Poisoning is among the leading causes of death worldwide, defined as someone being exposed to a substance — such as drugs or alcohol — that can damage or endanger their health.
In the United States, poisoning is recognized as the leading cause of death from injury by the Centers for Disease Control and Prevention; the majority of incidents are caused by drugs.
But two studies published Monday have revealed the extent of the problem in the United Kingdom, particularly among teenagers and toddlers, highlighting ways for health services to better target those most at risk of poisoning themselves.
Troubled teens
Researchers at the University of Nottingham found a steep rise in the number of deadly and non-deadly poisonings among teenagers in the UK over the past 20 years. The study found a 27% increase in the number of cases between 1992 and 2012, particularly among teenage girls, who had more than double the number of poisonings reported among males.
“We know that poisonings worldwide are among the most common causes of death among young people,” said Dr. Edward Tyrell, who led the study. In this age group, poisonings are often related to self-harm and the underlying mental health issues that can lead to it. “In the UK, there are no specific monitoring mechanisms to see how things change over time,” he said.
The team analyzed data from almost 1.3 million anonymous records of 10- to 17-year-olds submitted by general practitioners to the Health Improvement Network between 1992 and 2012. It found 17,862 reported poisonings — almost 1.4% — among that population.
The greatest increase was among teenage girls: Intentional poisonings among 16- to 17-year-olds and alcohol-related poisonings among 15- to 16-year-olds approximately doubled in number. In contrast, intentional poisonings were 80% lower among boys, highlighting the need to focus on females wanting to harm themselves.
“Self-harm is a sign of emotional distress, an indication that something else is wrong rather than a disorder itself,” said Alys Cole-King, consultant psychiatrist and Royal College of Psychiatrists spokeswoman on suicide and self-harm. “It is a way of coping with difficult or intolerable emotions and situations. For each person, the underlying reasons are different.”
For this reason, it’s crucial to know how to spot the range of factors associated with someone considering harm.
“We wanted to identify the young people at most risk,” Tyrell said. “If you don’t know who they are, it’s hard to target them most appropriately.”
Teenagers from the most deprived areas were also at greater risk of poisoning themselves. Teens from the most poverty-stricken areas were two to three times more likely to poison themselves than teenagers from the least deprived areas included in the study.
Links between poor health and poverty are widely acknowledged, and one key finding of the study was that links between poisonings and poverty didn’t change at all over the 20-year period.
“There is an ethical concern that this has not improved over time,” said Tyrell. “If we could be doing things differently in areas where rates are highest, we could bring it down to the rates of less deprived communities.”
The team believes that actual numbers of poisonings are likely to be higher than observed, as not all cases will have been reported to health practitioners. However, an increase in people’s tendency to report poisonings and improved record-keeping are also likely to be behind part of the increase seen over time.
“Every young person considering self-harm or suicide needs to know they can be supported through tough times,” Cole-King said. “They need a safety plan with details of what they can do to help themselves and who they can contact for support.”
Tyrell added that people should be looking out for anyone at risk. “We hope that parents, youth services and schools can be more aware and (highlight) when they have concerns.”
Accidents among toddlers
A separate study by researchers at Great North Children’s Hospital in Newcastle upon Tyne in the UK revealed another group at risk of poisoning: toddlers. This time, however, the predominant causes were unintentional.
Although deaths, and severe side affects, from prescription drugs are rare among toddlers, the team set out to identify when cases are more serious in order to better tailor methods to prevent them.
“Harm has reduced in this age group in the last 30 years, but there is still some harm occurring,” said Mark Anderson, a pediatric consultant who led the research. Hospital admissions among preschoolers fell by 20% between 2000 and 2011.
Of the unintentional drug poisonings identified in the study, more than half were due to toddlers having ingested methadone, the main drug prescribed for opiate substitution therapy.
“If you know the biggest cause of harm, that’s where you can make the biggest difference,” Anderson said. “It’s worth seeing what happens when it is serious and what causes it.”
Anderson’s team analyzed national data on childhood poisonings as well as hospital treatments of children admitted into intensive care for accidental poisoning between 2001 and 2013. During this period, 28 children died as a result of unintentional poisoning from a prescribed drug, 16 (57%) of which were due to methadone. In addition, 201 children were admitted into intensive care from accidental poisoning, with the majority of poisonings caused by tranquilizers used to treat anxiety and sleeping problems, methadone and other opiates.
Methadone’s long-lasting course of action is what puts toddlers at increased risk if they consume it. The team suggests that people on an opiate substitution therapy be urged to store their medication safely.
“A child will have gotten hold of the medication which was accidentally left out … or having rifled through a handbag,” for example, Anderson said.
He also hopes to use evidence from studies such as these to inform pharmaceutical companies to better supply child-resistant packaging.
Both studies highlight the ease with which poisonings can take place right in front of you. If correct attention isn’t given to protect those most at risk, then services and measures aren’t in place to help the people in most need, in the UK and beyond. “These poisonings are preventable,” Tyrell said.