Abstract
Background
Intentional substance abuse by adolescents is common, can have serious consequences, and includes a wide variety of substances such as prescription medications (Rx), over-the-counter medications (OTC), and non-drug substances. Previous literature published in 2013 focused on Rx and OTC intentional abuse exposures reported to US Poison Control Centers (PCCs). This study describes the trends in demographics, substance(s), and medical outcomes of intentional substance abuse exposures by adolescents aged 11-18 reported to US Poison Control Centers (PCCs) from 2013-2018.
Methods
A retrospective review of intentional substance abuse exposures by adolescents aged 11-18 years old reported to PCCs from 2013-2018 was performed. Exposures were excluded if the following medical outcomes were coded: a) confirmed non-exposure and b) unrelated effect- the exposure was probably not responsible for the effects. This study was reviewed by our institutional review board and deemed non-human subject research. Statistics were descriptive in nature and performed by Microsoft Excel and SPSS.
Results
A total of 64,131 exposures were identified after exclusion criteria was applied. The average number of substances involved in an exposure was 1.3 (SD 0.73). The median patient age was 16 years (IQR 15-17 years), and the mean patient age was 15.8 years [SD 1.6]. The sample was 36.4% female.
Pharmaceutical and illicit drugs were the most common substances abused by adolescents during the study period and included benzodiazepines (n=5,594, 8.7%), ethanol (beverages) (n=5,163, 8.0%), dextromethorphan preparations (not otherwise classified) (n=4725, 7.4%), marijuana: dried plant (n=4,346, 6.8%), and synthetic cannabinoids, analogs and precursors (n=3,735, 5.9%).
The number of exposures that included a non-drug substance was 5,217 (8.1%). The most common non-drug substances were freon and other propellants (n=793, 1.2%), hand sanitizers: ethanol based (n=436, 0.68%), plants: hallucinogenic (n=368, 0.57%), gasolines (n=303, 0.47%), mouthwashes: ethanol containing (n=217, 0.34%), other chemicals (n=247, 0.39%). Non-drug substances were involved in more than 20% of exposures in patients 11 and 12 years old (28%, 20% respectively) compared to less than 10% in patients 14 years and older.
The most common medical outcomes, accounting for 74.6% of all exposures, were moderate effect (n=21,109; 32.9%), minor effect (n=20,164; 31.4%), and unable to follow, judged as a potentially toxic exposure (n=6,592; 10.28%). The most common outcome for ages 11-15 years old was minor effect (range 28.1-33.8%). The most common outcome for ages 16-18 years old was moderate effect (range 34.3-36.5%).
Overall 141 (direct and indirect) fatalities were reported. The most common single substance exposures resulting in death were fentanyl (prescription) (n=14, 0.02%), hallucinogenic amphetamines (n=9, 0.01%), miscellaneous unknown drugs (n=6, 0.009%), ethanol (beverages) (n=5, 0.008%), and heroin (n=5, 0.008%).
Conclusion
The most common substances involved in adolescent intentional abuse exposures reported to US PCCs included benzodiazepines, dextromethorphan preparations (not otherwise classified), and ethanol (beverages). As patient age increased, exposures to non-drug substances decreased and exposures to pharmaceuticals increased. Additionally, as patient age increased, medical outcomes increased in severity.
Responses
Nice work Sawyer. Who do you think might be some appropriate organizations to share your data with and what sort of action would you recommend that they take?
That’s a great question Dr. Witt.
I would share this information with law enforcement agencies and pharmacy chains, and here’s why. Despite novel psychoactive substances becoming available in the last decade, the trends seen here match what the data shows from previous studies: most of the substances that are abused are OTC and prescription drugs. I would encourage these organizations to become consistent locations that drugs can be disposed of safely. Tomorrow is National Drug Take Back Day, and having additional drop off locations for the day is a good thing. That being said, I suspect that as we make it consistently easier for the general public to discard these substances, there is likely to be less of these medications available and less potential for abuse and harm.
Great job, Sawyer! And good answer to Dr. Witt’s question 🙂
Thanks Amber!
Oh my gosh this is an eye opener. Thanks.
Thanks for checking it out!
Sawyer, beautiful research and poster. Also, your answer to Dr. Witt’s question seems so correct. I would imagine that parents learning the results of your research would be eye-opening for them and perhaps lead to greater motivation to remove unused medications from the home. Is there a plan for the PCC, for example, to distribute your findings in their news letters and public outreach?
I hadn’t considered the having the poison center make the results available in resources adapted to the general public. That being said, it seems like an excellent idea and one to investigate because I agree with you: with more education I suspect more people will be motivated to dispose of unused medications. Thanks Dr. Keefe!
Great job!
Excellent job, Sawyer! Obviously as I continue to gain experience at UPCC these sorts of questions come up, so it is fascinating to see the data and trends placed to the speculations I have had as a PIP.
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