Pediatric opioid and cannabis poisoning hospitalizations in the United States, 2016–2022: a national age-matched inpatient analysis

Vollständiger Abstract

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Objective Pediatric poisonings involving opioids and cannabis represent two evolving public health challenges. This study compared national inpatient outcomes, complications, and hospital charges among children and adolescents hospitalized with a principal diagnosis of opioid vs. cannabis poisoning in the United States. Methods We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2022. Children and adolescents aged 0–18 years with a principal diagnosis of opioid or cannabis poisoning were identified using ICD-10-CM codes. National estimates were generated using the NIS discharge weight (DISCWT), with variance estimation accounting for NIS_STRATUM and HOSP_NIS. A 1:1 nearest-neighbor age-matched analysis was performed on the unweighted discharge records before application of the national weights. Survey-weighted logistic regression was used for binary outcomes, and survey-weighted linear regression was used for length of stay and total hospital charges. Multivariable models were adjusted for age, sex, race , median household income quartile, weekend admission, and admission year. Results The study included 17,555 weighted pediatric hospitalizations, comprising 10,780 opioid-related and 6,775 cannabis-related poisonings. The proportion classified as cannabis poisoning increased from 24.0% in 2016 to 47.2% in 2022 (survey-weighted trend odds ratio per year, 1.18; 95% CI, 1.14–1.23; P < 0.001). In the age-matched analysis, opioid poisoning was associated with higher risks of mechanical ventilation for more than 24 h (RR, 3.15; 95% CI, 2.00–4.95), acute kidney injury (RR, 1.58; 95% CI, 1.10–2.25), and respiratory failure (RR, 2.33; 95% CI, 1.25–4.35). In the full multivariable analysis, opioid poisoning remained associated with mechanical ventilation for more than 24 h (aOR, 4.65; 95% CI, 2.96–7.31) and acute kidney injury (aOR, 2.55; 95% CI, 1.77–3.69). Opioid poisoning was also associated with an adjusted increase of 1.06 hospital days (95% CI, 0.78–1.34) and $17,286 in hospital charges (95% CI, $12,752-$21,820). Mortality was not reported comparatively because the unweighted number of events in one exposure group was 10 or fewer. Conclusion Cannabis poisoning accounted for an increasing proportion of pediatric opioid and cannabis poisoning hospitalizations during the study period. Nevertheless, opioid poisoning was associated with greater respiratory morbidity, longer hospitalization, and higher hospital charges. These findings support opioid-related respiratory monitoring and harm-reduction efforts by clinicians and public health agencies, together with child-resistant packaging, safe-storage counseling, and caregiver education for cannabis products.