Buprenorphine tops list for pediatric poisoning requiring hospitalization

Although child-resistant packaging and public education efforts have helped to prevent accidental poisonings from medication, children younger than 6 years old are still at serious risk for emergency hospitalization following unsupervised ingestion of prescription drugs, according to a study published online September 15 for Pediatrics.

Researchers from the Centers for Disease Control and Prevention (CDC) and FDA undertook a study to determine the most commonly implicated active ingredients responsible for childhood poisonings that required emergency hospitalization in the hope of identifying prevention and intervention strategies.

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Using data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and IMS Health’s data of retail pharmacy prescriptions over a 5-year period from 2007-2011, the researchers estimated more than 9,000 annual hospitalizations in the United States following unsupervised ingestion of prescription drugs in children less than 6 years old. Three quarters of the hospitalized children were between 1 and 2 years of age and one-fifth had taken two or more medications.

“Opioid analgesics were implicated in a significantly higher proportion of hospitalizations (17.6%) than any other medication class. Other commonly implicated classes included benzodiazepines (10.1%), sulfonylureas (8.2%), beta-blockers (8.0%), centrally acting antiadrenergics (8.0%), and calcium channel blockers (7.8%),” the authors noted.

Buprenorphine tops list

Buprenorphine and clonidine were the most common of 12 active ingredients that were found in 45.0% of these hospitalizations. Almost all of the buprenorphine poisonings involved a combination buprenorphine/naloxone product. The hospitalization rate for buprenorphine products (13.6 per 100,000 outpatient prescriptions) in these cases was much higher than for all other commonly implicated prescription drugs except clonidine (6.0 per 100,000 outpatient prescriptions).

“Accounting for numbers of dispensed prescriptions, the hospitalization rate for buprenorphine products was 27 times higher than the rate for oxycodone products (0.5 hospitalizations per 100,000 outpatient prescriptions) and 67 times higher than the rate for hydrocodone products (0.2 hospitalizations per 100,000 outpatient prescriptions),” they wrote.

The authors concluded that targeted preventive measures should focus on medications with the highest rates of poisonings that contribute to pediatric hospitalization. They did note that in 2013, branded buprenorphine/naloxone products were transitioned to unit-dose packaging, which is a “passive approach” to help limit childhood poisonings due to unsupervised ingestion of these medications.