10/18/2017

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Diane P. Calello, MD

NJ AAP

School Health Conference

October 18, 2017

Diane P. Calello, MD

NJ AAP

School Health Conference

October 18, 2017

10/18/2017

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• Discuss impact of opioid exposure on children

throughout development

• Neonatal/Perinatal

• The Drug-Endangered Child

• Pediatric Opioid Exposures

• Adolescent addiction

• Outline strategies to mitigate harm to children at all

points of exposure

• I have nothing to disclose.

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Young Victims of the Opioid Epidemic. The New York Times: Jan 16, 2017

Prenatal

Exposure

Neonatal

Withdrawal

Opioid Poisoning

Exposures

The Drug-Endangered Child

Adolescent

Addiction,

Mental

Illness

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• “Those at risk for suffering physical or emotional

harm as a result of caregiver substance use,

possession, manufacturing, cultivation or

distribution”

Families affected by substance abuse. AAP Committee on

Substance Abuse and Prevention, Pediatrics 2016

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The Washington Post: September 9,2016

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• Parental substance use may affect the ability to

consistently prioritize the child’s basic physical

and emotional well-being

• Home may be unsanitary or unsafe

• Drugs, chemicals, paraphernalia

• Delays to and inadequate medical care

• Increased mental health diagnoses in children

with PSUD

Families Affected by Parental Substance Use,

AAP 2016

• Living in DEC environs• 3x more likely to be physically, emotionally, or

sexually abused

• 4x more likely to suffer neglect, especially in neonatal period

• Environmental hazards: • Open flames, lighters

• Infectious agents

• Decreased resources, food insecurity, homelessness

• “Waste, vermin, insects, clutter, garbage, sex abuse/human trafficking”

Families Affected by Parental Substance Use,

AAP 2016

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www.pbs.org

The New York Times, September 20, 2017

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The Washington Post, March 20 2017

Allen et al. Prescription opioid exposures among children and adolescents

in the United States: 2000-2015. Pediatrics 2017

• Pediatric poisoning exposures up overall

• Opioids repeatedly demonstrated to be primarily responsible: • Up 101% in 7 year

study period, admissions 86%

• Spiller, et al: 21% increase in opioid fatalities

Bond GR, et al. The Growing Impact of Pediatric

Pharmaceutical Poisoning, J Pediatr 2012

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Burghardt LC, et al. Adult prescription drug use and pediatric medication

exposures and poisonings. Pediatrics 2013

• Original container• Child-resistant closure

• Diversion increases risk of improper storage:

• purse, wallet, cups, pockets, cigarette box, eyeglass cases, breath mint containers1

• Locked cupboard or pouch

• Perceived danger: • Only 41% viewed as dangerous

to children2

• Impact of parental response• Most fatalities involve delay to

care

1) Lavonas et al. J Pediatr 2013

2) Mullin A, et al. Harm Reduction Journal 2008

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!

Compton Arch Gen Psych 2007;64Compton et al., 2007

Age of onset,

yrs

19

OUD:

2/3 : 1ST Use < 25

1/3 : 1ST Use < 18

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CDC Wonder, 2016

SAMHSA, NSDUH, 2015

• “Gas pedal”,

reward

centers

mature first

• “Brakes”

develop late

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Addiction

Unsafe sex

Infection: HIV/Hep C

Psychosocial impairment

Motor vehicle accidents

Suicide

Overdose

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SOURCE: NCHS, National Vital Statistics System, Mortality

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Heroin

U-47700/Furanyl

Fentanyl

Fentanyl

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• First synthesized in 1960

• “N-allylnoroxymorphone”

• Opioid antagonist

• Other opioid antagonists- nalmefene and

naltrexone (long-acting)

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• 4mg/0.1 mL spray

• 1 spray

• 16% rise in opioid deaths last year

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• Opioid epidemic has implications at all stages of

development

• Neonatal Withdrawal

• The Drug Endangered Child

• Pediatric Opioid Exposures

• Addiction and Overdose in Adolescence

• NJ is far from immune

"Children are one

third of our

population and all of

our future." —

Select Panel for the Promotion of Child

Health, 1981

Conclusions