Intentional Ingestion of Substances an Ongoing Threat to Health of Children in the US

Since 2000 in the United States, over 300,000 cases of intentional misuse or abuse of medications or household products occurred among children. These findings were published in Clinical Toxicology.

Investigators from the Oregon Health and Science University sourced data for this study from the US Poison Control Centers. Between 2000 and 2020, incidence of intentional misuse or abuse of substances among children aged 6 to 18 years were evaluated for trends.

A total of 338,727 intentional poisoning cases were reported. The rates fluctuated over time, peaking in 2011. The majority of cases occurred among boys (58.3%) aged 13 to 18 years (>80%).

Stratified by motivation, more poisonings occurred from intentional abuse (57.4%) than from misuse (42.6%).

Most cases occurred after ingestion of a single substance (81.2%), in which the largest number of cases throughout the study period was from dextromethorphan (15.25%), followed by benzodiazepines (7.68%). The investigators did note that ingestion of diphenhydramine has been steadily increasing from 193 cases in 2000 to 668 in 2020 and a similar pattern was observed for marijuana from 510 to 1761 cases in 2000 and 2020, respectively. Conversely, cases of ethanol have been decreasing by 28.1 exposures each year (P <.01).

Stratified by age, the most common substances ingested for ages 6 to 9 years were vitamins, plants, and objects; ages 10 to 12 years were vitamins, marijuana, and melatonin; ages 13 to 15 years were marijuana, diphenhydramine, and benzodiazepines; and ages 16 to 18 years were marijuana, benzodiazepines, and e-cigarettes.

For marijuana specifically, the greatest increase by preparation was dried plant for ages 10 to 12 years, edibles for ages 13 to 15, and edible or concentrated extract for ages 16 to 18 years (all P <.01).

Overall, these ingestions resulted in 450 deaths. The highest mortality rates after ingestion were observed for nonprescription fentanyl (36.2%), synthetic opioids (16.7%), and monoamine oxidase inhibitors (14.3%).

Risk for mortality after ingestion was associated with ingestion of opioids (odds ratio [OR], 15.6; P <.01); abuse compared with misuse (OR, 5.9; P <.01); ingestion at another residence (OR, 2.4), in a public area (OR, 1.8), or other site (1.5) compared with ingestion at own residence (P <.01); ingestion of methamphetamines (OR, 2.5; P <.01); ingestion of multiple substances (OR, 1.6; P <.01); and male gender compared with female gender (OR, 1.4; P <.01).

Lower mortality risk was associated with ingestion at school compared with own residence (OR, 0.1; P <.01), ingestion of dextromethorphan (OR, 0.1; P <.01), ingestion of acetaminophen (OR, 0.2; P <.01), ages 13 to 15 years (OR, 0.4; P <.01), and ingestion of benzodiazepines (OR, 0.7; P =.01).

This study is likely an underrepresentation of misuse and abuse, as reporting to the National Poison Data System is voluntary.

Study authors concluded, “US Poison Centers reported greater than 330,000 misuse and abuse exposure cases and 450 deaths over 20 years for school-aged children and adolescents, demonstrating a substantial ongoing health impact on this vulnerable population. The substances most commonly misused/abused reflect widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth.”