Medications Removed from Packaging Pose Risk to Young Children

There are approximately 400,000 poison center calls, and 50,000 emergency room visits each year resulting from unsupervised young children ingesting medications.¹

Deaths from accidental medication ingestion decreased significantly after the 1970s Poison Prevention Packaging Act, which mandated the use of child-resistant packaging for most drugs in the United States.² However, as medication use has increased through the years so has accidental drug ingestion.

Pharmacists can play an important role in poison prevention.

Study Design and Key Findings

According to a study published in the Journal of Pediatrics, 51.5% of drug exposures involving prescription medications involved children accessing products that had previously been removed from child-resistant packaging by an adult.² This was a cross-sectional study involving unsupervised solid dose medication exposure calls by children aged 5 years and younger at 5 US poison control centers from February-September 2017.

The medications included in the study could be prescription or over-the-counter (OTC) drugs, dietary supplements, or homeopathic products. There were 7252 eligible calls, and 62% of those callers agreed to participate in the study.

Among the 4496 study participants, 71.6% of the calls involved children aged 2 years and younger.²

Attention deficit hyperactivity disorder medications (49.3%), opioids (42.6%), and muscle relaxants (36.7%) were often not in any container such as loose pills.² Anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic drugs (30.8%) were often transferred to alternate containers.

Most exposures involved parents’ medications. However, grandparents’ medications were involved in 30.7% of prescription drug exposures.²

Study Implications and Poison Prevention Tips

The study sheds light on the importance of child-resistant packaging. One limitation includes that surveys have self-reported information, which cannot show cause-and-effect. If pills must be removed from the original containers, then it is important to provide safe guards such as using a container that is child-resistant, and securely closing the container after each use.¹

Pharmacists can educate families about poison prevention strategies, especially during National Poison Prevention Week, March 15-21, 2020.³ Parents, grandparents, and other caregivers should have the Poison Help number (1-800-222-1222) handy, which is a free service available 24/7, and staffed by trained health care professionals that can provide guidance on accidental medication exposures.¹

It is extremely important to poison proof the home by keeping all prescription and OTC medications out of a child’s reach and in a locked area immediately after every use. All purses and bags that contain medications should also be kept out of reach of children. Grandparents’ and other caregiver homes that children spend time at should also be poison proofed. Families should survey their home floors periodically to ensure there are no loose pills that children may find.

REFERENCES

• Adults Unintentionally Make It Easy for Young Children to Eat Dangerous Pills [news release]. Atlanta, GA; February 12, 2020: CDC website. https://www.cdc.gov/media/releases/2020/p0212-dangerous-pills.html. Accessed February 18, 2020.
• Agarwal M, Lovegrove MC, Geller RJ, et al. Circumstances involved in unsupervised solid dose medication exposures among young children. J Pediatr; pii: S0022-3476(19)31706-8. doi: 10.1016/j.jpeds.2019.12.027. [Epub ahead of print January 28, 2020].
• AAPCC. National Poison Prevention Week. AAPCC website. https://www.aapcc.org/. Accessed February 19, 2020.