Opioid addiction is a big problem in the United States. Drug overdose is the leading cause of accidental death, with 52,404 lethal drug overdoses in 2015 in the U.S. And opioid addiction is driving the epidemic, with 20,101 overdose deaths related to prescription pain relievers, compared to 12,990 overdose deaths related to heroin.

Although alcohol and cigarette abuse is far more prevalent among teens, as of 2014, about a half-million adolescents reported using prescription drugs for nonmedical purposes. Such drug use is a gateway to heroin, as 4 out of 5 heroin users report having started with opioid prescription drugs often obtained from friends.

The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007.

That's a lot of numbers, but the bottom line is the opioid epidemic knows no age limits. In fact, an increasing number of children who are addicted to opioids are arriving at emergency departments (EDs).

Data from the Nationwide Emergency Department Sample — the largest all-payer ED database in the U.S. — showed that 257,165 visits to EDs by children up to 21 years of age were dependent on opioids, and these numbers may not be completely accurate because only the providers who thought to screen for opioid use were taken into account.

The data, which did account for those who entered through a different route, showed that the number of ED visits by patients 21 years of age and younger for any reason who were diagnosed with addiction or dependency on opioids — including pain killers as well as illicit drugs such as heroin — rose from 32,235 in 2008 to 49,626 in 2013.

Veerajalandhar Allareddy, M.D., MBA, medical director of the pediatric intensive care unit at the University of Iowa Stead Family Children's Hospital, performed a retrospective analysis of the 2008-2013 ED data. He recently shared those findings in a letter to the editor in the journal Pediatric Research.

Allareddy found that an alarming average of 135 children had tested positive for opioid addiction or dependency in EDs. After the ED visit, 31 percent of children had been admitted as inpatients.

Children living in high-income households were more likely to have been hospitalized rather than routinely discharged, while uninsured patients were less likely to be hospitalized, suggesting that household income was predictive of hospital admission.

For whatever reason, the physicians in this study were concerned enough about the potential for opioid abuse or dependence to test the children who arrived at the ED, so the number could have been much larger if physicians were unsuspecting.

Allareddy is calling this a pediatric public health crisis. Because most children are unlikely to verbalize an opioid problem, he recommends that more testing be performed on ED pediatric patients, including basic questions geared to uncover addiction issues, followed by appropriate testing. He also suggests that these questions should be asked during primary care visits.