Within the last three years, there has been a 449% increase in children under the age of 6 being exposed to fentanyl, according to a new study from Oregon Health and Science University. Researchers looked at U.S. poison control data and found significantly more incidents compared to previous years. There were no reported incidents of fentanyl poisoning in Oregon in 2020, but by 2023, there were 16. Robert Hendrickson is the medical director of the Oregon Poison Center at OHSU. He joins us to share more on the increase and why it’s happening.
Note: The following transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In 2016, poison centers across the U.S. only reported 10 cases of fentanyl exposure in children under six years old. Last year, there were 539, more than a 50 fold increase. Oregon has seen its own huge rise. There were just two cases three years ago and 16 last year. Rob Hendrickson is the medical director of the Oregon Poison Center at OHSU and the lead author of a new study that analyzed these numbers. He joins us now to talk about what he found. Welcome back to the show.
Robert Hendrickson: Thanks, Dave.
Miller: So I mentioned that age range, under six years old. What ages were most common for fentanyl exposure when you look nationally?
Hendrickson: We were really looking for accidental exposures to illicit fentanyl and we concentrated on that under six group. There’s obviously a much bigger group of adolescents and adults that are exposed to illicit fentanyl, for recreational reasons and things like that. We weren’t interested in that group. We specifically looked at the under six group.
Miller: And among that under six group, I mean, were there ages that were most likely to be exposed?
Hendrickson: Yeah. And it’s sort of the typical age that kids grab things in the house and they put it in their mouth. So our mean age was about one-and-a-half years old. Most of the children exposed were between one and two years old.
Miller: So, really, I mean, we can say under six, but we’re in a sense we’re talking about toddlers?
Hendrickson: Yeah.
Miller: You said in the home. Where are most of these cases happening?
Hendrickson: Yeah, more than 80% of these exposures happened in the child’s home. The rest we’re not really sure exactly where the exposure went. So I would say that the vast majority of these are happening, the child is in their own home or in a home, [maybe] that of a relative, and they’re finding fentanyl and putting it in their mouths.
Miller: In Oregon. I saw that there was an even higher prevalence of at home exposures, over 90%. Do you have any idea why that is?
Hendrickson: No, I’m not sure why it was somewhat higher in Oregon. I think in the end, I think the important point is that the vast majority of these are happening in the home. They’re not happening out in public spaces and things like that. And so it’s really, really important for people to understand that this is happening at homes, and one of my main messages is if you have children around the home and there is a substance that could potentially be harmful to a toddler, it needs to be stored up out of reach of them, preferably in a locked box or a locked bag for transportation. Obviously, I’m talking about fentanyl but that also relates to methamphetamine and cannabis, but also more importantly, probably and more commonly, medications, your medicine for blood pressure and your ADHD medicines and things like that.
Miller: I want to talk more about prevention in just a bit. But, I’m wondering, is it possible in the national data that you have access to, to find out anything about the likely circumstances here? I guess, let me put it this way. My assumption is that for the most part, these cases stem from family members using illicit fentanyl and then leaving it where a toddler or a little kid can get access to it. I mean, this is an uneducated guess. Do you have more granular data about what is happening?
Hendrickson: So for the Oregon data, we were able to actually read through the entire case and that is, what you described is exactly what we saw. I can’t confirm that for all of the national cases, but it does seem that that was the scenario, that someone who uses illicit fentanyl in the house and there was a toddler present, the toddler found that substance. In Oregon, all of the cases were tablets that contained fentanyl and the child ingested the tablet.
Miller: Years ago, there were stories about people touching residue or walking by vapor that somebody had breathed out and then passing out or being rushed to the emergency room, and it was never clear to me if those were urban myths or reality. Does that happen?
Hendrickson: So I would not be concerned if I was exposed to a small exposure, like a passive second hand smoke or vapor, in this case. In my job in the emergency department, we sometimes find that there’s bags of drugs and we have it on our hands. My recommendation is if you have it on your hand, just go and wash your hands, and that’s fine. But no, people shouldn’t be concerned about being near residue, being near someone who is smoking fentanyl, that you’re gonna get opioid effects. These cases that I’m describing here were really a child ingesting a tablet that had a large amount of fentanyl in it.
Miller: When you say a large amount, let’s say a two-year-old ingests an illicitly produced fentanyl pill. And I know we’ve talked about this in the past, that one of the challenges here is that you can basically never know for sure the actual dosage, these are just made by cartels who are not making medicine. But how big a dose might it be for a two-year-old body?
Hendrickson: Yeah. So we have analyzed a bunch of pills, obviously, not these specific pills that these children were exposed to. But what we’re seeing is somewhere between 1000 to 4000 mcg. in each of these tablets. That would be a dose that’s 40 or 50 times what a toddler should be ingesting. So these are extremely large overdoses for these small children. And that sort of reflected in what we saw. These children were very ill. Two-thirds of them needed naloxone to revive them. So they were very, very sick. These are very large ingestions for these small children.
Miller: Two-thirds needed naloxone. How common was it that these toddlers would die from fentanyl exposure?
Hendrickson: Luckily, the number of deaths nationally, it was 3.5%. So relatively low. Obviously, any death in a toddler in a situation like this is tragic. But as I said before, more than two-thirds of these children required naloxone. And so they were very, very ill.
Miller: Illicit fentanyl has gone from nearly unheard of in this country. I mean, [as] a powerful medication that is prescribed by doctors and used, say, in hospital settings or in a very controlled way. It went from that to being terrifyingly common in about seven years. And in the west coast, more recently than that, is when it’s been really readily accessible. I’m curious how the numbers that you looked at in terms of accidental exposure - separate from the effects of that exposure, but just that the raw numbers of exposures - compared to other drugs that have been around for much longer, drugs like meth or cannabis that you mentioned.
Hendrickson: Yeah, and we’re still seeing children exposed to meth and to cannabis, and to heroin. So that is still happening and those numbers are much larger than the numbers we’re seeing with fentanyl. What really separates these out is just how severely affected these children are and that really is reflected in the dose that they’re getting. They’re getting a very large amount of opioid, and so these children are really, really, really sick.
Miller: So let’s turn to prevention. Broadly, how do you think about it?
Hendrickson: I think there’s a few steps. One is, as I mentioned before, if there is a medication or a drug in the house that could be harmful to a toddler, and there are toddlers ever present in the home, it’s really important to store those drugs and medications up and out of the reach of children, preferably in a locked medicine box. And there are lockable bags that are available for transport as well and I highly recommend those. The second step is if a family member is using fentanyl or an opioid, get naloxone and know the signs of overdose, and use the naloxone if there’s an overdose.
Naloxone is the reversal agent for fentanyl and all other opioids. It is available in many pharmacies. It is paid for by many health insurance programs as well as the Oregon Health program. And the signs of overdose from opioids include someone who is exposed to an opioid who is sleepy or has loss of consciousness. They have shallow or slow breathing and blue discoloration of their lips or skin. Anyone who has an exposure to opioid and has those signs, give them naloxone.
There’s a couple of other important points. There’s a lot of adult naloxone kits out there. I wanna just make it very, very clear. Those adult naloxone kits are perfectly fine to use on a child. I think most people think about naloxone as being used on the person who uses opioids, which is true, but it also can be used on family members who accidentally ingest them and that includes toddlers. So nobody should hesitate for a second to give an adult naloxone kit to a child if they have an opioid overdose.
Miller: I want to go back to the point you’ve made twice now, which is that first of all, anybody who has prescription drugs should lock them away or keep them out of the sticky fingers of toddlers who put things in their mouths. And in particular, you noted, people who are actively dealing with substance use disorder, actively using opioids or fentanyl, they should really keep that away from kids. But my guess is that in general we’re talking about people who would never want to jeopardize the health of their kids, but they’re leading chaotic lives. They’re in the throes of a really serious substance use disorder. How do you reach that population with this message?
Hendrickson: We’re partnering with local public health departments and harm reduction agencies, and we’re trying to get the word out. I couldn’t agree with you more. What I see when I talk to people who have a child that got into something that caused an effect, and I see this all the time, the primary thing that I hear is, it never dawned on me that that would be dangerous to my kid. Obviously, no, they’re not trying to…They’re trying to protect their kids as best as they can, and I think just hearing that message that this substance, as well as many other substances, may be potentially harmful to their toddler or to a toddler that comes over occasionally or is occasionally in the home. That’s the message we have to get out. And we haven’t really been talking to people about that. People who have substance use disorder, we haven’t really been discussing safe poison prevention and safe storage. And I think it’s time that we start doing that.
Miller: As you noted at the beginning, you focused on this recent work, this recent study on exposure in toddlers, on kids under the age of six, but how much do you know right now about teens and adolescents and fentanyl overdose doses, or now we sometimes say fentanyl poisoning?
Hendrickson: Yeah, we obviously didn’t look specifically at that. It is a problem. I don’t have the data in front of me to tell you a number or anything like that, but we do see adolescents starting to use fentanyl, as fentanyl has become the predominant opioid or illicit opioid in this area.
Miller: The data that you looked at for people under the age of six, that was from last year. We’re two-and-a-half months into 2024. Have you gotten more reports of fentanyl poisoning among young Oregonians or young people across the country?
Hendrickson: Yes, we are continuing in the first couple of months of this year to have fentanyl cases in toddlers. Again, we’ve been reaching out to public health agencies and to harm reduction agencies to try to get the word out. Obviously, everyone’s goal is to get that number back down to zero and any of these cases is heartbreaking. So we’re doing everything we can to kind of decrease the amount of toddlers out there that are being exposed to fentanyl.
Miller: Rob Hendrickson, thanks very much.
Hendrickson: You’re very welcome, Dave.
Miller: Rob Hendrickson is the medical director of the Oregon Poison Center at OHSU.
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