Prescription opiates and kids: One pill can kill 10-21-08

Nine-month-old Shayla Davidson was a sick little girl, and her mother had no idea why.

Pale, listless and barely breathing, the baby wouldn’t wake up one day last month, even when 25-year-old Nicolle Jones rushed her to an emergency room near Cincinnati.

Medical crews were stumped, too, until they noted that Shayla’s pupils were constricted, a tell-tale sign of opiate poisoning.
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“They kept asking me, ‘Did she get a hold of any medicine?’” Jones recalled. “I said, ‘No.’”

In fact, Shayla had ingested medication, a single 60-milligram tablet of oxycontin, a powerful prescription painkiller.

But pediatric specialists at the Cincinnati Children’s Hospital and Medical Center wouldn’t know that until later, after they’d treated the child five times with a strong antidote and performed tests that linked Shayla’s life-threatening condition to the common drug her grandfather takes for back pain.

“I about fell on the floor when they told me,” said Jones, who lives with her parents in nearby Independence, Ky. “My dad keeps his medicines up high. We’re thinking he dropped it.”

Shayla’s fine now, but she’s also lucky, according to a recently released report from the nation’s poison control centers. It shows a rising tide of prescription drug use is threatening unintended users: young children who accidentally ingest the powerful painkillers.

Some 9,179 toddlers and kids under age 6 were exposed to widely prescribed drugs such as hydrocodone, oxycodone and methadone between January 2003 and June 2006, according to a report published online in September in the Annals of Emergency Medicine.

Exposures ranged from a pill snatched quickly from a kid's mouth to actual ingestion, said Dr. Richard C. Dart, medical director for the Rocky Mountain Poison and Drug Center in Denver, and a co-author of the report.

'One pill is enough'
Eight children died, 43 suffered life-threatening injuries or serious disabilities and 214 required prolonged medical treatment, all because they mistakenly took strong medications belonging to their parents, grandparents and other adults.

“For opioids, really, one pill is enough,” said Dart. “One pill can kill or at least cause major effects.”

Young kids at risk for poisoning

More than 9,000 children under age 6 were exposed to powerful prescription painkillers between 2003 and 2006, the nation's poison control centers reported. The average age of kids affected was 2 and nearly all of the events occurred at home.

Here's how to protect your young children from accidental injury:
— Keep drugs in a locked cabinet. Keeping medications up high is a good start, but that won't completely deter curious kids. A locked cabinet is the safest solution.
— Keep track of your medications. One dropped pill can kill or seriously injure a young child. Count your pills so that you know if any are missing.
— Childproof packages aren't. Never rely on packaging to keep kids safe. Even the best deterrents can be overcome by a determined child.
— Never leave medications, vitamins or other products in the open. Young children may try to imitate adults.
— When guests visit, put purses, suitcases, jackets and bags away. Visitors may forget they've got medications with them and kids may be attracted by the lure of grandma's purse.
— Store drugs in their original containers.
— Discard unused medications. Don't keep them around after an illness or injury.
— Seek help immediately. The symptoms of opiate poisoning include shallow breathing, clammy skin, constricted pupils, convulsion and coma. If young children exhibit these signs, even if you don't know they've ingested medication, seek emergency medical help.
The incidents represent a surge in injuries and near-misses that have made prescription drugs a top cause of child poisonings, second only to carbon monoxide poisoning, said Dart. The study, which used data from the Researched Abuse, Diversion and Addiction-Related Surveillance — RADARS — system, probably underestimates the extent of the problem, he added, because not all poison control centers participated and not all exposures are reported.

“Conservatively, you can say the number is twice that high and probably higher than that,” Dart said. “I knew we would find something, but I was stunned.”

The accidents have been fueled by skyrocketing rates of legal and illegal prescription painkiller use. There were 119 million prescriptions written for hydrocodone in the United States in 2007, up from 112 million in 2006, according to figures from IMS Health, a healthcare information and consulting company. Prescriptions for variations of oxycodone topped 38 million, up from 34 million a year earlier.

At the same time, about 5.2 million people aged 12 and older used prescription pain relievers for non-medical purposes in 2007, latest figures from the federal Office of Applied Studies showed.

Overall, deaths caused by unintentional drug poisonings spiked by nearly 70 percent between 1999 and 2004, according to a report last year from the federal Centers for Disease Control and Prevention, which attributed most of the increase to overdoses of prescription painkillers.

“I think what we’ve noticed over the years is that as the prescription opiate pain reliever base goes up — legitimately and illegitimately — more kids are getting into these pills,” said Dr. Randall Bond, medical director for the Cincinnati Drug and Poison Information Center.

Other drugs, such as heart medications, certain antidepressants and anti-malaria drugs are equally dangerous, Bond added. But they're not nearly as common as the potent pain relievers.

Not necessarily neglect
About half of the opiate exposures occurred in what Dart described as “complicated” households, those with many adults living together or with histories of drug use or child neglect. The rest occurred in “competent” families with no signs of neglect or abuse, he added.

“For good families, if you have patient opioids in the household, you’d be surprised how fast a kid can get a hold of these,” Dart said.

Some of the children in the report drank liquid methadone stored in refrigerators. Others encountered dropped drugs while crawling or toddling, and still others got into a grandparent’s purse or suitcase and found untended bottles of pills.

“Those caps are only child-resistant,” Dart said. “They just slow down a child.”

Once a child ingests a strong painkiller, the effects can be quick — and deadly. The drugs generally act by depressing respiration, so a youngster affected may simply stop breathing.

In Shayla Davidson’s case, it was fortunate that her family noticed her behavior during the day. “If the child had gotten into it right before bed, she might never have woken up,” said Bond.

Nicolle Jones, Shayla’s mother, said her family always took precautions with medications, but they’ve made them even stronger. They keep the drugs in a locked cabinet and there’s a new hook on the bathroom door.

“Oh my God, my dad felt so bad that she got hold of one of his medicines,” Jones said. “It was a scary situation. I could have lost my baby."

Comment:

I only bring this subject up because this can happen more easily to pets. It's not just the painkillers you have to worry about; any prescriptions can be deadly to young children or pets.

Seniors, who really love their grandchildren, never mean for any harm to come to them. But with their arthritis, neuropathy, surgeries etc.., they don't often feel or notice if they drop pills.

What is the answer, well there is no perfect answer. Here are some ideas: Keep all your pills in a basket or tray you can keep in a high locked cabinet or lock the door when young children are around. When you are taking your pills, take them over a lasagna sized cake pan or incase you drop anything, you will hear it and catch it. Infact you can keep the basket inside the pan and your cup for taking them inside the basket.

Here are some other helpful items:

Target this month rolled out a flattened bottle with easier-to-read labels and plastic rings that can be color-coded for each family member.

To make it all fit, Target flipped the bottle on its head, so it rests on the cap, making the label that wraps over the top visible from above. A card with information about side effects slips into a slot aimed at keeping it with the pills. Bottles for liquids get a receptacle for oral syringes.

ScriptTalk is a portable, handheld electronic device used to identify prescription (Rx) information stored in the memory of a microchip embedded within the paper label of a pill bottle. Upon identifying the Rx data within a label, ScriptTalk then "speaks" the Rx data in a human language. Features include: Portable device, will survive drops onto hard surfaces, not waterproof, but to some extent resists water; Battery operated and rechargeable - requires 2 rechargeable AA alkaline batteries. Provides up to 2000 reads per charge. It has an Audible Low Battery Indicator and a Wall Transformer for AC operation; Has tactile pushbuttons with tone and verbal responses to button press. The read range for the labels is such that the label can be read from any orientation. Provides on-board help; Understandable synthesized speech output with volume control. Offers voice pitch and speed control. Supports English and Spanish at this time. ScripTalk is a component of a larger system that additionally comprises smart label printer/programmer inside the pharmacy.

Talking RX

60 second digital recording device that fits on the bottom of the prescription bottle and can tell the user what they need to know about their medication.