Children and the Opioid Crisis
What Cook Children's Is Doing About It
Today, President Donald Trump announced that he would direct his Department of Health and Human Services to declare the opioid crisis a nationwide public health emergency.
The announcement is not a surprise by any means for caregivers at Cook Children’s who see opioid abuse and misuse among children ranging from babies to teens. Neonates are exposed in utero and experience neonatal abstinence syndrome as a result.
In 2016, 21 children were seen by Cook Children’s Emergency Department as a result of poisonings by opioids (10 accidentally, 11 intentionally). Nearly twice a month, children between the ages of 1 and 19 were arriving at Cook Children’s because of these dangerous drugs.
Much of the national focus has been on adults addicted to opioids. In fact, most programs and position statements refer to adults and fail to address the issues our children are combatting. Until now.
Artee Gandhi, M.D., is among Cook Children’s caregivers who are leading efforts to make changes in opioid distribution.
She is working on new guidelines to create patient information handouts on safe opioid prescribing within Cook Children’s. A plan is also in place to establish safe monitoring and risk assessment through electronic records. Dr. Gandhi is also on the Fort Worth Safe Communities Coalition Drug Overdose and Poisoning Prevention Task Force.
Dr. Gandhi says the problem for many children is that health care has focused its attention on treating children with medications.
“These are kids that were prescribed opioids for some reason, most of the time for some pain-related condition by dentists, emergency room doctors or primary care physicians,” said Dr. Gandhi, who is the medical director of Pain Management at Cook Children’s. “These kids are going back and taking these medications at a later time. They are using these left overs for non-medical use. We now know that the risk of death from overdose has increased. We also know that the use of opioid prescriptions leads to a higher incidence of anxiety and depression. Interestingly enough, even those kids that are given opioids for a legitimate reason will tend to misuse and abuse drugs.”
Another danger is when younger children find grownups’ prescription drugs and pop them in their mouth. Jamye Coffman, M.D., a pediatrician who specializes in child abuse, says that leaving these prescriptions where young children can access them usually falls under neglectful supervision from the perspective of the Texas Department of Family and Protective Services.
“However, there is also potential for a criminal charge for child endangerment,” Dr. Coffman said. “We see the criminal charge for the most part with illegal drugs which would include opioids obtained illegally. If you have followed the usual precautions of keeping them out of reach of the child, but they somehow manage to get it then it is an unfortunate accident.”
The Centers for Disease Control and Prevention (CDC) reports that nearly 2 million Americans, 12 years of age or older, either abused or were dependent on opioid painkillers in 2013.
“No part of our society — not young or old, rich or poor, urban or rural — has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids,” President Trump said. “This epidemic is a national health emergency.”
In one study of illicit drug use among teens, opioids accounted for 100 percent of the deaths.
The Pain Management Program at Cook Children’s treats kids with pain ranging from fibromyalgia to migraine headaches to end-of-life patients to kids with life- limiting conditions such as neuromuscular disorders, and pain related diseases such as arthritis, cerebral palsy, etc.
The specially trained physicians at Cook Children’s create a treatment plan that is focused on each particular child and opioids aren’t often the first or only pain medicine used to treat children.
“The danger comes when physicians think the only way they can treat pain is through a narcotic and that’s not the case,” Dr. Gandhi says. “We need to know what type of pain the patient is having and take into account the child’s experience of pain. We are all individuals and no two people react the same way."
Dr. Gandhi says that between 15 to 20 percent of the kids seen at her clinic are on chronic opioids, but they are kids that have life-limiting medical conditions or end- of-life conditions.
The other 80 percent of the pain management patients work with physical and occupational therapists and receive therapies such as massage, biofeedback, cognitive behavioral therapy and acupuncture. Music, art and animal assisted therapies are also available for children. They look at all factors that contribute to the pain experience such as diet, nutrition, sleep habits, stress management and coping mechanisms. They create an environment of integrative health where practitioners and patients work together.
“We need to be much more vigilant on how we treat kids’ pain and how we create centers that address that pain,” Dr. Gandhi says. “If you look in Fort Worth or Tarrant County, there are probably 60 adult pain centers in this area, but for kids there are 35 in the entire country. That’s a huge difference. That perspective is crazy.”