Who Ya Gonna Call? The AAPCC for all Poison Problems.

1-800-222-1222 is a number we should all have memorized. Why? It is the American Association of Poison Control Center's (AAPCC) phone number. 

Picture by Allison Cook. The homepage of the American Association of 
Poison Control Center (AAPCC).

According to AAPCC's 2015 Annual Report, from 2000 to 2015 the poison centers have logged 18,324,650 information calls. 2015 alone had 560,467 calls and of those, 34.96% were under a category known as Drug ID. Interestingly, though, this popular call type has actually seen a decline since mid-2008. It is good to note that these numbers include both calls about humans as well as animals. 

Of the human exposures, the call data is broken down even further by age and gender. 47.63% of the exposures were males, and just over half, 51.54% of the males were children, which are defined by the AAPCC as humans under the age of 19. On the other hand, 51.85% of the exposures were females, but only 48.04% were children. Overall, children five and younger were roughly half, 46.9%, of all human exposures. 

The majority of these human exposers, 87.2%, were acute cases. This means that the subject was exposed to the toxin either once, repeatedly or continuously for less than 8 hours. Chronic, meaning repeated or continuous exposure for more than 8 hours, exposures made up 2.05% and acute-on-chronic exposures, single exposure followed by a repeated, continuous, or intermittent exposure for more than 8 hours, made up 9.35%.

Now that the breakdown of the calls has been presented, we can start to break down the data in a different way: why were these people exposed? The largest reason was unintentional exposure, 78.4%. This can be broken down further by general, therapeutic, misuse, environmental, bite or sting, occupational, food poisoning, and unknown. The most common of the unintentional was "general," 52.5, followed by therapeutic at 12.7% and misuse at 6%. After unintentional, the intentional exposures contributed 17.6% of the cases and Adverse Reaction contributed 2.4%. Under 1% of the reasons was unknown reasoning (0.8%), malicious (0.3%), contamination or tampering (0.3%) and withdrawal (0.1%).

If we cross the reason with the age, we will find that the majority of unintentional cases, 62.16%, occurred with children 5 and younger. The majority of intentional cases occurred in adults, or people 20 and up. In fact, with all other reasons except unintentional, the majority of cases happened to adults.  

The most common route of exposure in humans was ingestion, making up 79.56% of all routes and 83.63% of all cases. Next was dermal making up 6.62% and 6.96%, respectively, and inhalation or nasal came in a close third making up 6.01% and 6.32%. 

Finally, the data can be broken down by scenario, "of therapeutic error regardless of reason" (pg. 937). The most common scenario was inadvertent double-dosing at 30.1%. Among that 30.1 percent, 59.16% were adults 20 and up. The second most common scenario was incorrect medication given or taken making up 14.6% of cases, and 60.5% of these cases were adults 20 and up. While the scenario "confused units of measure" comes in eighth, it was the most common for children 5 years or younger. 

So, what can be done to bring the numbers of exposures down, especially in children? The AAPCC has eight alerts, or categories, of important information on their home page. Below is the alert title, a couple quick facts from that alert's page and a direct link to the page.

Photo by Allison Cook. The main page of the alerts. These alerts are the
most up-to-date information and issues faced by the population when 
dealing with poison. 

1. "Bath Salts" - Also known as "Cloud 9" and "Bliss." Not actually bath salts, but instead powerful, untested illegal drugs. In 2016, 382 exposures were reported to poison centers. The most common age group among these exposures was young adults in their 20s. http://www.aapcc.org/alerts/bath-salts/

2. "Current Annual Report Highlights" - just a quick fact sheet of 2014's annual report. http://www.aapcc.org/alerts/current-annual-report-highlights/

3. "E-Cigarettes and Liquid Nicotine" - Mostly concerned with children 6 years or younger being exposed to these substances and becoming very sick. There are proactive recommendations on how to keep children and pets from being exposed to these harmful substances. http://www.aapcc.org/alerts/e-cigarettes/

4. "Food and Mushroom Poisoning & Recalls" - Food poisoning is caused by food that infectious organisms contaminated and either they or their toxins are ingested. The contamination can happen at any point between production and serving. The Centers for Disease Control and Prevention (CDC) estimate roughly 48 million Americans will get sick from food poisoning. http://www.aapcc.org/alerts/food-poisoning-recalls/

5. "Hand Sanitizer" - There is a large concern with children ingesting hand sanitizers and becoming at risk of alcohol poisoning. It is recommended only a dime-sized drop is applied and the sanitizer is rubbed in completely, leaving hands entirely dry. http://www.aapcc.org/alerts/hand-sanitizer/

Photo by Allison Cook. It is recommended to only use a dime-sized drop of
hand sanitizer and rub it completely dry into your hands. Also, keep an eye 
on children when they are using hand sanitizers to ensure they do not ingest 
it. When not using, keep out of their reach.

6. "Laundry Detergent Packets" - Also a concern with children, but in this case ingesting the highly concentrated liquid packets.  In 2016, 11,528 exposures to children 5 years and younger to these packets were reported to poison control center. http://www.aapcc.org/alerts/laundry-detergent-packets/

Photo by Allison Cook. A Tide Pod is just one of the many
types of laundry detergent packets. While they may be
handy for a quick load, they are highly concentrated and
can be harmful to children.

7. "Opioid (Narcotic) Pain Medications" - Opioids are medicines that are pain relievers. The CDC reported 28,000 deaths in 2014 from these. CDC also has determined that the U.S. is in the middle of a "prescription painkiller overdose epidemic." http://www.aapcc.org/alerts/opioids/

8. "Synthetic Cannabinoids" - More commonly known as "synthetic marijuana," this illegal substance is anything but marijuana. The chemicals found in the substance are made to be abused and, therefore, are extremely addictive. In 2016, there were an estimated 2,695 exposures called into the poison centers. http://www.aapcc.org/alerts/synthetic-cannabinoids/

Aside from becoming informed about the different and current toxic issues we are facing, it is also important for us to be aware of the most common substances that the AAPCC gets calls for. This is important because by being aware of these we can be more focused on preventing these exposures from happening. 

In the 2015 annual report, there is a list of "the most common 25 substance categories," (pg. 941). The most frequent substance involved in human exposures was analgesics, or painkillers, which made up 11.11% of all substances and 9.55% of single substance exposures. Coming in second was "Cleaning Substances (Household)" and "Cosmetics/Personal Care Products" came in third. The substance with the "greatest rate of exposure increase" (942), was "Sedative/Hypnotics/Antipsychotics."

Above all, it is critical to keep any item or substance that could cause harm to children out of their reach and to read instructions on both medications for you and for children carefully. And remember, if there is an incident of poisoning or you are unsure if someone has been poisoned, call 1-800-222-1222.