Overview

A poison is any substance that is harmful to your body when ingested (eaten), inhaled (breathed), injected, or absorbed through the skin. Any substance can be poisonous if enough is taken. For this reason, poisoning implies that too much of some substance has been taken. This definition does not include adverse reactions to medications taken correctly.

Poisonings are either intentional or unintentional. Intentional poisoning is the result of a person taking or giving a substance with the intention of causing harm. Suicide and assault by poisoning fall into this category.  If the person taking or giving a substance did not mean to cause harm, then it is an unintentional poisoning. Unintentional poisoning includes the use of drugs or chemicals for recreational purposes in excessive amounts, such as an overdose. It also includes the excessive use of drugs or chemicals for nonrecreational purposes, such as by a toddler. When the distinction between intentional and unintentional is unclear, poisonings are usually labeled undetermined in intent.

Occurrence  

• In the United States in 2003, 5,543 (19.3%) of the 28,700 poisoning deaths in the United States were intentional; 5,462 were suicides and 81 were homicides.
• In 2004, intentional poisoning led to about 279,802 emergency department (ED) visits; 272,275 involved self-harm and 7,527 were assaults.
   
  • Among these intentional poisoning ED visits, 203,849 (72.8%) resulted in hospitalization or transfer to another facility.

• Self-harm poisoning was the second-leading cause of ED visits for intentional injury in 2004.
• That same year, poison control centers reported 205,455 cases where the reason for poison exposure was suspected suicide attempt or assault.   

Unintentional

• In 2003, 19,457 (67.8%) of the 28,700 poisoning deaths in the United States were unintentional, and 3,700 (12.9%) were of undetermined intent.
• Unintentional poisoning was second only to motor vehicle crashes as a cause of unintentional injury death that same year.
• In 2004, unintentional poisoning caused about 577,886 emergency department (ED) visits.
• Almost 25% of these unintentional ED visits resulted in hospitalization or transfer to another facility.
• In 2004, poison control centers reported about two million unintentional poisoning or poison exposure cases. 

Most common poisons

Intentional

• In 2003, 71.2% of poisoning suicides were caused by drugs both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications. Most nondrug-related suicides were due to carbon monoxide from motor vehicle exhaust. 
   
• Most nonfatal, poison-related suicide attempts involved prescription drugs. Among the 121,585 drug-related suicide attempts in the United States in 2004, pain medications, sedatives and hypnotics, and antidepressants were the most common drugs taken. Among pain medications, opioids were the most widely used, while benzodiazepines were the most common sedatives.

Unintentional

• In 2003, drugs caused 94.3% of the unintentional and undetermined poisoning deaths. Opioid pain medications were most commonly involved, followed by cocaine and heroin.
• Nonfatal poisonings treated in emergency departments that involve accidentally taking prescription or over-the-counter drugs primarily affect children. Among such incidents in 2004, pain and cardiovascular medications, antidepressants, and sedative/hypnotics were most commonly ingested. Acetaminophen-containing drugs, nonsteroidal anti-inflammatory drugs, and opioids were the leading types of pain medications.
• Among those treated in EDs for nonfatal poisonings involving intentional, nonmedical use (such as misuse or abuse) of prescription or over-the-counter drugs in 2004, benzodiazepines and opioid pain medications were used most frequently.

Costs

• In 2000, poisonings led to $26 billion in medical expenses and made up 6% of the economic costs of all injuries in the United States.
• Males accounted for 75% of the total costs of poisoning injuries ($19 billion).
• Females accounted for 25% of the total costs of poisoning injuries (almost $7 billion).

Groups at Risk

Intentional

Among those who commit suicide by poisoning:

• men are 1.3 times more likely than women;
• whites are 3.6 times more likely than blacks; and
• the peak age is 45-49 years old. 

Among those who intentionally harm themselves with poison, receive treatment in emergency departments, and survive:

• women are 1.7 times more likely than men; and
• the peak age is 15-19 years old, and rates decline steadily as age increases.

Unintentional

Among those who die from unintentional poisoning:

• men are 2.1 times more likely than women;
• Native Americans have the highest death rate;
• whites and blacks have comparable rates; the peak age is 40-44 years of age; and
• the lowest mortality rates are among children less than 15 years old.

Among people who unintentionally poison themselves, receive treatment in emergency departments and survive:

• men are 1.5 times more likely than women;
• the highest rates are in the 40-44 year old age group, closely followed by the 0-4 and the 85 years and older age groups.