More children and teens are arriving in U.S. emergency rooms dependent on or addicted to opioids, HealthDay reports.

Almost 50,000 ER patients ages 21 and younger were diagnosed with opioid dependence or addiction in 2013, up from 32,200 in 2008, according to a study presented at the annual meeting of the American Academy of Pediatrics.

“It was very concerning to see that by the last year we studied, an average of 135 children each day were testing positive for opioid addiction or dependency in emergency departments,” study co-author Veerajalandhar Allareddy, MD of the University of Iowa said in a news release. “In our opinion, this is a pediatric public health crisis.”