10/18/2017 1 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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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