New picture of poisoning

woman taking pills

Paracetamol is the second most common substance involved in calls to Australian Poisons Information Centres, new data show

Research led by Alanna Huynh, a poisons information specialist and research associate at the University of Sydney, used data from call records from all four Australian Poisons Information Centres (PICs) to analyse poisoning exposures by age group, circumstances of exposure, and the types of substances involved.

There were 170,469 calls (including re-calls about an exposure) related to 164,363 poison exposure events in 2015.

Of those:

  • 64.4% were unintentional
  • 18.1% were the consequences of medication error, and
  • 10.7% involved deliberate self-poisoning.

The most common substances involved in exposures overall were household cleaners (10.2%) and paracetamol-containing analgesics (7.3%).

“Most exposures were of 20-74 year-old adults (40.1%) or 1-4 year-old toddlers (36.0%),” Ms Huynh and colleagues wrote.

“Deliberate self-poisoning (49.1%) and hospital referral (23.9%) were most frequent for adolescents.

“Poisoning with over-the-counter medications (including paracetamol and NSAIDs) was common in this group, suggesting that reducing sales of these agents to adolescents would be a useful prevention strategy.”

“High rates of poisoning with antidepressants and antipsychotics indicate that prescribing these agents should be restricted to those most likely to benefit, and their toxicity profile should be considered when prescribing them for adolescents at higher risk of deliberate self-poisoning.

Amongst adolescents, 77% of deliberate self-poisonings, 66% of adverse reactions, and 61% of unintentional exposures were in girls, while 60% of recreational exposures were in boys.

Most calls about exposures of older adults, including adverse reactions (63%), unintentional (61%) and deliberate self-poisoning (55%), food poisoning (91%), and medication errors (68%) were about women; most workplace exposures (69%) involved men.

“Exposures of adults (20-74 years) frequently involved psychotropic pharmaceuticals (17.8%) or painkillers (15.1%). Exposures in adults over 74 were typically medication errors involving cardiovascular (23.6%), anticoagulant (4.6%), or antidiabetic (4.1%) medications.”

Most of the calls about newborn babies (73%), infants (76%), toddlers (78%), and children (63%) were concerning non-medicinal and over-the-counter medicines.

“The proportion of exposures related to prescription items increased with age, from 13% for neonates and 7% for infants to 62% for older adults,” the authors wrote.

“Exposures to substances in Schedules 5–7 constituted the largest single category of unintentional exposures in adolescents (22%), adults (40%), and older adults (31%).

“Unintentional exposures to Schedule 3 (pharmacist-only drugs, such as cold preparations including pseudoephedrine), Schedule 8 (controlled drugs, such as oxycodone), and Schedule 9 (prohibited substances, such as heroin) were the least frequent in all age groups .

“In contrast, deliberate self-poisoning predominantly involved Schedule 4 (prescription-only medicines) and Schedule 2 (pharmacy medicines) items.

“Schedule 8 medications were least often implicated in unintentional and deliberate self poisoning in all age groups, suggesting that scheduling an item as Schedule 8 — with stringent criteria for prescribing, storage and dispensing — is effective in reducing access and poisonings,” they wrote.

Upscheduling alprazolam from Schedule 4 to 8 has reduced the numbers of prescriptions and of PIC calls related to this medicine, the authors wrote.

They called for better quality data on resource use, morbidity and mortality, and for other outcomes of poisoning in Australia.

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