An Understanding of Poison Control Centers Medication Mistakes Including Opioids

Awareness, Prevention, ResourceLenys Klumpp B.A.

Government and Community Relations Coordinator

Florida’s Poison Control Centers

This presentation is intended to:

Introduce poison control centers and

its services.

Increase awareness of common poisonings.

Identify most common fatal

poisoning.

Learn life saving poison prevention

strategies.

Identify Challenges for Poison Control

Centers.

Value poison control as a community resource.

Created in statute FS 395.1027; Florida’s three poison centers function under the aegis of

CMS/DOH

FPICN-Jacksonville and Data Center services provided by UF Health –

Jacksonville and the University of Florida College of Medicine

FPICN- Tampa services provided by Tampa General Hospital (Florida Health

Science Center, Inc.)

FPICN-Miami-services provided by UM/Miller School of Medicine and Jackson

Health System

North Florida – Jacksonville PIC

East coast counties – Jacksonville PIC

Central Florida – Tampa PIC

South Florida – Miami PIC

Counties Served by the FloridaPoison Information Centers (PIC)

A Statewide Network

Understanding Poison Control CentersA Brief History

After W.W.ll new drugs and chemicals entered the U.S

market. This caused an increase in childhood

accidental poisoning, as well as adult intentional poisoning.

In 1953 the first poison control center was established in

Chicago. Calls to poison control centers were from doctors

seeking advice for their patients.

By the time the American Association of Poison Control

Centers was established in 1957, poison control centers

were taking calls from the general public.

The establishment of the AAPCC included programs for education and prevention to physicians and the general

public.

Poison Control Centers today are part of the foundation of

health care delivery.

Immediate Emergency Access To Health Professionals

• Provide 24/7 immediate (free) access to Certified Specialists in Poison Information (CSPI) .

• CSPIs are specially trained and nationally certified doctors, nurses and pharmacists.

• CSPIs are supervised by board certified clinical & medical toxicologists immediately available for consultation to health care providers in the community.

• All calls are confidential and can be answered regardless of language.

• Poisoning data is immediately available to DOH epidemiologists and emergency preparedness staff to detect, track and mitigate public health threats.

CALLS TO FLORIDA’S POISON CONTROL CENTERS 2017

Florida’s Poison Control Centers :

Handled 135,914 calls

108,428 calls were known or possible exposures

29,934 calls for information

155, 297 follow up calls

Approximately 20% of calls to poison centers are from medical professionals.

Medication mistakes

Mistakes with household cleaners, pesticides, fertilizers etc..

Insect or snake bites

Marine stings

Food poisoning

Pill identification

Questions about a possible poisoning

When Should I Call Poison Control?

Age Distribution of Exposures46%

6% 8%

27%

8%5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

YoungChildren

(<6 y)

OlderChildren(6-12 y)

Teen (13-19 y)

Adult (20-59 y)

OlderAdult (60+

y)

Unknown

Young Children (<6 y)Older Children (6-12 y)Teen (13-19 y)Adult (20-59 y)Older Adult (60+ y)Unknown

Data from Table 3A of the 2016 AAPCC NPDS Annual Report - Age and Gender Distribution of Human Exposures. N=2,159,032 human exposure cases.

79%

7%

6%4%

2% 2%

Ingestion

Dermal

Inhalation, Nasal, orAspirationOcular

Bite or Sting

Other and Unknown

Data from Table 9. Route of Exposure for Human Exposure Cases. N=2,272,976 routes coded.

Route of Exposure

Most Common Exposures

1. Analgesics2. Cleaning Substances3. Sedatives/Hypnotics4. Cosmetics5. Anti depressants/Anti Anxiety6. Cardiovascular Drugs7. Antihistamines8. Pesticides9. Alcohols10. Foreign Body/Toys11. Stimulants & Street Drugs12. Topical Preparations13. Anticonvulsants14. Bites & Stings15. Cold & Cough Preparations

Data: www.FloridaPoisonControlCenters.org

What are Analgesics?Any member of the group of drugs used to relive pain.

A pain reliever; with or without prescriptions.

Opioids – Oxycodone /OxyContin®Hydrocodone /Vicodin®CodeineMorphineFentanyl

Acetaminophen – Tylenol®

Non Steroid Anti-inflammatory Drugs (NSAID)- Aspirin/Bayer®- Ibuprofen / Motrin®, Advil®- Naproxen / Aleve®

Examples of Analgesics Without Prescription

Most Deaths Include Single Substance or a Combination of :

Opioids:

Oxycodone - OxyContin®Hydrocodone - Vicodin®FentanylMorphineHeroin

Street Drugs & Stimulants:

CocaineAmphetamine:Adderall®Concerta®Ritalin®

Anti depressants /Anti anxiety:

Duloxetine -Cymbalta® Doxepin-Adapin®Fluoxetine-Prozac®Benzodiazepines- Xanax®Benzodiazepines -Valium ®

Opioid Overdoses Can Be ReversedFlorida law allows pharmacists to dispense Narcan/Naloxone without an individual prescription

Signs of an overdose:

Unresponsiveness Not breathing, turning blue, snoring Vomiting Gasping, gurgling Pinpoint pupils

What to do:

Narcan is also known by its generic drug name Naloxone must be given right away. Nasal or injection

Must call 911 Stay with the person Give a second dose if the person

remains unresponsive. Inform EMS that naloxone was

administered.

www.narcan.com

How to Dispose of Your MedicationsBest Option

Contact your local law enforcement agency to find out when and where they will have their drug take back day. U.S. Drug Enforcement Agency (DEA) sponsor drug take back days in communities nationwide.

Contact your local pharmacy; some pharmacies have mail back programs or medicine disposal kiosks.

Disposing Medicine From Home

Remove the drug from its original container and scratch out any personal information such as name and type of medication etc..

In a small bag such as a sandwich bag, mix drug with unappealing items such as coffee grounds, cat litter or dirt and throw it into the trash.

The Dose Makes the Poison

All things are poison, and nothing is without poison, the dosage alone makes it so a thing is not a poison.

~ Paracelsus1493 - 1541

Intentional Poisonings

Poisoning is the third most common method of

suicide in the U.S.

Most deaths seen by poison control centers

involve a deadly dose of medicine on purpose.

Less than 1% of homicides are poisoning

homicides.

Poison Specialists consider any attempt to hurt oneself as a mental

health emergency.

Prevention Strategies for Adults

Have a routine for taking medications.

Keep a list of list of all medications and supplements.

Know what the medication is for.

Know how long medication should be taken.

Know if medications can be addictive.

Know if there is a history of drug abuse.

Keep a pill organization system.

Ages and Stages of Poisoning

Under 6:

Oral Focus

Curiosity

Imitative Behavior

Parental Error

Lack of Supervision

Sibling Involvement

7-12 year old

Dares & Challenges

Experimental

13- 19 years old

Exploring with drugs & alcohol

20-65 years old

Highest death rate due to increase use of analgesics, mixing prescriptions with OTC medicine & alcohol

Over 65 years old

Increase risk of mistakes due to:Lack of routine for taking medicinesUsing poor lightingNot wearing glassesBody changes as we age

Ages & Stages of Poisoning

Children Under 6: Prevention Strategies

1. Never call medicine candy.

2. Throw all expired or unused medications away.

3. Store all poisons such as medicine, cleaners, perfumes up and away.

4. Teach children to ask before putting something in their mouths.

How Children Can See Things

https://www.adsoftheworld.com/media/outdoor/vwa_children_see_things_differently

What do you think is more dangerous for a toddler ?

Clorox ®

Question:

CamphorSlime

Answer:Camphor – causes seizures

Slime - non toxic

Clorox ®– causes gastrointestinal irritation/stomach upset

Which is the most dangerous for a toddler to ingest?

PoinsettiaVisine®

Question:

Answer:Visine®- Contains tetrahydrozoline which can cause seizures and drop blood pressure.

Poinsettias have a bad reputation. They may cause irritation.

What three situations can turn a medicine into a poison?

1) .

2) .

3) .

1. Taking too much

2. Taking someone else’s medicine

3. Combining medications, including over the counter medications.

Answer:

Poison Control only takes calls about exposures to a poison.

True or False

False: Poison Information Specialists respond to calls about poisoning exposures or questions about a poison or potential poison.

Poisonous Bites & Stings

PlantsPoisonous Irritant

Poisoning Trends

Poison Control CentersAn All Hazards Response Program

Florida’s Poison Control Centers partner with the Department of Health to provide support for public health threats such as:

Chemical Surveillance Tracking substances of abuse H1N1 Zika BP Oil Spill Available for CDC Flu pandemic response

Health Education Is Critical To Our Lifesaving MissionWe Are In Your Community Raising Awareness

Our Outreach Includes:

Information on poisoning trends

Presentations & Trainings

Participating in Health Fairs

Best practices to prevent poisonings

Providing educational materials and magnets online or in person at health fairs or presentations

Some Challenges for Poison Control Centers

Lack of awareness of the poison control program.

Searching the internet for help with a poisoning.

Belief that only small children are at risk.

Poison Control is only for snake or spider bites.

Embarrassed or ashamed to call.

Program Your Phone with the Lifesaving Helpline

Text POISON to: 797979

Ask for our Magnet

Please visit our web site where you can download materials

www.floridapoisoncontrol.org

Thank You For The Opportunity to Talk to You About Florida’s Poison Control Centers

Special thanks to Robert Del Valle, CSPI and Wendy Stephan, MPH, CHES