Opioid addiction is not just a problem among adults in the United States. A new study shows that an increasing number of children seen in the emergency department (ED), more than 100 each day, test positive for opioid addiction or dependency.

“We think, in all honestly, that this is probably just the tip of the iceberg, because we have only looked at this through the lens of the ED,” Dr. Veerajalandhar Allareddy from University of Iowa Stead Family Children’s Hospital noted in an interview with Reuters Health. These are children and adolescents who came to the ED for any cause, and “for whatever reason, the physician was concerned enough about the potential for opioid abuse or dependence that they test them. So the number could be much larger if physicians don’t suspect it,” he said.

Dr. Allareddy presented the study September 18 at the American Academy of Pediatrics (AAP) National Conference in Chicago, Illinois.The researchers analyzed data from the Nationwide Emergency Department Sample, the largest all-payer ED database in the United States. During the study period (2008-2013), 257,165 ED visits with opioid dependence or abuse diagnosis codes were made by individuals age 21 or younger.

The number of pediatric patients testing positive for opioid addiction or dependency in the ED jumped between 2008 and 2013, from 32,235 to 49,626. The vast majority of these visits involved individuals age 18 to 21 (88 percent), with about 8 percent made by those age 16 to 17. Males made up more than half of the visits (56 percent).

“About 117 children test positive for opioid abuse or dependence every day across emergency departments in the United States,” the authors report in their meeting abstract. “In our opinion, this is a pediatric public health crisis,” Dr. Allareddy said in a conference news release.

After the ED visit, 31 percent of children were admitted as inpatients. “What we don’t know is whether they were admitted because of the opioid abuse or because of what they came to the ED for, such as trauma. And for the two thirds who were discharged, was there sufficient follow-up for their opioid abuse? We don’t know,” Dr. Allareddy told Reuters Health.

“This was intended to be an exploratory study, one that we hope will help alert the public, researchers, and policymakers of the need to fully define and address this important, emerging public health problem among children in the United States,” he added in the release.