Pediatric Emergency Department Visits for Opioid Overdose in the United States

Fatal opioid overdoses among children have increased 4-fold since 2018, driven by unintentional fentanyl overdoses in adolescents. Detailed descriptions profiling nonfatal overdoses that present to emergency departments (EDs) amidst this surge in deaths are lacking.

We performed a retrospective cross-sectional study of the Pediatric Health Information System, an administrative database of tertiary-care children's hospitals. We included children and youths aged 0 to 19 years who had an ED visit for opioid overdose from 2017 to 2022 using International Classification of Diseases, Tenth Revision codes. We excluded incomplete encounters. We examined temporal trends using Poisson regression models or quasi-Poisson models if data was overdispersed.

We identified 4550 ED visits for opioid overdose. ED visits for opioid overdose rose 20.2% (incidence rate ratio [IRR], 1.0001; P < .001) from 2017 to 2022. Increases were highest among patients aged 0 to 4 and 15 to 19 years; male; those self-identifying as Black, Hispanic or multiracial; urban; and publicly insured. Children aged 0 to 4 and 15 to 19 years accounted for most visits (45.7% and 35.2%, respectively). Although synthetic opioid overdoses increased (IRR, 1.0002; P < .001) and were the predominant agent among children aged 0 to 4 years, prescription opioid overdoses were more common overall. Most adolescent overdoses were intentional. Rates of intensive care admission increased (IRR, 1.0004; P < .001). Fatal overdoses rose 200% (IRR, 1.0008; P = .02).

Increasing numbers of children are presenting to pediatric EDs for opioid overdose and in increasingly critical condition. Unlike fatal overdoses, most pediatric ED visits are for young children experiencing synthetic opioid overdose and adolescents with intentional prescription opioid overdose.