Naloxone successful in over half of uses in reversing signs of opioid overdose in the prehospital setting

Study of naloxone use documented by emergency responders found most involved teenagers, more often boys

Reports and Proceedings

American Academy of Pediatrics

ORLANDO, Fla.—The opioid epidemic is a leading cause of morbidity and mortality in the United States, and it is increasingly impacting children and teenagers. Naloxone can reverse the effects of opioid overdose and is being used in hospitals and by emergency responders outside the hospital to save the lives of young people poisoned by opioids.

Research titled, “Naloxone Administration to Pediatric Patients During Emergency Medical Service Events,” finds that among pediatric emergency medical service responses where naloxone was administered, the first dose was successful in improving clinical status in 54.1% of cases. Approximately one-third (32.7%) of pediatric patients received two or more naloxone doses, according to an abstract presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.

“Emergency medical services clinicians rarely reported that naloxone worsened clinical status, and naloxone improved a patient's clinical condition in over half of emergency responses in our study,” said lead study author Christopher Gaw, MD, MPH, MBE, FAAP, emergency medicine physician at Nationwide Children’s Hospital. “This finding underscores how naloxone can be a safe and effective antidote when used for suspected opioid poisonings in children and adolescents.”

Researchers examined data from the National Emergency Medicine Service Information System (NEMSIS) on emergency medical service activations for pediatric patients ages 17 and younger in 2022, and found naloxone was administered to teenagers and children at least 6,215 times that year. The study also found that one in five adolescents 13-17 years old were documented as receiving naloxone prior to emergency medical service arrival (20.7%), meaning that somebody on the scene administered naloxone. Naloxone administrations occurred most often in the home or residential setting (61.4%). The research also found that most overdoses occur in adolescents, ages 13-17 (79.4%), followed by children ages 1-5 (10.2%), and boys were also slightly more likely to receive naloxone (55.3%).

The calls for assistance suggest there may be initial confusion in the early emergency medical service response period before a diagnosis is made. In the study, the initial emergency call was for an overdose, poisoning, or ingestion in about a third of the calls for adolescents 13-17 (31.5%) and just 12.8% of calls for infants.

“Our study highlights how EMS clinicians are reporting naloxone use after responding to different types of emergency dispatch calls, such as poisonings, unconsciousness, and problems breathing,” Dr. Gaw said. “These signs and symptoms could represent a possible opioid poisoning, which may explain why naloxone was administered in those situations.”

Dr. Gaw is scheduled to present his research, which is below, from 4:15-5 p.m. Saturday, Sept. 28, at the Section of Emergency Medicine program during the national conference. 

In addition, Dr. Gaw will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon-1:30 pm Saturday in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.

 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

 

ABSTRACT

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Section on Emergency Medicine

Abstract Title: Naloxone Administration to Pediatric Patients During Emergency Medical Service Events

Christopher Gaw

Columbus, OH, United States

The opioid epidemic is a leading cause of morbidity and mortality in the United States. In recent years, opioids have been implicated in rising injury and fatality rates among children. Early recognition and reversal of opioid poisoning can be lifesaving, and emergency medical services (EMS) clinicians are often the first healthcare providers to respond to an overdose event. Few studies have characterized the pre-hospital response to pediatric opioid poisonings. The objective of this study is to describe the patient and EMS response characteristics for children and adolescents receiving naloxone in the prehospital setting.

We acquired data from the National Emergency Medicine Service Information System (NEMSIS) on EMS activations for pediatric patients 1 day to 17 years old in 2022. Among these activations, we identified children who received ≥ 1 dose of naloxone. We analyzed patient demographics and EMS response characteristics using descriptive statistics and characterized the incidence rate of pediatric EMS activations where naloxone was administered.

In 2022, 6,215 EMS activations met our inclusion criteria. Activations more commonly involved males (55.3%) and were dispatched to a home or residential setting (61.4%) (Table 1). Most responses involved adolescents 13-17 years old (79.4%), followed by children 1-5 years (10.2%) and infants < 1 year (6.0%). The incidence of naloxone administration per 10,000 activations was highest in the 13–17-year age group (57.5), followed by the < 1 year (17.9) and 1–5-year (11.1) age groups. One in five adolescents 13-17 years old were documented as receiving naloxone prior to EMS arrival (20.7%, 974/4,702) compared to fewer than one in ten infants < 1 year (8.2%, 28/341). Most EMS activations involving naloxone administration involved an advanced life support unit (91.0%) (Table 2). An initial dispatch complaint of an overdose, poisoning, or ingestion was more common among responses to adolescents 13-17 years old (31.5%, 1,555/4,937) compared to infants < 1 year (12.8%, 48/375). Approximately one third (32.7%) of pediatric patients received 2 or more naloxone doses. The first dose of naloxone led to a clinical improvement in a greater proportion of 1-5 years old (64.7%, 388/600) compared to infants < 1 year (51.3%, 184/359) and adolescents 13-17 years (54.0%, 2,474/4,580). Naloxone administration was followed by a worsening in clinical status in 11 individuals in our study population (0.2%).

Infants and young children administered naloxone received different EMS care compared to adolescents. EMS dispatches to infants receiving naloxone were uncommonly identified as poisonings or ingestions, and few infants received naloxone prior to EMS arrival. Notably, naloxone administration was rarely documented to worsen clinical status in pediatric patients. These findings highlight opportunities to improve community and prehospital provider identification and management of suspected pediatric opioid poisonings.

Table 1. Characteristics of pediatric patients receiving naloxone from emergency medical services, NEMSIS 2022

 

Table 2. Emergency medical service response characteristics of pediatric patients receiving naloxone by age, NEMSIS 202

Opioid poisoning in children increasing alongside adult misuse

Fentanyl found to be the most common drug causing the increase, according to new research

American Academy of Pediatrics

 

Orlando, Fla.—The impacts of the ongoing opioid crisis are trickling down to young children, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1.

One abstract, “Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service,” examined the demographic and medical records of 69 children who were assessed by Suspected Child Abuse and Neglect teams in the Philadelphia, PA area.

The study found that over a 10-year period from June 2012 to Dec. 2023, there was an increase in cases of children overdosing on opioids, with a four-fold increase from 2019 to 2023. Most of the children were under the age of 2, with the youngest being 19 -days old.

Dr. Maria Quidgley-Martin, Pediatric Emergency Medicine Attending and Clinical Assistant Professor of Emergency Medicine at the University of Florida and lead author on the study, found that fentanyl was the drug most often found in these overdose cases.

“As parents and other adults increasingly misuse opioids, it’s becoming more and more possible for those drugs to end up in children’s hands,” Quidgley-Martin explained. “Children are most often coming across these drugs in familiar settings such as their home or the home of a relative.”

Non-Hispanic Black children were the most susceptible as the group experienced an 11-fold increase from 2019 to 2023, a sharp increase even when compared to the four-fold general increase over that same timeframe.

Typical symptoms of opioid poisoning in children include changes in behavior, unresponsiveness, difficulty breathing and seizures. According to Dr. Quidgley-Martin, most also weren’t given naloxone, a powerful nasal drug used to counteract the effects of opioid overdose.

“Children are the overlooked tragic victims of the United States’ opioid epidemic and fentanyl is now the greatest danger,” Dr. Quidgley-Martin said. “We need our first responders to always consider administering naloxone to unconscious pediatric patients in case they have unknowingly been exposed.”

Over half of the patient’s families had previous contact with Child Protective Services with 65% reporting a family history of opioid abuse. These numbers highlight the ongoing crisis opioids are perpetuating on families across the country.

Of the 69 patients studied, four died. They were all younger than 2 -years-old and all tested positive for fentanyl.

“As a pediatric emergency medicine doctor, I have seen children injured and killed by fentanyl way too often,” Dr. Quidgley-Martin said. “We need to speak about this more and work together to protect our children.”

Study author Dr. Maria Quidgley-Martin, is scheduled to present her research, which is below, at the Council on Child Abuse and Neglect at 1:20 p.m. on Sunday, Sept. 29 in the Regency Ballroom R at the Hyatt Regency Orlando. To request an interview with the authors, contact Joey McCool Ryan at MCCOOL@chop.edu.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.   

 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/ 

 

ABSTRACT 

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Council on Child Abuse and Neglect

Abstract Title: Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service

Maria Quidgley Martin

Philadelphia, PA, United States

The opioid epidemic in the United States significantly affects children, with rising opioid exposures, notably fentanyl, leading to fatal poisonings among young children. Increased adult opioid misuse also correlates with heightened child abuse and neglect, requiring intervention from the child welfare system. However, to date, there is no literature that describes the demographic, clinical, and social characteristics, as well as acute medical outcomes of children with opioid poisoning evaluated for child maltreatment. This study aims to address this gap by detailing these features among children consulted by the child protection team at our institution.

This retrospective cohort study conducted at a quaternary urban children's hospital analyzed children who received a Suspected Child Abuse and Neglect (SCAN) team consultation for opioid exposure between June 2012 and December 2023. Demographic, clinical, and social de-identified data were collected from medical records from an existing patient registry and entered into a REDCap database. Descriptive statistics were used to characterize the population, and comparisons were made based on age and fentanyl exposure.

There were 69 consults for opioid ingestions, with a four-fold increase observed from 2019 to 2023. Most patients were under two years old (72%), with a notable proportion being non-Hispanic Black children (11-fold increase from 2019 to 2023). Fentanyl was the most common opioid. The majority (87%) of cases occurred in the patient's home or a relative's residence. The most common chief complaints were altered mental status, abnormal breathing, and seizures. Eleven patients presented in cardiac arrest (9 under age 2), and 71% had respiratory arrest or depression on presentation. Emergency medical services initially cared for 59% of patients, and 61% were transferred from 23 area hospitals. Naloxone was administered to 71% of patients, with higher odds in children under age 2 (OR 3.2, (1.04-9.8, p=0.04)). Fifty-eight percent were admitted to the ICU, with higher odds for those under age 2 (OR 3.33 (1.1 to 10, p=0.03)). Four children died, all under 2 due to fentanyl poisoning. Fifty-two percent of patients' families had prior child protective services (CPS) involvement, with higher odds in children under age 2 (OR 4.57 (1.42 to 14.7), p=0.01)). A family history of opioid abuse was reported in 65% of cases. Nearly half of patients were discharged to an out-of-home placement.

The increase in SCAN consults for opioid ingestions, primarily fentanyl-related, highlights the urgent need to address opioid exposure among children. Young children and non-Hispanic Black patients are disproportionately affected. Most ingestions occur in familiar settings, and pre-hospital care is often provided by emergency medical services, with many children transferred from general emergency departments. Results from this study can guide education, advocacy, and policy efforts to address the impact of the opioid crisis on children.

Race and Ethnicity Trends Over Time

 

There was an eleven-fold increase in the number of Non-Hispanic, Black patients consulted by the SCAN team between 2019 and 2023 compared to previous years.

Urine Drug Screen Results Over Time

 

There were 45 patients (65% of all) who tested positive for fentanyl, mostly all after 2019.

 

 

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Journal

PEDIATRICS

Telehealth program expansion to reduce alcohol use on college campuses

$3.2 million grant puts gold standard treatment online

University of Houston

 

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University of Houston Professor of Psychology Clayton Neighbors is adapting the gold standard treatment for college drinking into a telehealth format accessible on Zoom.

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Credit: University of Houston

The gold standard treatment motivating college students to reduce alcohol use to decrease the negative consequences of drinking is called the BASICS program, or Brief Alcohol Screening and Intervention for College Students. The prevention program targets students who drink alcohol heavily and have experienced or are at risk for alcohol-related problems.  

To reach a greater number of students, University of Houston Professor of Psychology Clayton Neighbors is adapting the treatment into a telehealth format accessible on Zoom. He is supported in his work by a $3.2 million grant from the National Institute on Alcohol Abuse and Alcoholism.  

According to the NIAAA, alcohol use is a significant public health problem among college students.  

The consequences of alcohol use in college include:  

• Death - About 1,519 college students ages 18 to 24 die from alcohol-related unintentional injuries each year  
• Assault - About 696,000 students ages 18 to 24 are assaulted by another student who has been drinking each year  
• Sexual assault - Research indicates that 1 in 5 college women experience sexual assault during their time in college  
• Academic performance - Heavy drinking can disrupt students' educational goals, reduce engagement and decrease academic performance  
• Drop out - Alcohol is a factor in students dropping out of college 

“We expect to show that the program administered in a telehealth format by Zoom will work as well as in an in-person format and will be more cost-effective,” said Neighbors. “The significance of this research lies in the potential to maximize access to the highest standard of care by establishing support for easier access without sacrificing any central features of the traditional BASICS intervention.” 

The BASICS screening and intervention is delivered in an empathetic, nonconfrontational, and nonjudgmental manner and is aimed at revealing the discrepancy between the student's risky drinking behavior and his or her goals and values. The intervention is delivered by trained personnel proficient in motivational interviewing. 

While it is the best treatment available, researchers report that the in-person delivery format of BASICS has presented barriers to wider implementation due to the time, effort and costs of traveling to and from sessions, the need for private meeting space, and the firmly fixed scheduling of intervention sessions. 

Three hundred mandated and 300 volunteer students who report hazardous drinking will be recruited from the University of Houston and the University of Missouri and randomly assigned to a condition (in person BASICS, Tele-BASICS, or treatment as usual). Follow-up assessments will occur 1, 3, 6 and 12-months 

 
The project includes investigators from the University of Houston, the University of Southern California and the University of Missouri. At UH, Neighbors is partnering with Reuben Parrish, director of UH Wellness, to work with students who are found to be in violation of campus alcohol policies. They will also work with volunteer students who have experienced unwanted alcohol-related consequences. 

Not only does Neighbors expect the telehealth service to be successful, but he also says it may be more successful among women, heavier drinkers, students without co-occurring substance use, and those with greater motivation.  

“Generally, women are more conscientious and will be more attentive in an online format than men. Heavier drinkers will be more invested in the information and will pay more attention in an online format than lighter drinkers. Students without co-occurring substance use will have less difficulty paying attention in an online format. Those with greater motivation will also be more attentive in an online format,” said Neighbors.