Poison Control Receives 29 Calls Daily for Improper ADHD Medication Exposure

Gary Smith, MD, DrPH

Each day, US Poison Control Centers get 29 calls each day—roughly 200 per week—related to children and adolescents under the age of 19 being exposed to medications intended for attention-deficit hyperactivity disorder (ADHD), according to new data.

In a study conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children's Hospital, it was noted that 156,365 total phone calls were made to poison control centers between January 2000 and December 2014 regarding ADHD medication. The majority of the calls, 76%, were about children aged 12 years and younger.

"Pediatric exposures to ADHD medications are an increasing problem in the US, affecting children of all ages," Gary Smith, MD, DrPH, the senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's Hospital, said in a statement. "We need to do more to prevent these exposures."

Methylphenidate and amphetamine therapies were involved in the majority of cases, accounting for 46.2% and 44.5% of exposures, respectively. In total, 60.4% of the individuals exposed to ADHD medications did not receive treatment at a health care facility, with only 6.2% admitted to the hospital for treatment. There were 3 deaths reported.

Slightly less than 30% of the calls had reported clinical effects, with the most common being agitation/irritability (11%), rapid heart rate (10%), drowsiness/lethargy (3%), high blood pressure (3%), and vomiting (2%).

The most commonly reported reason for the exposure was a therapeutic error, which occurred in 41.6% of cases. These included instances such as “being given or taking too much medication, or a dose too soon after the previous dose, or the wrong medication,” Smith said.

Among adolescents aged 13 to 19 years, intentional medication exposure—including medication abuse or misuse and suspected suicide attempts—were reported in 50.2% of cases. These exposures, Smith said, were more likely to result in serious medical outcomes than those in younger children. Smith noted that these “exposures associated with suspected suicide or medication abuse and/or misuse among adolescents are of particular concern, especially because these result in, more commonly, serious medical outcomes.”

"In young children, it is exploratory behavior and access to the medication bottle, while in school-age children it is usually the busy family schedule and a double-dosing medication error," said Henry Spiller, MS, D. ABAT, a co-author and the director of the Central Ohio Poison Center at Nationwide Children's Hospital. "In adolescents, it tends to be an intentional exposure. The strategies to prevent these events change as the child gets older, but the risks of a problem remain."

According to Smith, the best strategies to prevent these exposures are education—of the patients, caregivers, and parents—as well as safe storage of the medicines, and an increase in the use of non-pharmacologic interventions for ADHD.

While the overall number of calls fluctuated over the 14-year study period, the calls increased by 61% during the study; however, there was a correlation between that increase and a national increase in ADHD diagnoses and therapy prescriptions during the same period. From 2000 to 2011, the rate of reported exposures increased 71.2%, then decreased 6.2% from 2011 to 2014.

The study, “Pediatric ADHD Medication Exposures Reported to US Poison Control Centers,” was published in Pediatrics.