Pediatric emergency medicine trisk 3137 3137

Epidemiology of use of specific substances varies over time and by
geographical region.
Illicit drug adulteration is not uncommon, and thus patients may not be
using the substance that they think they are using.
Given the limitations of history and laboratory testing in this patient
population, careful clinical assessment and recognition of toxidromes
are crucial in guiding management.

Current Evidence
As a special category of pediatric toxicology, exposures to psychoactive drugs are
outlined in this section. In addition to the classic substances of abuse, it is
important to remember that misused and abused substances also include
prescription medications (notably ADHD medicines and opioids), OTC
medications, herbal products, supplements, and emerging synthetic agents. Three
distinct pediatric age groups may be at risk from exposures related to substance
use: (i) The adolescent or preadolescent who use drugs for their mind-altering
effects; (ii) the neonate who is exposed to substances during gestation and
manifests signs of intoxication or abstinence after birth; and (iii) the infant or
toddler who becomes exposed to drugs of abuse through either active
administration by a caregiver (chemical child abuse), the ingestion of a drug left
in an accessible place in their environment, or passive exposure created by being
in an environment where drugs of abuse are used (e.g., marijuana, cocaine,
phencyclidine [PCP], methamphetamine) or manufactured. In any of these
circumstances, the exposure can be sufficient to produce severe intoxication.
Thus, knowledge of the epidemiology and manifestations of substance use
becomes important in the management of children of all ages.