AAPCC Celebrates National Public Health Week

April 6-12 is National Public Health Week, and poisoning remains a critical public health concern for our nation.  As a matter of fact, poisoning is the #1 cause of injury-related death in the United States. It’s true- more people die of poisoning every year than either gun or car-related injuries.  The vast majority of these poisoning deaths are caused by drugs, a category which includes both over-the-counter and prescription medications, plus illicit or “street” drugs.

The U.S. government recognizes poison prevention as an effort critical to the nation’s health, designating the third week of March each year as National Poison Prevention Week, and including poison prevention as an explicit Healthy People objective.

The most important tool we have to help combat poisoning in this country is the national Poison Help phone number, 1 (800) 222-1222.  Clinical experts like nurses, pharmacists, and physicians who are specially trained and certified in toxicology answer the phone from the nation’s 55 poison centers to help people who have poison-related questions, concerns, or emergencies. Best of all, both members of the public and health care practitioners alike can use this invaluable resource any time around the clock, every day of the year, at zero cost to the caller or the patient.  Not only do poison centers provide life-saving treatment advice, they provide poison prevention education as well.  Finally, the American Association of Poison Control Centers manages the National Poison Data System, the only near real-time poison surveillance database available in the U.S.

If you only do one thing in observance of National Public Health Week, save Poison Help as a contact in your phone.  You never know when you might need this critical public health resource.2013 KO and NPPW posters

Krista Osterthaler, MPH

National Public Awareness and Outreach Manager

American Association of Poison Control Centers


The “Who, What, When, Where, and How” of Poison Centers

The 2013 National Poison Data System (NPDS) Annual Report is now available.  It’s a comprehensive look at the cases managed by the nation’s poison centers over the course of a year.  The staff at the AAPCC central office put together a shorter, more user-friendly summary with graphics for the public and poison prevention educators.  We call it the “Poison Center Data Snapshot” and it’s available here.  It answers the following questions:

  • Who calls the poison center?
  • When someone calls the poison center, who answers the phone?
  • About what kinds of things do people call the poison center?
  • When do people call the poison center?
  • Where do the most poison exposures occur?
  • Why do people call the poison center?

Interested in more detailed poison center data?  Visit http://www.aapcc.org/data-system/.

Krista Osterthaler, MPH
National Public Awareness and Outreach Manager
American Association of Poison Control Centers
Visit www.aapcc.org
Follow @AAPCC on Twitter
Friend AAPCC on Facebook

Poison Prevention

Guest Post: Keeping Kids Safe


 Gwenn Christianson, RN, MSN, CSPIChristianson, Gwenn, RN. MSN.14

Gwenn is a registered nurse and has worked at the Indiana Poison Center (IPC) for 26 years.  She is also a Certified  Specialist in Poison Information (CSPI).  Prior to working at IPC, Gwenn worked in Adult Critical Care and in a surgical ward at Methodist Hospital in Indianapolis, IN for a total of 7 years. Gwenn feels that she found her true area of interest in the field of toxicology as she can work directly with patients, nearly all of whom recover uneventfully.  Still, there are always new challenges, so the work is never less than stimulating.  In addition to her work at the Indiana Poison Center, Gwenn has been active in the American Association of Poison Control Centers (AAPCC) for 24 years, working with the SPI Committee, and serving on the Board of Directors, among other activities.

Gwenn is the mom of 5 children, the youngest of whom just graduated from high school.  Next year she’ll have 3 kids in college! She is also the proud grandmother of a 6 year old boy whose frequent visits keep her hopping.  In her spare time Gwenn likes to read, garden, sew and volunteer at her church.


You’re a careful parent. You use Child Resistant Caps (CRCs) on all of your medication bottles. You have those pesky plastic “ thingamajigs” on all of your bottom cabinets, which keep you – and hopefully your 2 year old – from accessing your lower cupboards. You even use baby gates to keep your child restricted to the “baby safe” rooms, out of the kitchen and laundry areas. Surely a poison exposure won’t happen in your home, right?

Not necessarily! Toddlers and preschoolers are particularly clever and agile little beings. They watch you like a hawk, seeing where you are “hiding” things, and plotting ways to reach those very items. Despite how it sounds, they’re really not devious little monsters – they are just curious, intelligent little people, eager to explore the world and to find out all about the fascinating things Mom, Dad, and other grown-ups use. Sometimes that curiosity involves tasting and eating new and inviting items.

How can you best make your home and environment Poison Safe? Follow these tips –

  1. Remember – NOTHING is POISON PROOF. Be constantly vigilant – stay on watch at all times – and if a poison exposure occurs, call your regional poison center right away at 1-800-222-1222.
  2. Keep all medications in a locked tackle box. Lock it with a combination lock or wear the key around your neck. Then, even if your child climbs up and gets the box down, he or she won’t be able to open the box and get the medications out.
  3. Do not use daily pill minders. These are nothing more than a handy multiple poison packaging device for two year olds, allowing them to take up to 7 doses of each medication at one time. Provide guests with a lock box for their medications.
  4. Lock up purses, backpacks, suitcases, and similar items. Put such items into a locked room and keep them there – and keep the kids out. These “big kid belongings” are fascinating for little ones, and they like nothing more than to go rummaging through them.
  5. Limit the number of household cleaning items you purchase. Can one multipurpose household cleaner do the job of 3 or 4 room-specific cleaners? That makes 2-3 less things for your child to encounter! Get the smallest size possible, use it all up, and throw it away in the outside trash – then the children won’t encounter the open bottle in storage. This is especially important for caustic products that can cause life-threatening burns, such as toilet bowl cleaners and drain cleaners. (No, it is not as cost-effective, but it is much safer – and which is more important?)
  6. Do not rely on putting items up high and out of reach to ensure safety. Kids climb! Kids pull out drawers and climb up on counters and cabinets, bookshelves and TV units. They stack their miniature chairs on their little tables and build towering edifices to reach the top of the refrigerator or the top shelf in the linen closet. While putting things up high may slow them down, it doesn’t stop a determined child from reaching what they want to find.

If the unexpected does occur, remember that this is NOT a reflection on your worthiness as a parent. Accidents happen! Collect your child and the product, grab the phone, and call your regional poison center at 1-800-222-1222. The friendly experts there are ready to help you assess the situation and determine what needs to be done. You will get the proper directions, your child will get the proper care, and you can learn more about how to make your home safe and prevent further exposures.


Meet Libbye Johnson – Poison Expert at the Mississippi Poison Control Center

Meet Libbye Johnson – Poison Expert at the Mississippi Poison Control Center

When you call the Poison Help line, a poison expert is on the other end of line to help you. While many of these experts are physicians, nurses and pharmacists, they’re also parents, grandparents, sisters, brothers and friends just like you.

The AAPCC is proud to showcase the dedicated professionals at America’s poison centers.

Libbye Johnson Spotlight

News, Poison Prevention

Presidential Proclamation — National Poison Prevention Week, 2014

For Immediate Release
March 14, 2014

Presidential Proclamation — National Poison Prevention Week, 2014


– – – – – – –



Over the past four decades, America has seen a steep decline in childhood deaths from accidental poisonings — thanks in part to improved safety measures and increased public awareness. During National Poison Prevention Week, we do our part to remain vigilant, ask our loved ones to use common-sense precautions, and learn about the potentially life-saving action we can take in case of emergency.

While we have made great strides, unintentional poisoning still takes the lives of about 30 American children every year and sends tens of thousands to the hospital. Because the vast majority of these accidents occur in the home, it is essential for parents and caregivers to keep potentially harmful products — including cleaning supplies and medication — out of their children’s reach and sight. If you ever suspect a child, family member, or anyone has been poisoned, quick action may prevent serious injury or death. You should immediately call the toll-free Poison Help Line at 1-800-222-1222.

Earlier this year, I signed the Poison Center Network Act, which supports the hotline, a poison prevention grant program, and an awareness campaign. As my Administration promotes safe practices across our country, each of us can make our homes and communities more secure. To safeguard against carbon monoxide, a deadly, colorless, odorless gas, every American should have heating systems inspected each year and install carbon monoxide alarms in their homes. And because prescription drug overdose remains the most common cause of fatal poisoning, we must properly store and dispose of medications. I encourage Americans to visit www.DEAdiversion.USDOJ.gov to read about safe prescription drug disposal and learn how to participate in the National Prescription Drug Take-Back Day on April 26. For information on preventing accidents and helping victims of poisoning, go to PoisonHelp.HRSA.gov.

To encourage Americans to learn more about the dangers of accidental poisonings and to take appropriate preventative measures, the Congress, by joint resolution approved September 26, 1961, as amended (75 Stat. 681) has authorized and requested the President to issue a proclamation designating the third week of March each year as “National Poison Prevention Week.”

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, do hereby proclaim March 16 through March 22, 2014, as National Poison Prevention Week. I call upon all Americans to observe this week by taking actions to protect their families from hazardous household materials and misuse of prescription medicines.

IN WITNESS WHEREOF, I have hereunto set my hand this fourteenth day of March, in the year of our Lord two thousand fourteen, and of the Independence of the United States of America the two hundred and thirty-eighth.



GUEST BLOG: What Happens to Leftover Medicine?

ImageWritten by:

Jeanie Jaramillo

Managing Director, Texas Panhandle Poison Center

Director, Medication Cleanout

Assistant Professor, Texas Tech University Health Sciences Center School of Pharmacy

What Happens to Leftover Medicine?

Most any of us could walk through our homes and find unused, leftover medicines somewhere – the bathroom medicine cabinet, a kitchen cupboard or drawer, perhaps a bedside table.  So, what happens to these medicines?  There was a time when we wouldn’t think much about disposing of leftover medicines by either flushing them or placing them in the trash.  However, as the message about environmental contamination with these agents has reached each of us through the media, we’ve become a society that no longer throws.  What do we do with them?  Unfortunately, we’re not provided with an easy answer and, as a result, many of us simply hold on these medications; storing them indefinitely in our homes.  In fact, in a survey conducted by our poison center through our medication take back program, we have found that ~75% of participants state they would simply keep old medications if they could not have brought them to us for disposal.

Is Leftover Medicine Really a Problem?

Leftover medicine is a big problem that is only getting bigger.  Many poisonings that occur in children are the result of children accessing the medicines on their own.  This occurs when we leave medicines in unsecure places, or when we have them out for our use and fail to return them to a secure location.  Small children like to explore, and they also mimic adults; so, if they see mom or dad taking medicine – they want to do the same.  Most childhood poisonings that require emergency room visits are due to medicines rather than other products around the home.

An even bigger problem occurs when teens decide to experiment with medicines in an attempt to get “high”.  They’ve learned enough to understand that illegal drugs like cocaine and heroin are dangerous.  But they feel that prescription medicines are safe.  If mom and dad keep these agents in the home, they must be safe, right?  And, they were prescribed by a physician.  Teens do not understand the danger of harm and even death that can occur from the inappropriate use of medicines.  Although prescription medicines present a greater risk of harm, even over the counter medications can be harmful when used inappropriately.

And, according to the Centers for Disease Control and Prevention, the abuse of prescription medications is the fastest growing drug problem in the U.S.  Additionally, every 14 minutes, someone loses their life as the result of an unintentional drug overdose.  We, as a society, cannot continue to leave medicines around our homes to serve as a potential source for poisonings and abuse.

What Can I do About it?

As someone who has worked in poison control for many years, the number one recommendation that I give is to get any medicines that are no longer needed out of the house.  I feel that the best method for med disposal at this time is to take any unused medicines to a community medicine take back program.  If a program is not available, another option is mail-back.  Many pharmacies sell envelopes in which medicines can be placed and then mailed for disposal. There are some medicines that should not be mailed, so instructions in the envelopes should be reviewed carefully.  If neither of those are an option, my next best recommendation is to use the kitty litter/coffee grounds method.  Pour the meds into a sealable zipper bag, add kitty litter or coffee grounds and a some water, seal the bag, place it in a disposable container (like a butter tub), and then place it in the trash (preferably directly into an alley or curbside disposal bin).  Although this method still may result in environmental impact, it is preferable over the harm that could occur to family members, friends, acquaintances, or even pets.

Our poison center started a medicine disposal program in 2009 and has conducted 29 events to date.  As a result, we have collected over 15,000 pounds of unused medicines for proper disposal.  These are meds that are no longer available to serve as a source for poisoning or abuse.

What Do Take-Back Programs Do With the Medicine?

Medication take back programs are likely to vary across the U.S. as each state has different environmental and pharmaceutical regulations.  With our program, medicines that are classified as “controlled”, like many pain medicines, are turned over to law enforcement as required by law.  This amounts to about 10% of our collected meds.  All other medicines are sent for incineration at a pharmaceutical-approved facility by a waste management company.  These facilities must meet strict environmental requirements that minimize environmental impact.

How Can People Find Take Back Programs in Their Area?

The U.S. Drug Enforcement Administration (DEA), in coordination with local law enforcement agencies, has been holding National Medicine Take Back days twice a year.  While it is unclear at this time how long the DEA will continue these, they do have a date set for this spring (April 26, 2014.)  Individuals can visit the DEA website at: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/ to determine if an event will be held in their communities.

Many take back programs exist across the country and are supported by various organizations.  In fact, there are too many to list here and I am unaware of a single site for referencing all of these.  I would recommend a general internet search for “medication take back program” as a good starting point.  Also, many local police and/or sheriffs’ departments now have drop boxes available, so a call to an individual’s local police or sheriff department is an option.

Poison Centers

Poison Centers in Action: The West Virginia Chemical Spill

As West Virginian residents begin to return to normalcy, after the last water ban was lifted following a chemical spill that threatened major water sources, the West Virginia Poison Center continues its efforts to address the health concerns of the community.

In a recent press conference, Governor Earl Ray Tomblin said, “We’ve been in this thing for 11 days. It’s a very complicated issue. I’m not a scientist, you know. I have to rely on the best information that I have.” Tomblin did not guarantee that the drinking water is safe but rather left it up to the individuals. “It’s your decision…if you do not feel comfortable drinking or cooking with this water then use bottled water.”

While the chemical spill itself created its own concerns and complications, investigation into the toxicity of the chemical itself created the most confusion. Few answers could be found on the chemical in question and its potential adverse effects in people.

Though the lack of definitive information on about 7,500 gallons of 4-methylcyclohexane methanol that leaked into the river may create its own limitations, Dr. Elizabeth Scharman, director of the West Virginia Poison Center, was confident that the available information, along with the expertise of a team of health care professionals and chemists, allowed for sufficient guidelines for the handling of immediate medical response to the chemical spill.

“When you don’t have specific information about a chemical’s toxicity, you can look at its structure and make some predictions about what could be expected.” said Scharman. “When you don’t have definitive information, you do what is best for public health and that is why the Governor put out a ‘do not use the water’ (except for flushing) order on the evening of January 9th.”

The West Virginia Poison Center collaborated with West Virginia’s state health department, the Centers for Disease Control (CDC), the Department of Environmental Protection (DEP), chemists, and others to ensure that the best interests for public health were being served.  .

While the unique experience of facing an incident involving a large number of individuals exposed to a large quantity of an unknown compound entering the water system, created its own obstacles, Dr. Scharman and her team of Poison Specialists, like many health care professionals dealing with the chemical spill’s aftermath, were faced with the increased challenge of managing an influx of new cases, maintaining regular daily Poison Center call volume, and effectively determining if those experiencing symptoms were effected by the chemical spill or some other illness – a lofty task during the onset of flu season.

“What the Poison Specialists were doing was to take individual assessments to determine whether the caller or their family member were exposed to the water and if so how (e.g., drank it, bathed in it, brushed their teeth with it), and if they were having symptoms.  If symptoms were not felt to be related to a pre-existing condition or other acute medical illness (in which case, a separate triage plan was followed), management recommendations and other information was provided specific to this water contamination incident.  “Poison Centers are in an ideal position to play this role as they are staffed by health care professionals,” said Dr. Scharman.

A handful of callers were referred to an emergency department by the West Virginia Poison Center. The number referred were a very small percentage of the number of individuals who called the center. Dr. Scharman cautioned that, for those individuals who were admitted to a hospital with a concern for contaminated water exposure, the fact that they were admitted did not mean that their symptoms were determined to be related to the spill.

Dr. Scharman also stated that the substance itself, though somewhat illusive in toxicology reference sources, was not highly toxic.

“We were not expecting that we would have people with severe or harmful effects and this is consistent with the types of calls we evaluated,” she said.

The most common symptoms reported were nausea, diarrhea, or rashes.

Although the water ban has now been lifted, the West Virginia Poison Center continues to answer calls related to the chemical spill.

As a part of that brain trust, the West Virginia Poison Center was front and center when news of the chemical spill broke. Before calls came in regarding specific cases, the poison center had received a call from a reporter on the afternoon of January 9thasking about the chemical after individuals had called the media asking about smelling licorice in the air.  While there hadn’t been any calls from the public at that time, the Poison Center began to research the chemical reported to have been involved in order to prepare itself should calls be received.

“That is part of what poison centers do. We do active surveillance in our communities in real time,” said Dr. Scharman.

When human exposure related calls began pouring in, 2,423 during the main phase of the incident, the poison center was ready.

Poison Specialist Jamie Cook, BSN, MSN, CSPI, who was answering the phones said, “I’ve been here for about three and a half years. This has definitely been the biggest [emergency situation]…We’ve really had to work together as a team. We’ve had to call in Poison Specialists, even those who were out for vacation.”

Cook said that perhaps one of the more challenging aspects of this particular situation was that the public had limited access to water which meant a decline in the ability to use soap and water for cleaning and the potential for some reported symptoms to be more a result of germs than the chemical spill as the duration of the “do not use” order became longer.

Despite the continued challenges of the chemical spill and the subsequent water ban, Cook is confident that the poison center played a crucial role in the health of the community and that the community is now more aware of the center’s role in their safety.

“I think there are people who were not aware that we were here or what we do, that are now,” she said.

As for the public, they’re strong she said, “West Virginians are very tough and very resilient and they’re always helping each other out.”