Widening access to buprenorphine/naloxone for the treatment of opioid addiction has brought with it an increase in accidental consumption by young children. CDC researchers speculated that the type of drug packaging might affect the incidence rate. To explore, they studied pediatric emergency department (ED) visits for buprenorphine/naloxone ingestions both before and after unit-dose, child-resistant pouches were introduced in late 2010. This packaging—which encloses each tablet or film strip until opened—was standard on most prescriptions by 2013–15, whereas multi-dose bottles of tablets—which had to be secured after each use—were the norm from 2008–10. Based on data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project, the investigators estimated that unintended buprenorphine/naloxone ingestions triggered 8,136 ED visits by children aged 6 years or younger during the study period. The pace of ED trips from 2008–10 declined by about 65% to 2013–15, indicating that unit-dose, child-resistant formulations reduced but did not eliminate pediatric ingestions. Part of the reason, the researchers believe, is that unit-dose packaging became less prevalent starting at the end of 2013 as generic versions of buprenorphine/naloxone hit the market in tablet form in multi-dose bottles. Should the trend shift back to this type of packaging, they conclude, it will be critical to track pediatric ingestions and to make changes if the data reflect an increase.
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