Drugs of abuse continue to have a significant impact on healthcare utilization in the pediatric population. The pediatric hospitalist should consider drugs of abuse in the differential diagnosis of any patient who presents with altered mental status (hallucinations, stupor, coma), abnormal motor activity (tremor, seizure), or behavioral disturbance (agitation, outburst, withdrawal, depression, suicidal or homicidal ideation).
Each fall, the American Association of Poison Control Centers publishes its annual summary of poisoning exposures reported to its member centers. In 2011, there were a total of 2.3 million exposures reported, 1158 of which led to a fatality.1 Of these fatalities, 41 (3.5%) involved a child (<20 years of age) who intentionally abused (alone or in combination with other substances) cannabinoids, hallucinogens, inhalants, narcotics, or stimulants (Table 169-1).
TABLE 169-1Drugs of Abuse (Intentional) in Pediatric Fatalities Reported to US Poison Centers, 2011 |Favorite Table|Download (.pdf) TABLE 169-1 Drugs of Abuse (Intentional) in Pediatric Fatalities Reported to US Poison Centers, 2011
|Class ||Substances ||Fatalities ||Age Range (yr) |
|Cannabinoids || |
|2 ||18-19 |
|Hallucinogens || |
Chlorpheniramine + Dextromethorphan
Other cough/Cold preparations
|3 ||15-19 |
|Inhalants || |
Air freshener (aerosol)
|4 ||8-17 |
|Narcotics || |
|24 ||13-19 |
|Narcotics plus Stimulants || |
Amphetamine (bath salts) + opioid
Heroin + cocaine
Methadone + cocaine
Morphine + methamphetamine
Morphine + MDMA
|6 ||18-19 |
|Stimulants || |
|2 ||18-19 |
Another annual resource is the National Institute on Drug Abuse’s Monitoring the Future surveys of eighth-, tenth-, and twelfth-grade students conducted to gauge trends in drug use as well as levels of perceived risk and disapproval among these children. First performed in 1975, the most recent of these extensive studies is in the public domain and posted on the organization’s website.2 The 2012 survey reached 45,000 students in 395 secondary schools. Compared to the prior year’s survey, there were no significant changes in the rate of use of most illicit drugs; however, there were statistically significant declines in the use of ecstasy (MDMA) and heroin (without a needle). Prescription narcotic analgesics are a class of significant concern, although the data have indicated a slight decrease in the use of Vicodin (hydrocodone/acetaminophen) and OxyContin (controlled-release oxycodone).
Initial assessment of a patient who may have been exposed to any drugs of abuse follows the principles outlined in Chapter 165. Reassessment should occur periodically, even in patients who appear to be stable on initial evaluation; if drug absorption and distribution are not complete at the time of presentation, the clinical condition may worsen with the passage of time.
After the initial assessment, the hospitalist should attempt to elicit a complete ...