title: Overdose Risk in Young Children of Women Prescribed Opioids.
abstract: OBJECTIVE
  Over the past 20 years, the prescribing of opioids has increased dramatically in North America, with parallel increases in opioid addiction, overdose, and associated deaths. We examined whether young children of women prescribed opioids were at increased risk of opioid overdose.
  
  
  METHODS
  We conducted a population-based, nested case control study in Ontario, Canada, between 2002 and 2015. We identified children aged ≤10 years, whose mothers received publicly funded prescriptions for an opioid or a nonsteroidal antiinflammatory drug (comparator analgesic) in the preceding year. Cases were children who presented to hospital for or died of opioid overdose. Each case was matched with 4 controls with no opioid overdose. The primary outcome was the risk of opioid overdose.
  
  
  RESULTS
  We identified 103 children who presented to the hospital with opioid overdose and matched them with 412 controls. Half of the children with opioid overdose were <2 years old. Compared with controls, children with an opioid overdose were far more likely to have a mother who received a prescription opioid (unadjusted odds ratio, 2.41; 95% confidence interval, 1.68-3.45) and who was prescribed antidepressants. The most commonly implicated overdose opioids were codeine (53.4%), oxycodone (32.0%), and methadone (15.5%).
  
  
  CONCLUSIONS
  Young children of mothers prescribed opioids are at a markedly increased risk of overdose. Physicians, pharmacists, and parents should take measures to mitigate the risk of opioid-related harm to children, such as prescribing smaller quantities, emphasizing the importance of secure medication storage, and the prompt disposal of unused opioids.
authors.affiliation: Divisions of Emergency Medicine, and yaron.finkelstein@sickkids.ca.|Clinical Pharmacology and Toxicology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.|The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Finkelstein
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gonzalez
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.|Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Marco L A
authors.initials: MLA
authors.lastname: Sivilotti
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.affiliation: The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, Ontario, Canada; and.|Departments of Medicine, Paediatrics and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
mesh_terms: D000061:Accidents, Home / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002675:Child, Preschool; D003061:Codeine / Q000009:adverse effects; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008691:Methadone / Q000009:adverse effects; D009864:Ontario; D010098:Oxycodone / Q000009:adverse effects; D055553:Prescription Drugs / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D055553:Prescription Drugs; D010098:Oxycodone; D008691:Methadone; D003061:Codeine