{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:09:28Z","timestamp":1790744968400,"version":"4.1.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Information about the trend in illicit substance ingestions among young children during the pandemic is limited.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To assess immediate and sustained changes in overall illicit substance ingestion rates among children younger than 6 years before and during the COVID-19 pandemic and to examine changes by substance type (amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids) while controlling for differing statewide medicinal and recreational cannabis legalization policies.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Retrospective cross-sectional study using an interrupted time series at 46 tertiary care children\u2019s hospitals within the Pediatric Health Information System (PHIS). Participants were children younger than 6 years who presented to a PHIS hospital for an illicit substance(s) ingestion between January 1, 2017, and December 31, 2021. Data were analyzed in February 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Absence or presence of the COVID-19 pandemic.<\/jats:p><\/jats:sec>Main Outcome(s) and Measure(s)<\/jats:title>The primary outcome was the monthly rate of encounters for illicit substance ingestions among children younger than 6 years defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification<\/jats:italic> diagnosis code(s) for poisoning by amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids. The secondary outcomes were the monthly rate of encounters for individual substances.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 7659 children presenting with ingestions, the mean (SD) age was 2.2 (1.3) years and 5825 (76.0%) were Medicaid insured\/self-pay. There was a 25.6% (95% CI, 13.2%-39.4%) immediate increase in overall ingestions at the onset of the pandemic compared with the prepandemic period, which was attributed to cannabis, opioid, and ethanol ingestions. There was a 1.8% (95% CI, 1.1%-2.4%) sustained monthly relative increase compared with prepandemic trends in overall ingestions which was due to opioids. There was no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study of illicit substance ingestions in young children before and during the COVID-19 pandemic, there was an immediate and sustained increase in illicit substance ingestions during the pandemic. Additional studies are needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.9549","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T16:56:28Z","timestamp":1682096188000},"page":"e239549","source":"Crossref","is-referenced-by-count":18,"title":["Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic"],"prefix":"10.1001","volume":"6","author":[{"given":"Brittany J.","family":"Raffa","sequence":"first","affiliation":[{"name":"Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill"},{"name":"The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Schilling","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Katherine","family":"Henry","sequence":"additional","affiliation":[{"name":"Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"},{"name":"Clinical Futures, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Ritter","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen E.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie S.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Laub","sequence":"additional","affiliation":[{"name":"Division of Child Abuse Pediatrics, Department of Pediatrics, University of California at San Diego"},{"name":"Department of Pediatrics, University of California San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"key":"zoi230301r1","doi-asserted-by":"publisher","DOI":"10.1177\/23780231211032028","article-title":"The care burden during COVID-19: a national database of child care closures in the United States.","volume":"7","author":"Lee","year":"2021","journal-title":"Socius: Sociol Res Dyn World"},{"issue":"7","key":"zoi230301r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.18223","article-title":"Methadone access for opioid use disorder during the COVID-19 pandemic within the United States and Canada.","volume":"4","author":"Joudrey","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi230301r9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-051001","article-title":"COVID-19 and pediatric ingestions.","volume":"148","author":"Lelak","year":"2021","journal-title":"Pediatrics"},{"issue":"10","key":"zoi230301r12","first-page":"22","article-title":"Achieving data quality. How data from a pediatric health information system earns the trust of its users.","volume":"75","author":"Fletcher","year":"2004","journal-title":"J AHIMA"},{"issue":"9596","key":"zoi230301r14","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"10","key":"zoi230301r15","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.1001\/jamainternmed.2020.3288","article-title":"Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US.","volume":"180","author":"Jeffery","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"23","key":"zoi230301r16","doi-asserted-by":"publisher","first-page":"699","DOI":"10.15585\/mmwr.mm6923e1","article-title":"Impact of the COVID-19 pandemic on emergency department visits \u2014 United States, January 1, 2019\u2013May 30, 2020.","volume":"69","author":"Hartnett","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"zoi230301r17","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3390\/pediatric14010010","article-title":"Impact of the COVID-19 pandemic on the pediatric hospital visits: evidence from the state of Florida.","volume":"14","author":"Symum","year":"2022","journal-title":"Pediatric Reports"},{"issue":"2","key":"zoi230301r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37227","article-title":"Trends in US pediatric hospital admissions in 2020 compared with the decade before the COVID-19 pandemic.","volume":"4","author":"Pelletier","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"8","key":"zoi230301r19","doi-asserted-by":"publisher","first-page":"313","DOI":"10.15585\/mmwr.mm7108e1","article-title":"Pediatric emergency department visits before and during the COVID-19 pandemic: United States, January 2019\u2013January 2022.","volume":"71","author":"Radhakrishnan","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"zoi230301r20","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions.","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"issue":"2","key":"zoi230301r21","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1080\/15563650.2021.1925687","article-title":"Hospital encounters for pediatric ingestions before and during the COVID-19 pandemic.","volume":"60","author":"Schultz","year":"2022","journal-title":"Clin Toxicol (Phila)"},{"issue":"7","key":"zoi230301r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.21776","article-title":"Childcare stress, burnout, and intent to reduce hours or leave the job during the COVID-19 pandemic among US health care workers.","volume":"5","author":"Harry","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi230301r25","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01070-6","article-title":"The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review.","volume":"18","author":"Kotlar","year":"2021","journal-title":"Reprod Health"},{"key":"zoi230301r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.abrep.2021.100388","article-title":"Impact of the COVID-19 pandemic on substance use among adults without children, parents, and adolescents.","volume":"14","author":"Dodge","year":"2021","journal-title":"Addict Behav Rep"},{"issue":"9","key":"zoi230301r27","doi-asserted-by":"publisher","first-page":"5586","DOI":"10.3390\/ijerph19095586","article-title":"At home and on the brink: U.S. parents\u2019 mental health during COVID-19.","volume":"19","author":"Moreland-Russell","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"zoi230301r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108176","article-title":"Signal of increased opioid overdose during COVID-19 from emergency medical services data.","volume":"214","author":"Slavova","year":"2020","journal-title":"Drug Alcohol Depend"},{"issue":"4","key":"zoi230301r29","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-016824","article-title":"Well-being of parents and children during the COVID-19 pandemic: a national survey.","volume":"146","author":"Patrick","year":"2020","journal-title":"Pediatrics"},{"issue":"32","key":"zoi230301r30","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.15585\/mmwr.mm6932a1","article-title":"Mental health, substance use, and suicidal ideation during the COVID-19 pandemic - United States, June 24-30, 2020.","volume":"69","author":"Czeisler","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"5","key":"zoi230301r31","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.5811\/westjem","article-title":"Cannabis in homes with children: a survey on use, storage, and attitudes.","volume":"22","author":"Gimelli","year":"2021","journal-title":"West J Emerg Med"},{"issue":"10297","key":"zoi230301r32","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/S0140-6736(21)01653-6","article-title":"A time of crisis for the opioid epidemic in the USA.","volume":"398","year":"2021","journal-title":"The Lancet"},{"issue":"50","key":"zoi230301r35","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.15585\/mmwr.mm7050e3","article-title":"Trends in and characteristics of drug overdose deaths involving illicitly manufactured fentanyls: United States, 2019-2020.","volume":"70","author":"O\u2019Donnell","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"zoi230301r36","doi-asserted-by":"publisher","first-page":"S621","DOI":"10.1016\/j.ajog.2021.11.1023","article-title":"Trends in maternal polysubstance use during the COVID-19 pandemic (poster).","volume":"226","author":"Vignes","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"zoi230301r37","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1080\/15563650.2021.1939881","article-title":"Pediatric cannabis intoxication trends in the pre and post-legalization era.","volume":"60","author":"Cohen","year":"2022","journal-title":"Clin Toxicol (Phila)"},{"issue":"9","key":"zoi230301r38","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.0971","article-title":"Unintentional pediatric exposures to marijuana in Colorado, 2009-2015.","volume":"170","author":"Wang","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"4","key":"zoi230301r39","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.acap.2021.07.018","article-title":"Recent trends in marijuana-related hospital encounters in young children.","volume":"22","author":"Bennett","year":"2022","journal-title":"Acad Pediatr"},{"key":"zoi230301r2","unstructured":"Teleworking and lost work during the pandemic: new evidence from the CPS. US Bureau of Labor Statistics. 2021. Accessed June 13, 2022. https:\/\/www.bls.gov\/opub\/mlr\/2021\/article\/teleworking-and-lost-work-during-the-pandemic-new-evidence-from-the-cps.htm"},{"key":"zoi230301r3","unstructured":"Igielnik? R. A rising share of working parents in the U.S. say it\u2019s been difficult to handle child care during the pandemic. Pew Research Center. January 26, 2021. Accessed May 30, 2022. https:\/\/www.pewresearch.org\/fact-tank\/2021\/01\/26\/a-rising-share-of-working-parents-in-the-u-s-say-its-been-difficult-to-handle-child-care-during-the-pandemic\/"},{"key":"zoi230301r4","unstructured":"McElrath? K. Nearly 93% of households with school-age children report some form of distance learning during COVID-19. United States Census Bureau. August 26, 2020. Accessed August 8, 2022. https:\/\/www.census.gov\/library\/stories\/2020\/08\/schooling-during-the-covid-19-pandemic.html"},{"key":"zoi230301r5","unstructured":"Labor force statistics from the current population survey. US Bureau of Labor Statistics. Accessed August 8, 2022. https:\/\/www.bls.gov\/cps\/effects-of-the-coronavirus-covid-19-pandemic.htm"},{"key":"zoi230301r7","unstructured":"The impact of COVID-19 on mental, neurological and substance use services: results of a rapid assessment. World Health Organization. October 5, 2020. Accessed March 15, 2023. https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1310579\/retrieve"},{"key":"zoi230301r8","unstructured":"Drug overdose deaths in the U.S. up 30% in 2020. Centers for Disease Control and Prevention, National Center for Health Statistics; July 14, 2021. Accessed March 15, 2023. https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2021\/20210714.htm"},{"key":"zoi230301r10","unstructured":"Poison statistics: national data 2020. Poison Control National Capital Poison Center. 2022. Accessed June 14, 2022. https:\/\/www.poison.org\/poison-statistics-national"},{"key":"zoi230301r11","unstructured":"Leverage clinical and resource utilization data. Children's Hospital Association. Accessed August 13, 2022, https:\/\/www.childrenshospitals.org\/content\/analytics\/product-program\/pediatric-health-information-system?"},{"key":"zoi230301r13","unstructured":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. 2022. Accessed March 15, 2023. https:\/\/www.equator-network.org\/reporting-guidelines\/strobe\/"},{"key":"zoi230301r22","unstructured":"Stress in America. One year later, a new wave of pandemic health concerns. 2021. Accessed March 15, 2023. https:\/\/www.apa.org\/news\/press\/releases\/stress\/2021\/sia-pandemic-report.pdf"},{"key":"zoi230301r23","unstructured":"Our COVID-19 pulse survey data. HRSA Maternal and Child Health Bureau. 2021. Accessed March 15, 2023. https:\/\/mchb.hrsa.gov\/covid-19\/data"},{"key":"zoi230301r33","unstructured":"Drug overdose deaths in the U.S. top 100,000 annually. National Center for Health Statistics. 2021. Accessed March 15, 2023. https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2021\/20211117.htm"},{"key":"zoi230301r34","unstructured":"Trends and statistics overdose death rates. National Institute on Drug Abuse. Accessed January 20, 2023, https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2804094\/raffa_2023_oi_230301_1681485526.43637.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T16:56:44Z","timestamp":1682096204000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2804094"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,21]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.9549","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,21]]}}}