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Reproduced from JAMA Network Open report "US National Trends in Pediatric Deaths From Prescription and Illicit Opioids, 1999-2016"; Chart: Axios Visuals

The death rate of children and teenagers from opioid poisoning almost tripled between 1999 and 2016, with nearly three quarters of them from prescription medicines, an analysis of national data published in JAMA Network Open Friday shows.

By the numbers: Almost 9,000 people in the U.S. under 20 died over the 18-year period — including a surprisingly large number of 0-5 year olds and a growing number of 15–19 year olds, study author Julie Gaither tells Axios.

"This study really speaks to how all segments of U.S. society have been affected. No one has been spared. And, there's no sign to date that this is going to change."
— Julie Gaither, instructor, Yale School of Medicine

What they did: The researchers examined death certificates from the Centers for Disease Control and Prevention for children and adolescents who died from opioid poisonings with prescription and illicit drugs during that time period. While certificates can sometimes misclassify deaths, Gaither says the numbers are likely underreported.

What they found: "About 500 children per year are dying from opioid poisoning," Gaither says, and that number is growing. This tracks the same team's findings in a 2016 study on opioid-related hospitalizations for youth.

  • Children are dying from opioids prescribed for pain relief and those designed to help people addicted to opioids recover, like methadone, a popular medication-assisted treatment (MAT).
  • "An opioid is an opioid, whether if it's to treat an addiction or not, children are at risk of poisoning," Gaither says.
  • One problem, Gaither notes, is that some MATs and prescribed opioids are not child-proofed. "One of them looks like brightly colored strips of paper, like Listerine strips, that are attractive to children," she says.


  • Out of the total 8,986 deaths, 73% (6,561) are linked to prescription opioids.
  • 81% of the deaths were unintentional.
  • Teens 15–19 had the highest death rate, mostly linked to heroin, which alone showed a 405% growth over that period.
  • Deaths in children aged 10–14 accounted for 4% and those ages 5–9 were 1%.
  • Children younger than 5 experienced almost 7% of the deaths — about 25% of which were from deliberate homicide, Gaither says. This finding needs further research, she adds.
  • 38% died at home — a finding that Gaither says "surprised" her.
  • Non-Hispanic white males experienced the highest mortality but in recent years non-Hispanic black children accounted for a larger proportion.

The big picture: "The epidemic is evolving in ways that we haven't been able to keep up with," Gaither says. Children's deaths track the overall epidemic waves, she says, with a spike from prescriptions in the late 1990s, showing a decline in 2008 as physicians became more careful in prescribing. But this was followed by increased usage and deaths from heroin and synthetic opioids, Gaither says.

What's next: Lawmakers, public health officials, clinicians and parents must implement protective measures to address the growing epidemic, Gaither says — such as efforts to make opioids and MATs more child-proof, and consideration of the family context when physicians write prescriptions.

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