Question: What is the rationale for the 18 years old and greater age for naloxone administration? (i.e. legal, risk factors?)
Great question. This is certainly an issue that is not specific to Naloxone. Generally speaking, the pediatric population is somewhat special in that they are often excluded from drug trials. As a result, it can take years for a drug to be in practice before we start to see good evidence for it in the pediatric population.
We also have to consider the frequency with which these events would occur in the pediatric population. There are many other etiologies that could cause a similar presentation and as such, a patch to the BHP and shared decision making may prevent unnecessary procedures and medications being delivered and other treatments can be prioritized.
Other than accidental ingestions, the other pediatric group to consider would be teenagers approaching adulthood and having increased use of illicit substances. However, these cases are still vastly outnumbered by those seen in the adult population.