Toxic Methanol in Hand Sanitizers: Poisonings Continue

Kathleen Doheny

August 17, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

As the FDA's warning list about dangerous hand sanitizers containing methanol grows, another troubling trend has emerged. Some people are drinking the sanitizers to get an alcohol high. Others have believed a rumor, circulated online, that drinking the highly potent and toxic alcohol can disinfect the body, protecting them from COVID-19 infection.

Drinking hand sanitizers to get a buzz is nothing new for people with a substance use disorder, says Maureen Roland, a registered nurse and managing director of the Banner Poison and Drug Information Center at Banner University Medical Center in Phoenix.

The FDA warned the public in July that "methanol is not an acceptable ingredient for hand sanitizers and must not be used due to its toxic effects. FDA’s investigation of methanol in certain hand sanitizers is ongoing."

But as more of the methanol-based sanitizers came on the market, Roland and her colleagues began noticing more cases of methanol ingestion beginning in May.

Roland and her colleagues alerted the state health department, who brought in the CDC and FDA to investigate. In the CDC's Morbidity and Mortality Weekly Report Aug. 14, public health officials from the CDC, Arizona, and elsewhere report on the first 15 cases seen in Arizona and New Mexico. The poisonings are continuing there, Roland says, despite ongoing warnings.

The poisonings aren't limited to the Southwest. Across the U.S., 1,585 exposures to hand sanitizer containing methanol have been reported from May to August, says Heba Hashem, a spokesperson for the American Association of Poison Control Centers.

The problem is also occurring globally. Researchers from Australia, Japan, Bangladesh, and other countries recently gathered COVID-19 rumors from what they term the "infodemic." They scoured online platforms, Facebook, Twitter, and online newspapers to find the rumors and conspiracy theories circulating about COVID-19.

A popular myth was that drinking highly concentrated alcohol could disinfect the body and kill the virus. After the suggestion became widespread, the researchers found that about 800 people have died after drinking methanol, 60 developed complete blindness, and about 5,900 have been hospitalized, mainly in Iran, Turkey, Qatar, and India.

"The source of the rumor could not be identified," says study leader Md. Saiful Islam, a PhD candidate at the University of New South Wales in Sydney. "However, during the end of February and early March, 2020, the rumor, 'gurgling or drinking alcoholic beverages would disinfect the mouth or inside the body and prevent the infection by killing the virus' was circulating in Iran," he says.

FDA's List Grows

The FDA first alerted consumers about toxic hand sanitizers in mid-June, when the agency warned against the use of hand sanitizer products with methanol made by Eskbiochem. By Aug. 12, that list had grown to 160 brands. 

Besides methanol, the FDA warns, some hand sanitizers don't contain high enough levels of ethyl alcohol or isopropyl alcohol, the acceptable active ingredients for hand sanitizers. And some products are contaminated with 1-propanol, which is not an acceptable ingredient. In some cases, the companies with methanol in their products have voluntarily recalled them, following the FDA's recommendation. For others, the FDA has issued an import alert to stop the product from entering the country.

Methanol, Ethanol, Isopropanol

While the CDC recommends the use of alcohol-based hand sanitizers that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol), the agency emphasizes that methanol (methyl alcohol) is not an acceptable ingredient and must not be used due to its toxic effects. While some hand sanitizers are marked "FDA approved," the FDA says that is a fraudulent claim, as there are none approved by the FDA. Under a final rule issued in 2019, the FDA stipulated which ingredients are allowed in over-the-counter hand sanitizers.

Methanol, also called wood alcohol, can be toxic when absorbed through the skin or ingested, the FDA warns. Poisoning from methanol being absorbed through the skin is rare, according to the CDC report.

Consumers who have hand sanitizers with methanol on the label should dispose of the products as hazardous waste, the FDA says, or follow the advice of their local waste management officials.

A Closer Look at the Arizona, New Mexico Cases

Of the 15 cases found in Arizona and New Mexico from May 1 to June 30, four patients died and three were discharged with visual impairment. The average age was 43 and ranged from 21 to 65. All but two were men. Six had seizures during their hospital stay. Nine needed kidney treatment such as dialysis.

Symptoms include headache, blurred vision, nausea and vomiting, loss of coordination, and a decreased level of consciousness. The methanol has a direct toxic effect on the optic nerve, and ingestion can lead to blindness.

Despite the warnings, the incidents are not declining, says Roland, who estimates the poison reports for her center are 30% higher in general than in previous months for hand sanitizer exposures. "For the state of Arizona, we have had over 40 intentional hand sanitizer ingestions with reported methanol since mid-May. We had three exposures over the weekend [of Aug. 8-9], and a fatality on Monday."

Before the pandemic and the methanol-containing hand sanitizers, Roland says, "methanol poisonings were from windshield washer fluid [and other products], not usually from hand sanitizer." To complicate matters, she says, not all hand sanitizers containing methanol have it listed on the label.

When methanol is metabolized, those breakdown products are toxic, Roland says. The antidote is an intravenous medicine called fomepizole, which makes the methanol less toxic, Roland says. Sometimes a second dose is needed. Patients may need to be intubated, and others need dialysis. Vision problems can be temporary or permanent.

Sources:

Maureen K. Roland, RN, managing director, Banner Poison and Drug Information Center, Banner University Medical Center, Phoenix.

Morbidity and Mortality Weekly Report: "Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol — Arizona and New Mexico, May–June 2020."

Md. Saiful Islam, PhD candidate, University of New South Wales, Sydney, Australia.

American Journal of Tropical Medicine and Hygiene: "COVID-19-Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis."

FDA: "FDA updates on hand sanitizers consumers should not use."

FDA: "FDA Takes Action  to Warn, Protect Consumers from Dangerous Alcohol-Based Hand Sanitizers Containing Methanol."

Heba Hashem, director of national data services, American Association of Poison Control Centers, Arlington, VA.

FDA news release: "FDA issues final rule on the safety and effectiveness of consumer hand sanitizers."

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