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Childhood Poisoning Safeguarding Young Children from Addictive Substances

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Childhood Poisoning Safeguarding Young Children from Addictive Substances Childhood Poisoning Safeguarding Young Children from Addictive Substances April 2018 Board of Directors (as of January 2018) Ursula M. Burns Doug Morris Chairman, VEON Ltd. Chairman, Sony Music Entertainment Columba Bush Caroline Netchvolodoff Former First Lady of Florida Vice President, Council on Foreign Relations Joseph A. Califano, Jr. James G. Niven, Co-Chairman Founder and Chairman Emeritus Founder, Jamie Niven LLC Kenneth I. Chenault Manuel T. Pacheco, Ph.D. Chairman and Managing Director, President Emeritus, University of Arizona and the General Catalyst Partners University of Missouri System Creighton Drury Herbert Pardes, M.D. President Executive Vice Chairman of the Board of Trustees, Victor F. Ganzi New York-Presbyterian Hospital Chairman of the Board PGA Tour Joseph J. Plumeri, Executive Chairman Melinda B. Hildebrand Vice Chairman of the Board, First Data Corporation Vice Chair, Hildebrand Foundation and James M. Ramstad Executive Chair, Episcopal High School, Former Member of Congress (MN-3) Houston, TX Michael I. Roth Gene F. Jankowski Chairman and CEO, The Interpublic President, CBS Broadcasting, Retired Group of Companies, Inc. Jeffrey B. Lane Louis W. Sullivan, M.D. Partner, YorkBridge Wealth Partners President Emeritus, Morehouse School of Medicine Rev. Edward A. Malloy, CSC Clyde C. Tuggle President Emeritus, University of Notre Dame Co-Founder, Pine Island Capital Partners Nelle P. Miller Elizabeth Vargas Managing Director and Head of New York City Co-Anchor, ABC 20/20 for JPMorgan Private Bank Directors Emeritus Samuel A. Ball, Ph.D. (2014-2017) Vincent A. LaPadula (2012-2016) Lee C. Bollinger (2001-2017) LaSalle D. Leffall, Jr., M.D., F.A.C.S. (1992-2001) James E. Burke (1992-1997) Alan I. Leshner, Ph.D. (2007-2015) Jamie Lee Curtis (2001-2009) Bruce E. Mosler (2009-2012) Jamie Dimon (1995-2009) Nancy Reagan (1995-2000) Peter R. Dolan (2002-2013) Shari E. Redstone (2003-2012) Mary Fisher (1996-2005) Linda Johnson Rice (1992-1996) Betty Ford (1992-1998) E. John Rosenwald, Jr. (1992-2017) William H. Foster, Ph.D. (2010-2013) George Rupp, PhD (1993-2002) Douglas A. Fraser (1992-2003) Peter Salovey, PhD (2015-2017) Ralph Izzo, Ph.D. (2011-2014) Mara Sandler, M.A., Ed.M. (2012-2016) Barbara C. Jordan (1992-1996) Michael P. Schulhof (1994-2012) Leo-Arthur Kelmenson (1998-2006) Michael I. Sovern (1992-1993) Donald R. Keough (1992-2010) John J. Sweeney (2002-2014) David A. Kessler, M.D. (1998-2012) Frank G. Wells (1992-1994) Jeffrey B. Kindler (2011-2015) Michael A. Wiener (1997-2009) Copyright ©2018. All rights reserved. May not be used or reproduced without the express written permission of The National Center on Addiction and Substance Abuse. Table of Contents Introduction Pg 4 6. Illicit Drugs Pg 68 7. Explaining Unintentional 1. Nicotine Pg 7 Pediatric Exposures Pg 78 8. Recommendations Pg 20 2. Alcohol and Conclusions Pg 90 3. Caffeine Pg 25 Appendix Pg 99 4. Prescription Drugs Pg 37 Notes Pg 101 5. Marijuana Pg 55 CHILDHOOD POISONING Introduction The opioid crisis has brought renewed attention to natural curiosity and explorative tendencies of babies the varied groups of people tragically affected by and toddlers, presents a potentially fatal scenario. substance use and addiction, and the complex and multifaceted set of strategies needed to control this Available data on pediatric exposures to addictive health emergency. This crisis is occurring against a substances likely underestimate the prevalence of this backdrop of increasing availability of prescription and public health issue. Incidents of exposure often go illicit opioids, which has been well documented,1 but unreported due to a variety of factors, including a fear also other addictive substances, especially marijuana, by caregivers of being held responsible or legally liable, nicotine, and caffeine products. Aside from higher and a lack of recognition that the incident is potentially odds of addiction and the adverse health and social dangerous to the child and may require professional effects associated with greater population-wide intervention. The ways in which exposure incidents are ‡ accessibility to addictive substances, a significant but tracked also contribute to their underestimation. The less recognized consequence is the risk to young majority of information that is available on pediatric children who inadvertently handle or ingest these exposures to and poisoning from addictive substances highly toxic substances. comes from data reported by local and state poison control centers, which receive calls from parents, In 2016,* an estimated 30,520 exposures to a range caregivers, and sometimes health professionals seeking of addictive substances† among children aged 5 and advice in the wake of a suspected exposure. However, younger were reported to poison control centers in the with the advent of the Internet and its unlimited United States. Symptoms from such exposures range resources for learning about the risks and symptoms from mild to severe, and because young children’s of exposure to toxic substances, fewer people call brains and bodies are undergoing rapid development, in to ask questions or report an incident, especially if they are especially sensitive to the toxins contained the symptoms do not appear to be particularly severe in these substances. Despite this, the myriad ways in or life threatening. Indeed, while the total number which young children are vulnerable to unintentional of reported exposures and deaths among young exposure to potentially toxic addictive substances are children has declined or remained stable over the past underappreciated and often overlooked in discussions 20 years, the number of reported cases with serious of the perils of substance use and addiction. consequences has increased.3 The danger to young children of rising availability of addictive substances is highlighted by the current opioid crisis, since one of its many tragic * The most recent year for which comprehensive data from the American consequences has been the proliferation of dangerous Association of Poison Control Centers’ (AAPCC) National Poison Data System drugs in many homes -- homes in which caregivers’ (NPDS) are available. (Please see the Appendix for more information about the AAPCC and its data). abilities to monitor and supervise their young children might be compromised by drug use.2 Even in homes † Addictive substances included in the estimate are nicotine and tobacco products, alcoholic beverages, caffeine, controlled prescription drugs where adults or teens do not use illicit drugs, the (select opioids, central nervous system stimulants, and central nervous system depressants), marijuana, and other illicit drugs (heroin, cocaine, presence of unsecured addictive products like liquid methamphetamines, hallucinogens, and club drugs). nicotine, alcoholic drinks, caffeinated energy drinks, ‡ Please see the Appendix for a more detailed description of the challenges or prescription pain medications, combined with the of interpreting and extrapolating from the data available from poison control centers, as collected by the AAPCC through the NPDS. INTRODUCTION 4 CHILDHOOD POISONING Despite the obstacles to collecting reliable data on the unintentional exposures among young children -- and prevalence of such incidents, recent developments the associated health consequences -- is too high to in the proliferation of certain types of addictive continue to be overlooked amid the growing public substances have raised renewed concern about the awareness around the costs and consequences of growing risk of pediatric exposures. For example: substance use and addiction. • Inconsistent regulation of non-cigarette nicotine We know that children exposed to toxic addictive products like e-cigarettes has been associated with a substances are at increased risk for other injuries and significant increase in the risk of nicotine exposures, life challenges, and that their families are prime targets with more than half involving children aged 5 and for early, health-promoting interventions. We know younger.4 that unintentional poisonings are largely preventable. • The well-documented increase in the use and misuse We know that the best outcomes can be achieved of prescription pain relievers in the U.S. was met with when a comprehensive approach is taken, in which a 93 percent annual rate increase in unintentional parents, other family members, educators, health exposures* among children aged 5 and younger professionals, policymakers, and the manufacturers between 2000 and 2009. As prescribing practices and distributors of these products all do their part to are being reined in and public attention drawn to the ensure that no child accesses, touches, or ingests opioid crisis, this trend in childhood exposures to potentially toxic addictive substances. On a positive prescription opioids is beginning to reverse.5 note, there is increasing movement toward enacting evidence-based practices that can protect children, • The legalization of medical and/or recreational such as requiring enhanced child safety packaging for marijuana has been associated with a 148 percent certain addictive products. Furthermore, the near- increase between 2006 and 2013 in the rate universal concern for babies’ and young children’s of marijuana exposures among children aged welfare presents a compelling window of opportunity 5 and younger.6 The growing popularity of for delivering effective prevention messages to the marijuana edibles -- many of which are virtually public
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