Naloxone proven effective in treating opioid poisonings among children and teens
The study points to areas where response efforts can be enhanced, particularly in the identification of opioid poisonings in infants and young children.
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A new study presented at the American Academy of Pediatrics 2024 National Conference & Exhibition sheds light on the effectiveness of naloxone in pre-hospital settings.
The research shows that naloxone improved the clinical condition of pediatric patients in 54.1% of emergency medical service (EMS) responses where it was administered, with about a third of children (32.7%) requiring 2 or more doses.
“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.”
The study analyzed data from the National Emergency Medicine Service Information System (NEMSIS) for EMS activations in 2022 involving pediatric patients aged 1 day to 17 years. A total of 6,215 EMS activations involved the administration of naloxone. The study revealed several important trends:
- Gender: Boys were slightly more likely to receive naloxone, accounting for 55.3% of cases.
- Location: Most naloxone administrations occurred in home or residential settings (61.4%).
- Age groups: Adolescents aged 13 to 17 years were most commonly affected, comprising 79.4% of cases, followed by children aged 1 to 5 years (10.2%) and infants under 1 year (6.0%).
- Incidence rates: The highest rate of naloxone administration occurred in the 13 to 17 age group, with 57.5 EMS activations per 10,000 involving naloxone administration, followed by infants under 1 year (17.9 per 10,000) and children aged 1 to 5 years (11.1 per 10,000).
Notably, naloxone was administered before EMS arrival in 20.7% of cases involving adolescents, compared to just 8.2% of cases for infants, indicating that bystanders or family members intervened in some instances.
The research highlights differences in the pre-hospital response to opioid poisonings across age groups. The initial emergency dispatch complaint was classified as an overdose, poisoning, or ingestion in 31.5% of cases involving adolescents, but only in 12.8% of cases involving infants. This suggests that opioid poisonings in younger children may be less recognized by the public, leading to delayed intervention.
Naloxone administration led to clinical improvement in varying proportions across age groups:
- Children aged 1 to 5 years: 64.7% improved after the first dose.
- Infants under 1 year: 51.3% showed improvement.
- Adolescents aged 13 to 17 years: 54.0% showed improvement.
While naloxone was effective in most cases, clinical status worsened in just .2% of the study population following naloxone administration. Most EMS responses (91%) involved advanced life support units, indicating the severity of the situations.
“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,” said Gaw. “These signs and symptoms could represent a possible opioid poisoning, which may explain why naloxone was administered in those situations.”
The study points to areas where response efforts can be enhanced, particularly in the identification of opioid poisonings in infants and young children. Infants who received naloxone were less likely to be identified as having poisonings or ingestions during dispatch calls, and few received naloxone before EMS arrived. However, the overall safety of naloxone administration was confirmed, with very few cases of worsened clinical status.
The authors of the study concluded that these findings highlight the importance of early recognition and intervention in pediatric opioid poisonings, offering opportunities to improve public and pre-hospital awareness, as well as life-saving measures for young patients.
