Opioid exposures in children under 5 years of age (2004–2019): a retrospective study of calls to Australia's largest poisons information centre

Aim: To describe time trends in opioid exposures in children under 5 years, and to describe patient demographics, the medicines involved, the reasons for exposure and disposition.

Methods: A retrospective analysis of paediatric (<5 years of age) opioid exposure calls to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004–2019. Joinpoint regression analysis was used to examine temporal trends.

Results: There were 4807 cases of paediatric opioid exposure during the 16 year study period, with an average of 300 exposures per year. Exposures increased, 2004–2007, with an annual percentage change (APC) of 14.6% (95% CI = 4.3 to 26.0%), then decreased, 2007–2016, APC −3.4% (95% CI = −5.3 to −1.3%). A steeper decrease was observed after 2016, APC −14.1% (95% CI = −21.8 to −5.6%). The overall APC was −2.3% (95% CI = −4.7 to 0.2%), 2004–2019. Accidental exposures accounted for 86% of calls (4137). The majority of calls were from family members regarding exposures that happened at home, highlighting the need for safety initiatives. The preparations most frequently involved were paracetamol/opioid combination products (primarily codeine), 53% (2566) and ibuprofen/opioid combinations 14% (650). Twenty-two percent of cases were referred to a hospital (1062), and a further 15% (719) of calls originated from hospital staff.

Conclusion: Opioid exposures in young Australian children continue to occur; however, the rate has declined since 2007. Safe storage and parent education initiatives could further reduce the burden of paediatric opioid poisoning in Australia.