Most deaths due to opioid poisoning in children and teenagers were observed in those aged between 15 and 19 years old (Table 1). The seventeen deaths in the 15 to 19 year old group are the lift-off to the rising curve of deaths by opioids, and deaths in the 10 to 14 year old age group also increased over the study period. This may indicate that the upswing of deaths due to opioid poisoning starts in these younger age groups and justifies the need for early recognition, support, and dedicated services for teenagers. The 15 to 19-year-old age group includes young adults, given that a child is defined as a person under the age of 16 years by the Children Acts of Scotland and England. Young adults are a particularly vulnerable group meriting specific care as they transition across from paediatric to adult services. There is a decreasing rate of deaths due to opioid poisoning in children aged one to nine years old, which could be the result of various factors such as: like prescription patterns; support programmes for parents; child protection processes; and primary schools’ roles; and education about drug safety.
After adjustment per capita, another small peak was revealed involving children under one year old. Although there were only three deaths in the study period in this age group, this finding merits specific discussion. Infants develop fine motor skills during the first year of life: at five months old, an infant develops a palmar grasp, with a neat pincer grip developing by about at ten months old [4]. Gross motor milestones see the development of crawling and pulling to standing at nine months old and independent walking from nine to 18 months old [4]. These very limited developmental abilities of infants under the age of one year old raise questions as to how they reached, picked up, and ingested opioid preparations, particularly as these are dispensed in childproof containers. The recommendation arising from this study is that all deaths in under one-year olds warrant comprehensive investigation with emphasis on safeguarding issues.
Some caution must be expressed in the conclusions of this study as the age of the person receiving an opioid prescription is unknown. Additionally, without access to post-mortem results, it is impossible to confirm that a particular prescribed medication is the same as that involved in an individual poisoning. Other limitations are inherent within the data sources, including inaccurate recording or underreporting of deaths by opioid poisoning. Finally, an important limitation is the relatively low number of opioid poisoning in children and teenagers (at least in comparison to adults), challenging any multivariable modelling and also analysis of evolution over time. Moreover, four data points are a limited number to detect a change over time. The reasons for this choice are as follows: First, the data transmitted by the ONS have been aggregated on an annual basis only. Second, in an average year of study, if it were 14 deaths, it could be a significant number of months without deaths, indicating an excess of “zeros”, as well as “overdispersion” (variance greater than the mean), violating two assumptions of the Poisson regression, which is why we completed the analysis with a linear regression, to try to unmask the temporal trends. Although there are caveats to the conclusions reached by this study, one could argue that all these deaths in children and teenagers are preventable, and continued surveillance is necessary, in parallel with specific support services for these vulnerable age groups. To be more specific, future work could include a case-by-case study, to help understand how each death happened. This would be important for solving problems, which may or may not be similar for different age groups.
