1 Poison Control, Suicide Prevention, & Military Outreach2017 DoD / VA Suicide Prevention Conference #BeThere – It Takes a Community August 3, 2017 Stephen T. Kaminski, JD Executive Director American Association of Poison Control Centers (703)
2 About AAPCC AAPCC.org PoisonHelp.orgNon-profit member organization founded in 1958 Represents 55 U.S. poison centers and ~1700 poison center staff Support 55 member poison centers through: Advocacy and Government Affairs Accreditation (centers) Certification (experts) Communications Promotion of local services Public education National meetings Collate and disseminate national data (NPDS). Located in Alexandria, VA AAPCC.org PoisonHelp.org AAPCC Webinar for School-Based Healthcare Practitioners
3 Poisoning is the #1 Cause of Injury Death in the U.S.Each year in poisoning accounts for: 41,600 fatalities 1.5 million days of acute hospital care admissions 438,000 hospitalizations Death rate for drug poisoning has more than quadrupled since 1979. Drug poisoning death rate exceeded the motor vehicle traffic death rate beginning in 2009. CDC MMWR. Source can be accessed at: AAPCC Webinar for School-Based Healthcare Practitioners
4 About Poison Control Centers55 poison control centers in the U.S. provide information and treatment advice, 24/7/365, through the national Poison Help line – +1 (800) Poison Help line covers 100% of the U.S. population; help is provided in 150 languages. Calls to Poison Help are free, confidential, and answered by experts: primarily specially trained pharmacists and nurses, with 24/7 Board-certified clinical and medical toxicologist oversight. Poison specialists: assess, triage, manage, monitor, and follow-up on all calls. Approximately 3 million calls annually (over 8,000 per day). AAPCC Webinar for School-Based Healthcare Practitioners
5 Who Calls Poison Control Centers?About 21% of call volume comes from health care practitioners, 71% from private residences, rest from, e.g., school and workplaces. Contrary to popular belief, less than half of all exposure calls are about children. Public Physicians Nurses Pharmacists Veterinarians Urgent Care Centers Occupational Medicine Centers Health Departments Government 911 PSAP (Public Safety Answering Point) Paramedics Police Fire Services Prison Officials Coroners Industry Schools
6 Value of Poison Control Centers: Healthcare System Cost SavingsTotal cost to fund the national poison center system is about $150 million annually; current HRSA support is $18.8M appropriated of $30.1M authorized. Poison centers save an estimated $307.6M in Medicare dollars and $382.4M in Medicaid dollars annually ($689.6M total of federal dollars) and approximately $1.8B overall in medical care and lost productivity.
7 About Poison Control Centers’ Cases and DataPCCs continuously feed call data into the National Poison Data System (NPDS)— the only near real-time comprehensive poisoning surveillance database in the U.S. Each year, poison centers manage approximately 3 million cases -- one every 11 seconds. 57% of human exposures involve pharmaceuticals. Other exposures include household products, plants, mushrooms, pesticides, animal bites and stings, carbon monoxide, and many other substances. AAPCC Webinar for School-Based Healthcare Practitioners
8 Value of Poison Centers: National Poison Data System (NPDS)NPDS as a nationwide repository of info/exposure data The only near real-time comprehensive poisoning surveillance database in the U.S. Standardized, systematic, defined data fields Data automatically uploaded in near-real time (avg. every 8 min.) Product-specific identifiers used 420,000+ products with product identifiers (product name, strength, dosage form, manufacturer Geocoded data (caller location as granular as 5-digit ZIP code) Captures information calls and exposure events *Data collection began in 1983, providing >30 years of data and more than 60 million exposure case records
9 Total Number of Suspected Suicides Reported to PCCs By AgeAge Group 2012 2013 2014 2015 2016 < = 5 years 137 167 39 8 12 6-12 years 1,892 2,465 2,998 3,311 3,674 13-19 years 51,033 56,844 65,149 71,868 76,495 20-29 years 53,620 51,958 52,703 55,117 58,060 30-39 years 40,032 39,587 40,100 41,034 41,907 40-49 years 37,120 35,912 35,667 35,345 35,008 50-59 years 24,082 25,126 26,395 27,105 27,648 60-69 years 7,466 8,127 8,940 9,594 10,523 70-79 years 2,104 2,363 2,568 2,722 3,055 >= 80 years 1,012 1,087 1,133 1,157 1,224 Unknown Age 7,594 6,444 6,111 5,698 5,255 Total: 226,092 230,080 241,803 252,959 262,861 *Note: If age is not provided, an estimated age group is used. READ: As you can see, suspected suicides are most prevalent amount Adults ages 19+
10 Total # of Suspected Suicide Cases Reported to PCCs, By Gender (2012-2016)2013 2014 2015 2016 Female 144,023 149,443 159,453 167,604 174,498 Male 80,720 79,326 81,110 84,181 87,046 Pregnant 340 331 362 318 373 Unknown 1,009 980 879 856 944 Total 226,092 230,080 241,804 252,959 262,861 As the number of suspected suicides has increased over the years, so has the number of Female suspected suicides.
11 2016 Top Suspected Suicide Exposure SubstancesGeneric Code Name 2016 Benzodiazepines (i.e. Xanax, Valium) 47,173 Ethanol (Alcoholic Beverages) 33,987 Atypical Antipsychotics (i.e. Latuda, Seroquel ) 28,173 Ibuprofen (i.e. Advil, Motrin) 21,348 Acetaminophen Alone (i.e. Tylenol Extra Strength) 17,043 Trazodone (i.e. Oleptro) 14,587 Other Antihistamines Alone (Excluding Cough and Cold Preparations) (i.e. Allegra, Zyrtec) 12,880 Gabapentin (i.e. Neurontin) 10,467 Sertraline (i.e. Zoloft) 9,444 Other Types of Sedative or Anti-Psychotic Drug (i.e. Ambien) 9,220 Acetaminophen with Hydrocodone (i.e. Vicodin) 8,236 Other Types of Selective Serotonin Reuptake Inhibitor (i.e. Vilazodone) 2,446 Other Types of Antidepressant (i.e. Venlafaxine) 223
12 Suspected Suicide By Medical Outcome2012 2013 2014 2015 2016 Death 890 785 790 814 902 Major effect (i.e. cardiac arrest, coma) 12,001 11,680 12,617 13,006 13,407 Moderate effect (i.e. high fever, disorientation) 62,079 64,923 67,868 72,854 76,938 Minor effect (i.e. drowsiness, cough) 71,110 72,010 77,242 81,129 86,103 No effect 42,448 44,498 47,601 49,841 51,308
13 Intersections of Suicide, the Military, and Poison Control CentersStudies indicate that suicide has become a leading cause of death among the US military, with rates possibly greater than that observed among the civilian population.1-3 The US has 65 military hospitals worldwide and 150 VA hospitals. Currently, information on poisonings managed at military and VA hospitals is limited.
14 AAPCC Developing a Comprehensive Military Outreach StrategyTwo Goals: Raise awareness- what is poison control, why would I want to take advantage of the resource, and how do I do so? Get the poison control contact information into smartphones Targeting by Audience: Active Duty: Families Active Duty: Single Soldiers/New Recruits Veterans/Retirees
15 How can military families and active duty members benefit from Poison Centers?Frequent moves and long deployments place a tremendous amount of stress on service members, and can often leave their families in unfamiliar territory, with a lack of resources. Poison centers offer free, confidential, expert medical advice 24 hours a day, seven days a week, to both stateside and overseas military installations, through the Poison Help line at and online at By texting “POISON” to , members and their families can save the poison contact information in their smart phones, and can call for advice on anything from alcohol poisoning and food poisoning, to common household poisoning hazards. Poison centers can also provide both print and digital resources to installations for use in the workplace, child development and youth centers, community centers, and installation medical facilities.
16 How can AAPCC reach military families and active duty members?General Online Resources: Both long and short-form opportunities to via Military OneSource Social Media: Targeting the Twitter and Facebook pages of each military branch and relevant support & resource groups, contributing digital assets to specific campaigns like the “101 Critical Days of Summer Campaign” Parents and Caregivers of Children: Reaching out to each branch’s Child & Youth Services departments and DOD schools with free program- “Over-the-Counter Medicine Safety” Military Medicine: Military Health System News, medicine by branch, Tricare Military Installations: Community centers
17 How can veterans benefit from Poison Control Centers?An estimated 1.6 million military personnel have served in the Iraq and Afghanistan wars, from which at least 300,000 troops have returned with some type of mental health issue or substance abuse problem.4 More than 2 of 10 Veterans with post-traumatic stress disorder (PTSD) also have substance use disorders (SUD).5 War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to bad memories of combat trauma. Almost 1 out of every 3 Veterans seeking treatment for SUD also has PTSD.
18 How can veterans benefit from Poison Control Centers?Pharmaceutical treatment of mental and physical disorders has led to additional poisoning risks within the veteran population. Prescription medications have been cited as the cause of both intentional deaths and unintentional deaths in veterans, often as a result of inappropriately combining prescriptions.5 The involvement of alcohol use or antidepressant medications may be associated with worse clinical outcomes in poisoning cases among veterans compared to other substances. Studies have shown an association between the use of antidepressant medications and opioid analgesics in attempted suicides among veteran poisonings.
19 How can AAPCC reach veterans?Department of Veterans Affairs and National Association of State Directors of Veterans Affairs Tricare Information dissemination via associations and other groups: National Association of American Veterans, AARP, National Organization of Veterans' Advocates, National Veterans Services Fund, Retired Enlisted Association, and many more. Social media and online resources (similar to active duty and family outreach)
20 Questions, comments, or suggestions?Stephen T. Kaminski, JD Executive Director American Association of Poison Control Centers (703)
21 References Armed Forces Health Surveillance Center (AFHSC). Deaths by suicide while on active duty, active and reserve components, US Armed Forces, 1998e2011. MSMR 2012;19:7e10. Black SA, Gallaway MS, Bell MR, Ritchie EC. Prevalence and risk factors associated with suicides of army soldiers 2001e2009. Mil Psychol 2011;23:433e51. Ramchand R, Acosta J, Burns RM, Jaycox LH, Pernin CG. The war within: preventing suicide in the US military. Santa Monica,CA: RAND Corporation; 2011. University of South Florida College of Public Health. (n.d.). Characterizations of Veteran’s Poisonings in the State of Florida. Retrieved from poster.pdf U.S. Department of Veterans Affairs. (2015). PTSD and Substance Abuse in Veterans. Retrieved from https://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp