Intentional substance exposures at school reported to United States poison centers, 2000-2024.
TL;DR
The increasing rate of reported intentional substance exposures at school among elementary school- and middle school-aged children, combined with the greater severity observed among high school-aged children, underscores the need for targeted and coordinated prevention and early identification strategies that integrate substance use education and mental health screening and intervention.
Abstract
Objective
The objective of this study was to investigate the characteristics and trends of intentional substance exposures at school among children 6-18 years old reported to United States (US) poison centers.
Methods
Using a retrospective cohort study design, National Poison Data System data from 2000 to 2024 were analyzed. National population estimates from the US Census Bureau were used to calculate population-based rates, including age- and sex-specific rates, of exposure per 100,000 US population. Analyses included descriptive statistics and calculation of risk ratios (RRs) with 95% confidence intervals (CIs).
Results
From 2000 to 2024, US poison centers received reports of 122,700 intentional exposures that occurred at school among children 6-18 years old. Exposures most commonly involved high school-aged children (45.9%), males (56.7%), or a single substance (91.3%). Although most intentional exposures did not receive treatment at a healthcare facility (64.2%), 23.2% were treated/evaluated and released, and 5.3% resulted in admission to a non-critical care or critical care unit. Almost half (48.2%) of intentional substance exposures were not followed (judged to be a non-toxic exposure or to have minimal clinical effects possible), while 21.8% were associated with a minor effect and 20.0% with no effect. However, 10.0% had a serious medical outcome, including 0.7% (n = 741) with a major effect; there were two deaths. More than half of the intentional exposures occurring at school were attributable to intentional misuse (62.2%), followed by abuse (23.6%) and suspected self-harm or suicidal intent (14.2%). Exposures among high school-aged children were more likely to be associated with a serious medical outcome (RR: 5.00, 95% CI: 4.78-5.22), abuse (RR: 2.99, 95% CI: 2.92-3.06), or suspected self-harm or suicidal intent (RR: 3.28, 95% CI: 3.17-3.39) than those among elementary school- and middle school-aged children. Abuse was more likely to be associated with a serious medical outcome (RR: 4.51, 95% CI: 4.35-4.68) than non-abuse-related intentional exposures. Likewise, suspected self-harm or suicidal intent-related exposures were more likely to be associated with a serious medical outcome (RR: 2.33, 95% CI: 2.24-2.43) than exposures not related to suspected self-harm or suicidal intent. The rate of intentional exposures at school per 100,000 US children 6-18 years old fluctuated over time and increased overall by 77.5% from 7.5 in 2000 to 13.3 in 2024, including a transient sharp decline in 2020 and 2021 coinciding with the COVID-19 pandemic. The rate increased by 287.4% from 3.1 in 2000 to 11.9 in 2024 among elementary school-aged children, 111.9% from 10.0 in 2000 to 21.3 in 2024 among middle school-aged children, but decreased by 4.2% from 10.1 in 2000 to 9.7 in 2024 among high school-aged children. The exposure rate of middle school-aged children surpassed that of high school-aged children in about 2015.
Conclusions
The increasing rate of reported intentional substance exposures at school among elementary school- and middle school-aged children, combined with the greater severity observed among high school-aged children, underscores the need for targeted and coordinated prevention and early identification strategies that integrate substance use education and mental health screening and intervention.