# Intoxication in Children From Opioids Prescribed to Family Members

## TL;DR

Children living in households where family members recently filled opioid prescriptions face a higher risk of opioid-related death and serious events compared to unexposed children.

## Contribution

This study quantifies the increased risk of pediatric opioid intoxication associated with family members' opioid prescriptions using a large, population-based case-control design.

## Key findings

- Children with family members who filled opioid prescriptions had nearly 4-fold higher odds of opioid-related death compared to unexposed children.
- Odds of any serious opioid event were 3-fold higher in children exposed to opioids compared to unexposed children.
- The association remained robust in stratified and sensitivity analyses, indicating consistent risk across subgroups.

## Abstract

Are children living in households of family members who recently filled an opioid prescription at increased risk of opioid-related death and other serious opioid events (SOEs)?

In this 27-year, population-based case-control study of 3 761 618 children in Denmark, the odds were nearly 4-fold higher of opioid-related death and nearly 3-fold higher of any SOE among children whose family members filled an opioid prescription in the prior 3 months compared with children in unexposed households, and the odds were also higher compared with children exposed to nonopioid analgesics.

This study suggests that opioids prescribed to household family members are associated with a markedly increased risk of fatal and nonfatal opioid intoxication in children; mitigation strategies may include improved prescribing stewardship and caregiver education to reduce pediatric intoxication.

Worldwide, 480 000 deaths are attributable to opioids annually. The risk that they pose to children through family members’ prescriptions is unknown.

To quantify the association between opioid prescriptions dispensed to a household family member and a serious opioid intoxication event (SOE) in a child.

This case-control, population-based study used data from Denmark’s comprehensive nationwide longitudinal prescription and health care registries over a 27-year period from April 1, 1995, to June 30, 2022. Among 3 761 618 Danish residents younger than 20 years, cases were individuals who experienced an SOE. For each case, there were 10 matched population-based controls without a prior SOE. Household family members were individually linked to case and control participants. Statistical analyses were performed between August 2024 and January 2025.

An analgesic prescription filled by a household family member within 3 months before a child’s SOE. The study included 3 categories of children whose family members were (1) exposed to prescription opioids, (2) exposed to nonsteroidal anti-inflammatory drugs (NSAIDs), and (3) unexposed.

SOE, defined as death, hospitalization, or emergency department visit due to opioid intoxication. The incidence rate ratio of SOEs among children whose family members redeemed an opioid prescription was compared with those in unexposed households and with those whose family members filled NSAID prescriptions. Conditional logistic regression was used to compute adjusted odds ratios (AORs), controlling for potential sociodemographic and mental health confounders. Subsequently, analyses were stratified by sex, age brackets (<13 vs ≥13 years), SOE calendar year, and hospital disposition. Finally, a sensitivity analysis was conducted restricting the interval between prescription dispensing and the SOE to 1 month.

A total of 2000 children (median age at SOE, 17.8 years [IQR, 15.7-19.0 years]; 1096 boys [54.8%]) experienced an SOE and were matched with 19 840 controls (median age at index, 17.7 years [IQR, 15.6-19.0 years]; 10 872 boys [54.8%]). Among 2000 cases, 1116 (55.8%) were hospitalized and 60 (3.0%) died. Having a family member fill an opioid prescription (319 cases and 1137 controls) was associated with increased odds of an SOE compared with unexposed children (1398 cases and 16 181 controls; AOR, 2.87; 95% CI, 2.45-3.38) and with children exposed to NSAIDs (283 cases and 2522 controls; AOR, 2.22; 95% CI, 1.81-2.72). Odds of an opioid-related death were nearly 4-fold higher compared with unexposed children (15 cases and 33 controls vs 42 cases and 496 controls, respectively; AOR, 3.70; 95% CI, 1.55-8.84). The association remained robust in stratified and sensitivity analyses.

This study suggests that children of family members prescribed opioids had increased odds of opioid intoxication–related death and other SOEs compared with children of unexposed families or those exposed to nonopioid analgesics. Public health strategies to mitigate the opioid crisis should consider unique pediatric aspects that can reduce the likelihood of pediatric SOEs.

This case-control study of more than 3 million Danish residents quantifies the association between opioid prescriptions dispensed to a household family member and a serious opioid intoxication event in a child.