Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Buprenorphine Exposures Among Children and Adolescents Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH What is the background for this study?

Response: Buprenorphine is a prescription opioid medication commonly used to treat opioid use disorder. From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000. Although buprenorphine is important for the treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes. What are the main findings? 

Response: From January 2007 through December 2016, there were more than 11,000 calls to US poison control centers for pediatric exposures to buprenorphine. The exposure rate per 1,000,000 children fluctuated during the study period, starting at 6.4 in 2007 and arriving at 12.6 in 2016 after peaking at 20.2 in 2010. Most (86%) of the exposures were among children younger than 6 years old. Most (98%) buprenorphine exposures among younger children were unintentional. Nearly half (45%) of the exposures resulted in the child being admitted to a healthcare facility and 21% resulted in serious medical outcomes, including 11 deaths. The most common symptoms for buprenorphine alone were drowsiness/lethargy (47%) and vomiting (17%).

While most buprenorphine exposures among younger children were unintentional, 77% of exposures among teenagers (age 13-19 years) were intentional and 28% involved more than one substance. More than one-fifth of teen exposures resulted in being admitted to a healthcare facility, and 22% experienced a serious medical outcome, including 4 deaths. There were 150 suspected teen suicide attempts, 59% of which involved at least one other drug. What should readers take away from your report?

Response: Safe storage of all opioids, including buprenorphine, is crucial. Parents and caregivers who use buprenorphine need to store it safely: up, away, and out of sight – in a locked cabinet is best.

Physicians should inform patients and their families about the dangers of buprenorphine exposure and about safe storage and disposal of all opioids, including buprenorphine. Physicians can request that their prescriptions for buprenorphine be dispensed in unit-dose packaging.

Teenagers should receive information regarding the risks of substance abuse and misuse. Suspected suicide accounted for 12% of teen exposures, highlighting the need for access to mental health services for this age group.

Drug manufacturers should use unit-dose packaging for all buprenorphine products to help prevent unintentional access and exposure by young children. What recommendations do you have for future research as a result of this work?

Response: Researchers should continue to monitor calls to poison control centers regarding pediatric exposures to buprenorphine. Evaluation of prevention strategies to reduce pediatric exposures is an area of future research.

Disclosures- I have no financial relationships or potential conflicts of interest relevant to this article to disclose.


Buprenorphine Exposures Among Children and Adolescents Reported to US Poison Control Centers
Sara Post, Henry A. Spiller, Marcel J. Casavant, Thitphalak Chounthirath, Gary A. Smith
Pediatrics June 2018 From the American Academy of Pediatrics

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Last Updated on June 27, 2018 by Marie Benz MD FAAD