New research demonstrates the dangers of having powerful opioids such as fentanyl around children and adolescents. National Poison Data System reports show that many are ingesting the drugs unintentionally, but particularly concerning is a rise in the proportion of suspected suicides.

Among children, the proportion of opioid poisonings resulting in admission to a hospital critical care unit has increased since 2005, according to an analysis by Emory and Children’s Healthcare of Atlanta doctors.

Megan Land, MD, Jocelyn Grunwell, MD, PhD and colleagues in the Division of Critical Care in the Department of Pediatrics conducted the research, which is published in the journal Clinical Toxicology.

In a December 20 broadcast, critical care fellow Land told NPR’s Rhitu Chatterjee about her encounter with a child with severe respiratory distress as a result of consuming a fentanyl patch. Grunwell has previous experience studying pediatric intensive care admissions procedures and poisonings.

The good news is: the number of pediatric opioid poisoning incidents reported overall has declined. But the proportion of intensive care unit admissions rose from 6.6 percent (5,203 out of 80,141) in 2005-2009 to 9.6 percent (4,586 out of 48,435) in 2015-2018. The proportion of admissions to a psychiatric care facility also increased (3.6 percent to 8.2 percent). During the same time periods, the proportion of reports connected with suspected suicide increased from 14.0 to 21.2 percent, even as the proportion attributed to “misuse or abuse” has fallen from 13.7 to 9.4 percent.

“A trend in the proportion of severe admissions for acute opioid poisonings, especially following attempted suicide, has increased despite efforts to limit and monitor access to prescription opioids,” the doctors conclude. “Efforts focused on addressing adolescent suicide and mental health are needed to reduce the serious consequences of opioid poisoning in the pediatric population.”

The doctors analyzed data from the National Poison Data System, which collects information from the 55 poison control centers in the United States. Children under 19 with a primary opioid ingestion between 2005 and 2018 were included in the analysis. Over half of the pediatric opioid poisoning reports care are considered unintentional; about half affect children under the age of 5.

Fentanyl, heroin and methadone were the drugs most associated with having a PICU procedure, such as mechanical ventilation. Most children admitted to critical care for opioid poisoning did not require invasive procedures – about 40 percent received the antidote naloxone.