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Objective: To assess the association of the COVID-19 pandemic with pediatric poison exposures with a focus on unintentional exposures associated with exploratory behavior among children <6 years old., Methods: An interrupted time series analysis was conducted to evaluate the association of the pandemic with poison exposures among youth <20 years old. Exposures reported to US poison centers (PCs) from 1 March 2017 through 28 February 2020 (pre-pandemic) compared with 1 March 2020 through 28 February 2021 (pandemic) were analyzed., Results: From March 2017 through February 2021, there were 5,244,684 exposures reported to US PCs involving youth <20 years old. There was a 6.0% decrease in poison exposures among youth <20 years old reported to US PCs from pre-pandemic (annual average) to pandemic periods, and there were 93,336 (95% CI: 92,738-93,937) fewer exposures than expected among these individuals during March 2020 through February 2021. Unintentional poison exposures associated with exploratory behavior among children <6 years old accounted for 91.4% of exposures in this age group, and although there were 17,207 (95% CI: 16,951-17,466) fewer of these exposures than expected during the pandemic period, these exposures initially increased during the first two months of the pandemic before decreasing., Conclusions: The COVID-19 pandemic was associated with changes in poison exposure patterns among youth <20 years old, resulting in a decrease in the number of exposures reported to US PCs during the first pandemic year. Exposure patterns changed with progression from the initial months of the pandemic to later months and varied by age group and reason for exposure. Unintentional poison exposures associated with exploratory behavior among children <6 years demonstrated an increase during the initial first two months of the pandemic before decreasing. Understanding these patterns will help guide an appropriate response to similar future public health events.

Purpose: To study cosmetics and personal care products-related ocular exposures in the United States., Methods: A retrospective analysis of cosmetics and personal care products-related ocular exposures from 2000 through 2018 was conducted using data from the National Poison Data System., Results: From January 2000 through December 2018, United States Poison Control Centers received 266,743 calls concerning eye exposures to cosmetics and personal care products, corresponding to a mean of 14,039 calls per year. Young children (<6 years old) represented 51.6% of exposures, while older children and teenagers (6-19 years old) and adults (≥ 20 years old) represented 19.5% and 28.9% of exposures, respectively. Over the study period, the annual frequency of exposures decreased by 46.0%. The product subcategories associated with the highest proportion of exposures were perfumes, colognes, and aftershaves (19.0%), suntan and/or sunscreen products (11.2%), nail polishes (9.5%), soaps (6.3%), and creams, lotions, and make-up (5.8%). The product subcategories associated with the greatest proportion of moderate or major medical outcomes were acrylic nail adhesives (14.4%), miscellaneous nail products (12.9%), other hair care products excluding peroxides (10.9%), hair coloring agents excluding peroxides (8.9%), and peroxides (7.5%)., Conclusions: Although the annual frequency of exposures to cosmetics and personal care products declined during the study period, public health efforts are needed to prevent further ocular exposures to these products. Containers of potentially ocular-toxic products should be redesigned to reduce confusion with eye dropper bottles and to reduce attractiveness to young children, with immediate priority placed on acrylic nail adhesives.

Context/objective: This study investigates characteristics of suspected suicides and nonfatal suicide attempts involving antidepressants among individuals 13 years and older reported to US poison control centers from 2000-2020., Methods: Data from the National Poison Data System were retrospectively analyzed., Results/discussion: There were 744,853 suspected suicides and nonfatal suicide attempts among individuals 13 years and older involving antidepressants as the first-ranked substance during the study period. Teenagers accounted for 28.6% of cases and females represented 68.7% of cases. From 2000-2019, the rate of calls received by US poison control centers for suspected suicides and nonfatal suicide attempts involving antidepressants per 100,000 US population 13 years and older increased from 17.4 to 28.4 ( p  < 0.0001); however, teenagers experienced the largest increase in rate from 30.4 in 2000 to 83.3 in 2019, with a rapid rate increase beginning in 2011. Individuals 60 years and older were more likely to be admitted to a health care facility than teenagers (OR: 2.18, 95% CI: 2.12-2.25). A serious medical outcome was documented in 36.3% of cases, with death occurring in 0.2% of cases. A serious medical outcome was more than twice as likely (OR: 2.57, 95% CI: 2.51-2.64) and death was 16 times more likely (OR: 16.19, 95% CI: 13.29-19.73) to occur among individuals 60 years or older than teenagers. SSRIs were most often involved (41.0%) in cases; however, TCAs had the largest proportion of serious medical outcomes (59.8%). TCAs were more likely to result in a serious medical outcome (OR: 4.36, 95% CI: 4.29-4.43) or death (OR: 12.56, 95% CI: 10.91-14.46) than SSRIs., Conclusions: The increase in the rate of suspected suicides and nonfatal suicide attempts involving antidepressants reported to US poison control centers, particularly among teenagers, emphasizes the need for increased prevention efforts. The greater severity of medical outcomes among older adults also warrants attention.

Objective: To investigate characteristics of cocaine exposures reported to US Poison Control Centers. Methods: Data from the National Poison Data System regarding cocaine-related calls to regional poison control centers from January 1, 2000 to December 31, 2020 were analyzed. Results: There were 59,466 first-ranked cocaine-related calls managed by poison control centers during the study period. Males accounted for more than two-thirds (70.3%) of these cases. The 20-29-year-old age group had the highest cocaine exposure rate, followed by 30-39-year-olds. Admission to a health care facility (HCF) occurred in 38.9% of cases and 41.1% of individuals had a serious medical outcome. Serious medical outcome (OR: 1.50, 95% CI: 1.39-1.61) and admission to a HCF (OR: 1.12, 95% CI: 1.06-1.19) were more likely to occur among individuals 13 years or older than among individuals <13 years old. Cocaine exposures involving additional substances were more likely to lead to a serious medical outcome (OR: 2.22, 95% CI: 2.14-2.29) and admission to a HCF (OR: 2.52, 95% CI: 2.43-2.61) than exposures to cocaine alone. Overall, the proportion of exposures resulting in a serious medical outcome increased from 39.9% in 2000 to 60.4% in 2020 ( p  < 0.0001). Likewise, the proportion of exposures resulting in admission to a HCF increased from 49.1% in 2000 to 54.4% in 2020 ( p  < 0.0001). There was also an increase in the rate of fatal cocaine cases from 2012 to 2020, driven by multiple-substance exposures. Conclusions: Cocaine exposures are a serious public health problem associated with substantial morbidity and mortality. The severity of cocaine exposures increased during the study period, reflected in an increased rate of fatal cocaine exposures since 2012 and increased proportions of serious medical outcomes and cases requiring admission to a health care facility. Additional efforts to prevent initiation of cocaine use and treat addiction among high-risk groups should be undertaken.

Objective: To investigate characteristics and trends of methamphetamine exposures reported to United States (US) poison control centers., Methods: Data from the National Poison Data System were analyzed., Results: From January 1, 2000 through December 31, 2019, US poison control centers managed 54,199 cases involving methamphetamine as the first-ranked substance. Adults 20-39 years old accounted for more than half (56.3%) of cases. There were 1,291 deaths, of which 43.0% involved multiple-substance exposures. Among multiple-substance exposures in which methamphetamine was the first-ranked substance, stimulants and street drugs (excluding methamphetamine) were most commonly also present (22.7%), followed by opioids (19.0%). The substance class associated with the most fatalities was opioids ( n  = 243, 26.6%). The rate of methamphetamine exposures per 100,000 US population increased from 0.6 to 1.1 from 2000-2005, then decreased from 1.1 to 0.4 from 2005-2007, followed by an increase from 0.4 to 2.6 from 2007-2019. From 2007-2019, the rate significantly increased in all US regions, and among all age groups, except among 6-12-year-olds. Also, the rates of single-substance and multiple-substance exposures each increased significantly (both p  < 0.0001) from 2007-2019, as did the overall methamphetamine fatality rate per 100,000 US population (0.0036 to 0.022, p  < 0.0001). From 2000-2019, the proportions of cases resulting in admission to a health care facility and serious medical outcome increased from 30.2% to 47.8% ( p  < 0.0001) and from 37.6% to 54.0% ( p  < 0.0001), respectively., Conclusions: The rate of exposure to methamphetamine in the US declined initially following passage of the Combat Methamphetamine Epidemic Act of 2005. However, since 2007, the rate and severity of exposures to methamphetamine have increased, primarily driven by individuals 20 years or older. Increased prevention efforts are needed, including prevention of methamphetamine initiation among adolescents and young adults, improved access to effective treatment for co-occurring mental health and substance use disorders, and prevention of unintentional exposures among children.

Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10-25 years old from 2000 to 2018. Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10-25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics. Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10-25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10-12, 13-15 and 16-18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10-15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19-25 year-old age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10-18 years during the traditional non-school months of June-August compared with September-May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19-21 years, and there was an increase during summer months in the age group 22-25 years. Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.