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By Alan Mozes
Health Day Reporter
WEDNESDAY, December 28, 2022 (HealthDay News) — When a toddler or infant accidentally ingests a prescription opioid drug, the immediate consequences can prove fatal, experts warn.
But another worrying new dynamic is afoot in the United States, a just-released study reveals: pediatric poisoning by a particularly deadly combination — a powerful synthetic opioid known as fentanyl and a powerful veterinary tranquilizer known as xylazine.
“Infants or young children exposed to fentanyl are life-threatening,” even without the added threat of xylazine, said lead author Dr. Stephanie Deutsch, medical director of the Nemours CARE program at Nemours Children’s Health in Wilmington, Delaware.
In both children and adults, fentanyl rapidly slows both breathing and heart rate while inducing an altered state of mind.
And in the world of overdose deaths, that risk is becoming increasingly common, the new study authors pointed out. While exposure to fentanyl alone accounted for 14% of overdose deaths in the United States in 2010, that number rose to nearly 60% by 2017.
The good news: If children or adults with fentanyl poisoning are offered quick access to the opioid overdose drug naloxone, it’s often possible to prevent potentially fatal cardiac arrest, Deutsch said.
The bad news: Xylazine isn’t an opioid, and there’s no known antidote or drug to reverse its effects, she said.
While xylazine can provide significant pain relief and muscle relaxation when treating large animals (such as cattle and horses), an adult or child exposed to xylazine-opioid combinations can experience severe respiratory and central nervous system depression and cardiovascular effects do not respond to naloxone, Deutsch noted.
On the street, the xylazine-opioid combination is commonly sold as “Anastesia de Caballo” (horse tranquilizer), “Tranq,” or “sleep cure,” noted Deutsch and her Nemours colleague and co-author Dr. Allan De Jong.
The combination is increasingly sought after by recreational drug users looking for a sustained and euphoric high despite the risks.
A database of fatal drug overdoses in 38 states and Washington, DC, cited by Deutsch and De Jong, shows that the search has become more important.
Since 2019, adult opioid overdose deaths laced with xylazine — a drug that has been around since 1962 but was never approved for human use — have been on the rise.
Opioid xylazine intoxication in infants and young children is a different matter, the study authors pointed out.
By definition, such children are unwitting victims, poisoned due to the negligence or poor decisions of adult caregivers who bring the deadly combination into the home.
Three recent cases cited in the new study make the point in chilling detail.
One involved a 15-month-old boy who went into cardiac arrest after going limp and blue in a car seat after exposure to the deadly drug couple, believed to be via his mother, who nearly died from similar exposure a week earlier.
Another involved a 7-month-old boy who collapsed after being exposed to a parental hideout.
And a third involved a 19-month-old boy who went into cardiac arrest while strapped into a car seat, likely due to parental exposure.
On the one hand, Deutsch said, “infants and young children’s developmental curiosity and hand-mouth behaviors make them vulnerable to accidental, exploratory ingestion and exposure,” which is facilitated by close proximity to parental care. Most pediatric fentanyl xylazine overdoses are accidental, she added.
But there are cases where caregivers intentionally give an infant or child the drug combination to “change behavior.”
In all three cases cited in the study, the children survived after treatment in the emergency room. “(But) some infants have died from xylazine exposure,” noted Deutsch.
So what can you do?
“Families and carers should always ensure that medications and other items that could be harmful to children are kept in elevated places – preferably in locked cabinets,” said Dr. Danielle Orsagh-Yentis. She is an assistant professor in the Department of Pediatrics at Vanderbilt University in Nashville, Tennessee, which reviewed the new study results.
“If anyone believes that his or her child may have ingested such a substance, he or she should contact the Poisons Center immediately,” she added.
Deutsch agreed that caregivers should take steps to keep the opioid/sedative out of the reach of children.
From a broader perspective, Deutsch suggested that the risk of pediatric poisoning could be reduced by ensuring that adults with a known substance use disorder are referred to treatment programs and receive help to manage their addiction.
The results were published online in the journal on December 23 paediatrics.
More information
To learn more about parental substance abuse and the risk it poses to children, visit the US Substance Abuse and Mental Health Administration (SAMHSA).
SOURCES: Stephanie Anne Deutsch, MD, MS, FAAP, Medical Director, Nemours CARE Program, Nemours Children’s Health, Wilmington, Delaware; Danielle Orsagh-Yentis, MD, Assistant Professor, Pediatrics, Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, Tennessee; paediatricsDecember 23, 2022, online
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