COMMENTARY

ADHD Drugs: Calls to Poison Control

William T. Basco, Jr, MD, MS

Disclosures

August 13, 2018

Poison Control Calls For ADHD Drug

With 69% of children with attention-deficit/hyperactivity disorder (ADHD) receiving medication, it is not surprising that calls to poison control centers for exposures to these drugs are frequent. A recent study [1] amalgamated data from the National Poison Data System, which gets information from regional poison control centers, to evaluate annual rates of exposure to ADHD drugs, along with describing any trends from 2000-2014.

The affected children were all < 20 years old, and the study focused on stimulant drugs (eliminating clonidine, for example). The analysis included 156,365 poison control center calls related to ADHD medication exposure. Most (65.3%) of the calls concerned boys. Methylphenidate derivatives (46.2%) and amphetamine derivatives (44.5%) comprised the majority of the drugs involved.

The exposures were classified as unintentional in 81.9% of cases; 41.6% of these unintentional exposures were the result of "therapeutic error" (eg, inappropriate doses) and 39.6% of unintentional exposures were accidental (peak age, about 2 years).

Of the 14.7% of intentional exposures, 6.3% were suicide attempts, 3.7% were a response to abuse, and 3.2% were the result of drug misuse.

The accidental exposures were clustered among the children aged 5 years and younger, the therapeutic errors peaked among those aged 6-12 years, and the intentional exposures were most common among the children aged 13-19 years. For example, although suicide attempts were linked to 6.3% of the exposures in all children, almost 80% of these attempts occurred among 13- to 19-year-olds (peak age, 15-16 years), and suicide attempts were linked with 23.9% of all exposures among that age group.

Exposures among all children increased by 76% over the 15 years of the study, although the rate declined from 2011 to 2014. A total of three deaths were reported in the study, all as a result of intentional exposures by teenagers. The primary study conclusion was that both intentional and unintentional ADHD medication exposures are increasing in the United States and represent a public health concern.

Viewpoint

This study highlights the need to focus on proper medication storage and disposal when we prescribe medications to families. We know that families do a poor job of properly storing medications, and every pediatric provider has unlimited tales of accidental exposures among toddlers.

For that not-quite-teen, early teen group in the middle, I can't help wondering how many of the therapeutic errors were double-dosing—where the child took his/her medication, and forgot, only to have the parent redose later, or where the parent gave medication to the wrong child.

Perhaps the guidance for patients those ages should focus on a system for drug administration to prevent redundant or wrong-child dosing.

Finally, with 23% of the intentional exposures among the older adolescents representing suicide attempts, one should again emphasize medication control/proper storage by parents, but providers should also recognize that these exposures are "red flags" that should prompt comprehensive evaluation to help these teenagers.

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