Children are natural explorers and imitators. But, they don’t have the capacity to understand the potential danger in some activities. That helps explain why among 2-year-olds, one of every 180 ends up in the emergency room due to medication poisoning every year.
For most children, the outcomes are good. They’re treated, and they suffer no lasting damage. But, some drugs can be deadly with only a single dose — including a medication prescribed to help adults combat drug addiction.
Buprenorphine is used alone (brand name Subutex) or in combination with another drug called naloxone (brand name Suboxone) to ease the symptoms of withdrawal in people trying to beat addictions to heroin, certain prescription painkillers or other opioid drugs. One dose of this medication can be fatal to a small child.
Each year, nearly 1,500 children under 6 years old are treated in U.S. emergency departments as a result of accidental ingestion of buprenorphine. A new study examines 2,380 of these cases from October 2009 to March 2012.
“These were small children, so it was unintentional ingestion, and we were interested to find out what happened to these kids after the ingestion, and what led to this exposure in the first place,” explained Dr. Eric Lavonas, lead study author and associate director of the Rocky Mountain Poison and Drug Center in Denver.
“Most of the children did well. About 500 had to go to the intensive care unit, and tragically, four children died,” Lavonas said.
Results of the study were released online Aug. 29 in the Journal of Pediatrics.
The average age of the children was 2 years. Symptoms included lethargy, small pupils, trouble breathing and vomiting.
Lavonas and his colleagues found that most of the accidental exposure to buprenorphine occurred in the home. However, about 6 percent of the cases occurred in other places.
The most common places that children found the medications were in wallets, purses, couches, cars, parents’ pockets, floors, hotel rooms, cups, cigarette packages, eyeglass cases, cellophane, tissue paper, breath mint containers and trash cans, according to the study.
At the time of the accidental ingestion, parents were usually the ones taking care of their children. But in 117 cases, a grandparent, babysitter or other caregiver was watching the child.
The medication comes in either tablet form or as a film strip. Tablets were far more likely to be the source of accidental ingestions — 95 percent of the cases involved tablets. Lavonas said this is likely because the film strips are packaged individually in foil wrappers, which adds an additional layer of protection.
Often, medication was stored within the sight of the child. In at least 110 of the cases, a child accessed the medication from a bag or purse. And, 75 of the children were able to access the medication because it wasn’t stored in its original childproof container.
One expert explained why medication gets shifted to unsafe storage areas.
“It’s not uncommon for people to load up a week’s worth of medication in a purse or desk drawer. It’s easier to get to and remember,” said Dr. Michael Hobaugh, president of the medical staff at LaRabida Children’s Hospital in Chicago.
“But, if you’re taking buprenorphine, you need to remember that you have a very dangerous medicine in your possession. You may be on it for weeks or months, and it will become part of your routine to have it around, and it’s that sense of routine that leads to a lack of caution. This is not the type of medicine you can drop on the floor and give up if you can’t find it. You have to find it or your child might,” he cautioned.
Study author Lavonas said that other commonly used medications, such as high blood pressure medications, some diabetes drugs, strong painkillers, some medications used for arthritis and some drugs for attention-deficit/hyperactivity disorder, can potentially be fatal to a small child with just a single dose.
He’d like to see a change in the way these types of medications are packaged. “For medications where one dose can be life-threatening to a child, the default packaging should be single-dose child-resistant packaging,” Lavonas said. “Though, of course, there need to be provisions for older people with arthritis. But, right now, we’re not doing everything we can to prevent exposure to medications where one dose can kill.”
Both experts recommended leaving medications in their original child-resistant containers, and storing them up and out of sight of children. Lavonas also recommended checking the floors when you visit someone who takes medications, or even when staying in a hotel. He said it’s easy for someone to drop a pill, especially small ones, and not even realize it. But, a small child who’s crawling around on the floor might find it.