a significant and increasing problem, and interventions need to take into account the increases in adult prescriptions available to children,” they observed.

Moreover, “the rise in deaths and healthcare use related to opioid diversion has been paralleled by a 300% increase in the sales of opioids since 1999,” they wrote.

Limitations of the study included its reliance on patient and parent reports of ingestion to the national poison center and its exclusion of combination medications, which may have resulted in underestimated numbers.