Pediatric Drug Overdose Mortality: Contextual and Policy Effects for Children Under 12

BACKGROUND: We determine trends in fatal pediatric drug overdose from 1999 to 2018 and describe the influence of contextual factors and policies on such overdoses. METHODS: Combining restricted CDC mortality files with data from other sources, we conducted between-county multilevel models to examine associations of demographic and socioeconomic characteristics with pediatric overdose mortality and a fixed-effects analysis to identify how changes in contexts and policies over time shaped county-level fatal pediatric overdoses per 100,000 children under 12. RESULTS: Pediatric overdose deaths rose from 0.08/100,000 children in 1999 to a peak of 0.19/100,000 children in 2016, with opioids accounting for an increasing proportion of deaths. Spatial patterns of pediatric overdose deaths are heterogenous. Socioeconomic characteristics are not associated with between-county differences in pediatric overdose mortality. Greater state expenditures on public welfare (b=−0.099; CI:[−0.193,−0.005]) and hospitals (b=−0.222; CI:[−.437,−.007]) were associated with lower pediatric overdose mortality. In years when a Good Samaritan law is in effect, the county-level pediatric overdose rate was lower (b=−0.095; CI:[−0.177,−0.013]). CONCLUSIONS: Pediatric overdose mortality increased since 1999, peaking in 2016. Good Samaritan laws and investment in hospitals and public welfare may temper pediatric overdoses. Multi-faceted approaches using policy and individual intervention is necessary to reduce pediatric overdose mortality.