Evidence Summary on the Prevention of Poisoning in Canada PARACHUTE AND INJURY PREVENTION CENTRE, UNIVERSITY OF ALBERTA JULY 23, 2020 Suggested citation: Jiang A, Belton, KL, & Fuselli P (2020). Evidence Summary on the Prevention of Poisoning in Canada. Parachute: Toronto, ON. ACKNOWLEDGEMENTS Working collectively on a collaborative project is very rewarding. The process brings together individuals from different organizations who occupy a wide range of roles. Together, the following advisors have generously contributed their time and expertise to the creation of this paper, and we extend our sincerest gratitude. Felix Bang, Public Health Agency of Canada James Hardy, Health Canada Minh Do, Health Canada Richard Wootton, Health Canada Lisa Belzak, Public Health Agency of Canada Steven McFaull, Public Health Agency of Canada Xiaoquan Yao, Public Health Agency of Canada Laurie Mosher, IWK Poison Centre Dr. Nancy Murphy, IWK Poison Centre Sandra Newton, Child Safety Link Guillaume Bélair, Centre Antipoison du Quebec Dr. Maude St. Onge, Centre Antipoison du Quebec Anna Leah Desembrana, Ontario Poison Centre Dr. Margaret Thompson, Ontario Poison Centre Sandra Padovani, Parachute Kelley Teahen, Parachute Cara Zukewich, Saskatchewan Prevention Institute Colleen Drul, Injury Prevention Centre George Frost, Injury Prevention Centre Patricia Chambers, PADIS Jane Huang, PADIS Dr. Mark Yarema, PADIS Victoria Wan, BCCDC Dr. Roy Purssell, BC Drug and Poison Information Centre Dr. Ian Pike, BC Injury Prevention Research & Prevention Unit Fahra Rajabali, BC Injury Prevention Research & Prevention Unit Evidence Summary on the Prevention of Poisoning in Canada ACKNOWLEDGEMENT | 1 TABLE OF CONTENTS Executive Summary . 3 Current Poisoning Prevention Initiatives . 42 Surveillance and Surveillance Systems ....... 42 Purpose . 4 Public Health Agency of Canada ........ 42 Introduction . 5 Toxicovigilance Canada ................ 43 Canadian Surveillance System for Poison Definition Of Poisoning . 6 Information (CSSPI) .................... 44 Poison Prevention Week ................... 45 Poison Centres In Canada . 7 Toxicovigilance canada’s Public outreach History ................................... 7 and Communication Working Group ........ 45 Canadian Poison Centres .................... 7 Canadian Collaborating Centres on Injury Prevention ......................... 45 Canadian Association of Poison Control Centres ........................... 7 Parachute’s #PotcanPoisonkids Program .... 46 Product Formulations Database .............. 8 Government of Canada: Federal Actions on Opioids ................. 46 Populations At Risk . 9 Remaining Challenges . 47 Pediatric, Youth and Young Adults ........... 9 National Poison Centre Access .............. 47 Older Adults ............................. 10 Products Database ........................ 47 Intentional Self-Harm Poisonings ........... 10 Integrated Surveillance Systems ............. 47 Indigenous Peoples .........................11 Emerging Poisoning Issues ................. 47 The Impact Of Poisonings In Canada . 12 Recommendations And Future Steps . 48 Methodology ............................. 12 Advocating for Best Practices ............... 49 Deaths ................................... 13 Access to Canadian-Specific Hospitalizations .......................... 16 Product Information ....................... 49 Emergency Department Visits .............. 19 Understanding Emerging Issues ............ 49 Canadian Hospitals Injury Reporting and Carbon Monoxide Detectors ................ 50 Prevention Program (CHIRPP) .............. 22 National Leadership ....................... 50 Calls to Canadian Poison Centres ........... 23 Limitations of Poisoning Data .............. 25 Conclusion . 50 Economic Burden of Unintentional Poisonings in Canada ................................ 26 Appendices . 51 A: Poison Control Centres ................. 51 Emerging Poisoning Issues . 27 B: Data Sources and Methodology ........... 52 Cannabis ................................. 27 C: Top Causes for Poison Centre Calls ........ 53 Opioids and Illicit Drugs ................... 28 D: Undetermined Poisonings ............... 55 E-Cigarettes and Vaping ................... 30 Laundry Detergent Pods ................... 32 References . 58 Poisoning Prevention Best Practices . 33 Poison Centres ............................ 34 Legislation and Policy ..................... 35 Safer Medication and Substance Packaging ... 35 Safe Storage .............................. 36 Carbon Monoxide Detectors ................ 37 Interventions for Poisonings due to Illicit Drug Use ................................ 40 Raising Awareness and Educating .......... 41 Evidence Summary on the Prevention of Poisoning in Canada TablE OF CONTENTS | 2 EXECUTIVE SUMMARY Poisoning represents a major cause of mortality unintentional poisoning hospitalizations remained and morbidity in Canada and around the quite similar from 2008 to 2014; however, rates world. Furthermore, poisonings account among males in the later end of the observed time for a significant number of hospitalizations period increased compared to females. and an even greater number of emergency department visits each year in Canada. While Available data from emergency departments in it is important to recognize that poisonings two Canadian provinces (Alberta and Ontario) can occur in individuals from all walks of demonstrate a gradual increase in visits due to life regardless of age, sex or socioeconomic both unintentional and intentional poisonings, status, certain populations have been identified with the rate of unintentional poisonings being through research and surveillance as being at more than double that of intentional self-harm an elevated risk for poisoning. These include poisonings in 2018 (Figure 9). pediatric, youth and young adults, older adults Based on data from five Canadian poison and Indigenous peoples. centres that collectively serve 11 provinces and Data indicate that deaths due to unintentional territories (British Columbia, Yukon, Alberta, poisonings have shown a marked increase from Saskatchewan, Northwest Territories, Nova 2008 to 2018, with a peak observed in 2017 Scotia, Prince Edward Island, Ontario, Manitoba, (Figure 3). Comparatively, poisoning deaths due Nunavut, and Québec), 209,534 cases were to suicide have shown a modest decrease during opened in 2018 to local poison centres, which the same time period. When poisoning deaths are averages to 574 cases per day. analyzed by sex (Figure 4), mortality rates among Over the past decade, there has been an males are consistently higher than females for emergence of several issues that have produced both unintentional and intentional poisoning changes in the trends associated with poisoning. deaths during the available time period. The legalization of cannabis, the opioid crisis and Importantly, the mortality rate for unintentional the introduction of new products such as laundry poisonings among males more than tripled detergent pods have resulted in an increase in from 2008 to 2017, and the bulk of the observed calls to poison centres, emergency responses and increase in unintentional poisoning deaths are the healthcare system as a whole. among males as opposed to females. The age groups with the highest observed mortality rate Using an evidence-informed approach in due to unintentional poisonings were individuals prevention planning ensures that the use of ages 30 to 49 (Figure 5). Individuals ages 40 to different types of evidence occurs at more than 64 had the highest mortality rates from suicide one point in the planning process (MacKay poisoning (Figure 5). 2005). Knowledge of this process is essential in order to ensure a plan has real impact and uses Data on rates of hospitalization due to scarce resources effectively. There are essential poisonings indicate that unintentional poisoning components that need to be considered, which hospitalizations have shown a steady increase include: using the best available research; from 2008 to 2018 (Figure 6). Hospitalization considering the local health issues and local rates for intentional self-harm poisonings context; using existing public health resources; were consistently higher than unintentional and understanding the community and political poisonings but did not show a clear trend during climate (National Collaborating Centre for the observed time period. When analyzing data Methods and Tools, 2013; Brownson et al., 2009; between males and females (Figure 7), rates for Saunders et al., 2005; Ciliska et al., 2010). Evidence Summary on the Prevention of Poisoning in Canada EXECUTIVE SUMMary | 3 Over the past decade, there has been increased across all age groups to inform current and activity in the field of poison prevention and future prevention initiatives. Recent statistics the theme woven throughout all activity is and analyses are provided to reflect the growing collaboration. We are collaborating to create magnitude of the issue, as well as discussion and launch a new surveillance system along of emerging issues, poisoning prevention best with supporting working groups, taking practices and current poisoning prevention collective action on public awareness efforts initiatives across the country. through Poison Prevention Week, integrating professionals who are focused on prevention Broad recommendations are made from the and treatment of those affected by poisoning and evidence gathered as well as proposed actions. supporting government action on issues such