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BACKGROUND/INTRODUCTION

Over the past 15 years, poisoning death rates have increased in the United States from a rate of 9.19 per 100,000 in 2002, to 23.13 per 100,000, or 75,354 poisoning deaths in 2017. Increases in drug poisonings have contributed significantly to the increase in poisonings overall. This chapter provides a broad overview of the nature and burden of fatal and nonfatal poisonings and in addition to drug poisonings includes nondrug poisonings such as ingestion or exposure to household substances. Poisonings related to environmental factors such as lead, pesticides, and carbon monoxide are included within morbidity and mortality statistics, but are more closely associated with environmental health topics and risk factors and prevention strategies will not be discussed further in this chapter. The primary focus is on poisoning in the United States; however, some sections highlight where data from other countries are important to understanding effectiveness of interventions and the public health problem in a global perspective. The majority of poisonings are unintentional and preventable. Intentional poisonings are covered briefly in this chapter, specifically demographics, type of poisonings, and poisoning-specific prevention strategies, but for more information the reader is referred to Holland et al., in this textbook. Outlined in Chapter 175: The Epidemiology and Prevention of Self-Directed Violence are risk and protective factors separated by age group, in particular children compared to adolescents and adults. For example, parental characteristics such as younger maternal age, less supervision, single parent status, and a greater number of children in the household have been associated with increased risk for unintentional poisoning in children. Interventions specific to removing household risks, including safe storage of medications and household cleaning supplies, as well as parental education and training can reduce these poisonings. In comparison, unintentional poisonings in adults are largely due to drug overdoses. Interventions for drug overdoses, in particular opioid overdoses, include safe prescribing to prevent people from opioid use disorder, using lowest effective dosages of medication, minimizing drug interactions, and increasing access to naloxone. More recently, interventions have been focused on addressing the problem of illicit opioids, such as heroin and illicitly manufactured fentanyl. By focusing on intent, age group, and type of substance involved in the poisoning, implementing evidence-based interventions for poisonings can decrease burden.

NATURE AND BURDEN OF THE PROBLEM

Definitions

Definitions of poisoning have varied depending on perspective, analysis intent, and data source considered.1 Consensus recommendations for national and state poisoning surveillance have defined poisoning as “an exposure to any extrinsic substance by ingestion, inhalation, injection, or absorption through the skin or mucous membranes that results in at least one related adverse clinical effect.” Excluded from this definition are bites and stings without envenomation, infections, and exposure to radiation sources external to the body.2 A subset of poisoning involving drugs is of particular interest given the public health burden, and is often referred to as “overdose.” A drug ...

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