Poison Control Centers National Data Research Articles

The Food and Drug Administration's (FDA's) Drug Safety Surveillance During the COVID-19 Pandemic.

On 4 February, 2020, the Secretary of the Department of Health and Human Services declared a public health emergency related to coronavirus disease 2019 (COVID-19), and on 27 March, 2020 declared circumstances existed to justify the authorization of the emergency use of drug and biological products (hereafter, "drugs") for COVID-19. At the outset of the pandemic with uncertainty relating to the virus, many drugs were being used to treat or prevent COVID-19, resulting in the US Food and Drug Administration's (FDA's) need to initiate heightened surveillance across these drugs. We aimed to describe the FDA's approach to monitoring the safety of drugs to treat or prevent COVID-19 across multiple data sources and the subsequent actions taken by the FDA to protect public health. The FDA conducted surveillance of adverse event and medication error data using the FDA Adverse Event Reporting System, biomedical literature, FDA-American College of Medical Toxicology COVID-19 Toxicology Investigators Consortium Pharmacovigilance Project Sub-registry, and the American Association of Poison Control Centers National Poison Data System. From 4 February, 2020, through 31 January, 2022, we identified 22,944 unique adverse event cases worldwide and 1052 unique medication error cases domestically with drugs to treat or prevent COVID-19. These were from the FDA Adverse Event Reporting System (22,219), biomedical literature (1107), FDA-American College of Medical Toxicology COVID-19 Toxicology Investigator's Consortium Sub-registry (638), and the National Poison Data System (32), resulting in the detection of several important safety issues. Safety surveillance using near real-time data was critical during the COVID-19 pandemic because the FDA monitored an unprecedented number of drugs to treat or prevent COVID-19. Additionally, the pandemic prompted the FDA to accelerate innovation, forging new collaborations and leveraging data sources to conduct safety surveillance to respond to the pandemic.

Exposures in pregnant patients reported to United States Poison Centers

Background Limited data describe poisoning exposures in pregnant women. Previous studies are limited to inpatient populations, those seen only by toxicologists, or single poison centers. This study aimed to describe poison exposures reported to U.S. poison control centers in pregnant patients compared to non-pregnant controls. Methods This was a retrospective observational study of exposures reported to the American Association of Poison Control Centers National Poison Data System from 2000 through 2019. Pregnant patients were included from 15–44 years along with a random sampling of 5:1 age and year matched control group of non-pregnant exposures. Demographics, primary substance, and known medical outcomes were described. Chi square analysis was performed for comparisons. Results From 2000 to 2019, a total of 131,619 pregnant cases and 658,095 non-pregnant controls were identified. The median age was 27 years (IQR: 22, 31) for the matched groups. For known trimester of pregnancy: 29.8, 37.0, and 28.2% were in the first, second, and third trimester, respectively. Most common exposures were analgesics and cleaning products. Intentional exposures were more common in non-pregnant compared to pregnant cases (41.2 vs 21.9%; OR 2.71, 95% CI 2.67–2.75), mostly self-harm attempts (31.5 vs. 15.8%). Notably, there was a large discrepancy in the proportion of environmental exposures, with fewer in non-pregnant controls compared with pregnant cases (3.8 vs. 12.1%; OR 0.29, 95% CI 0.28–0.29). More non-pregnant cases had multiple substance exposures compared with pregnant cases (22.2 vs. 10.9%; OR 2.34, 95% CI 2.29–2.38). There were more moderate effect outcomes in non-pregnant compared with pregnant cases (13.2 vs. 6.3%; OR 2.25, 95% CI 2.20–2.30). Conclusions Outcomes of poisoning exposures in pregnant patients reported to U.S. poison centers are less serious compared to non-pregnant controls, likely due to the lower rates of intentional abuse and self-harm exposures and greater number of minimally toxic environmental exposures.

COVID-19 and Pediatric Ingestions.

On March 13, 2020, the United States declared the coronavirus disease 2019 outbreak a national emergency.1 Consequently, the abrupt shift in the school and home dynamics, combined with ensuing psychosocial and economic household stressors, placed children at increased risk of harm.2 In particular, early 2020 data indicated an increase in household cleaner and disinfectant exposures.3 However, the impact of the pandemic on overall pediatric ingestions is unclear. Our objective was to compare national trends in pediatric ingestions during the pandemic to a similar prepandemic period.All closed cases of ingestions involving children aged ≤19 years reported to US poison control centers from March 13 to December 31, 2020 (pandemic), were compared with an identical period from 2017 to 2019 (prepandemic). A closed case is either one in which the regional poison center determined no further follow-up or recommendations were required or no further information on the case was available.4 All US poison control center operations and reporting were consistent across the study period. Aggregate national data were abstracted from the American Association of Poison Control Centers National Poison Data System.4 Information requests and animal calls were excluded. Abstracted data included age group, sex, substance ingested, reason, exposure and management site, disposition, and medical outcome. Clinically significant outcomes were defined as a moderate or major effect or death.4 Descriptive statistics were used to describe the study cohorts, and categorical variables were compared by using the χ2 test. The significance level was set to α < .05. The study was exempt from review by our institutional review board.There were 861 626 pediatric ingestions during the pandemic, representing a 6.3% absolute decrease compared with the prepandemic years (Fig 1A). The pandemic period had an increase in proportion of teenagers and children aged ≤5 years compared with the prepandemic years (Table 1). There was a relative increase in intentional ingestions accounting for 10.8% of all ingestions during the pandemic period versus 10.3% during the prepandemic period (0.5% difference, 95% confidence interval: 0.4%–0.6%, P < .001) (Table 1). In addition, there was a relative increase in ingestions occurring at home during the pandemic period when compared with the prepandemic period (1.9% difference, 95% confidence interval: 1.8%–2.0%, P < .0001).Ingestions of hand sanitizers increased by 43% (18 099 vs 12 653, P < .0001) and melatonin by 70% (44 957 vs 26 431, P < .0001) during the pandemic period. Additionally, melatonin ingestions supplanted analgesics as the most frequently ingested substance during the pandemic period (Fig 1B). Clinically significant outcomes associated with ingestions increased during the pandemic period (4.2% vs 3.6%, P < .001). Whereas overall ingestions managed at a health care facility decreased by 14.2% during the pandemic, there was an increase in the proportion of adolescents (P < .001), intentional ingestions (P < .001) and hospitalizations (P < .001) (Table 1).Ingestion-related calls to poison control centers and those subsequently managed at health care facilities decreased during the pandemic. The latter is consistent with a report of an overall decrease in pediatric emergency department visits.5 This decline may be secondary to a combination of social restrictions, apprehensions in seeking care at a medical center, and increased parental supervision due to work-from-home advisories.5,6 The majority of ingestions occurred at the home, aligning with school and child care closures during the pandemic.The increase in clinically significant ingestions observed in our study could be a consequence of misperceptions of health care facility safety during the pandemic. This may have subsequently contributed to delays in presentations and potentially worse outcomes.6The increase in the proportions of adolescent and intentional ingestions may reflect heightened social, emotional, and psychological stressors on this age group. Initiatives focusing on implementing support systems for this vulnerable population are warranted. The heightened hand sanitizer and melatonin ingestions parallel the ubiquitous rise in the sale and use of such products during the pandemic and ease of accessibility among children.3,7 This demands continued attention, given reports of methanol-contaminated hand sanitizer ingestions with severe adverse outcomes.8Limitations include voluntary reporting to poison control centers and reliance on secondhand narratives, which may include partially incomplete information. Additionally, drug concentrations are rarely obtained to confirm ingestions. Finally, incomplete coding of the poison control center data may have also skewed ingestion frequencies.Pediatric ingestion calls to poison control centers decreased during the pandemic. However, there were significant increases in intentional hand sanitizer and melatonin ingestions and those with clinically significant outcomes. Further studies are required to determine the long-term impact of the pandemic on pediatric ingestions to institute appropriate preventive measures and resource allocation.

Hand Sanitizer in a Pandemic: Wrong Formulations in the Wrong Hands.

BackgroundHouseholds are increasingly stockpiling and producing hand sanitizer amid the coronavirus disease 2019 (COVID-19) pandemic, which can pose an increased risk for unintentional toxicity among children. Despite guidelines for hand sanitizer production published by the World Health Organization, many turn to streaming media for instruction.ObjectiveThe purpose of this investigation was to evaluate hand sanitizer formulations and safety precautions discussed in popular do-it-yourself (DIY) YouTube videos, and to assess the frequency of calls to poison control centers for pediatric hand sanitizer exposure before and after the arrival of COVID-19 in the United States.MethodsThe first 100 videos on YouTube with the most views using the search term “DIY hand sanitizer” were evaluated for accuracy compared with the World Health Organization local hand sanitizer production guidelines. The incidence of pediatric hand sanitizer exposure reported to participating U.S. poison control centers from January 2018 through May 2020 was reviewed from the American Association of Poison Control Centers National Poison Data System. The average number of calls between January 2020 and May 2020 was compared, and the average number of calls in March 2020 was compared with March 2019 and March 2018.ResultsOf the YouTube videos that met inclusion criteria, 27% discussed the use of at least 96% ethanol or 99.8% isopropyl alcohol, 4.1% incorporated 3% hydrogen peroxide, 82% used glycerol or an alternative humectant, and 4.1% specified the need for distilled or previously boiled water. Most of the videos failed to describe labeling storage containers, 69% of videos encouraged the use of oils or perfumes to enhance hand sanitizer scent, and 2% of videos promoted the use of coloring agents to be more attractive for use among children specifically. There was a significantly increased average number of daily calls to poison control centers regarding unsafe pediatric hand sanitizer exposure since the first confirmed COVID-19 patient in the United States. There was a significantly increased average number of daily calls in March 2020 compared with the previous 2 years.ConclusionsYouTube may not be an accurate source for effective hand sanitizer concoction. Health care providers and parents should be aware of the increased surge in hand sanitizer exposure among children and should take proper precautionary measures.

Adolescent Intentional Abuse Ingestions: Overall 10-Year Trends and Regional Variation.

Adolescent intentional ingestions remain a significant public health problem in the United States with little research to date on the over-the-counter or prescription medicines that adolescents abuse. These data are important for anticipatory guidance by primary care providers, preventive health, and poison center outreach. This was an observational study using the American Association of Poison Control Centers National Poison Data System. The study population consisted of all cases of patients aged 13 to 19 years from 2004 to 2013 with a coding of "intentional abuse." There were 95,695 patient calls that were coded for intentional abuse between 2004 and 2013 for adolescents aged 13 to 19 years. The most common agent reportedly ingested in intentional-abuse cases was antihistamine and/or decongestant with dextromethorphan, and this agent remained the most common throughout the 10-year study period. The next 4 most common agents remained similar across the study period as well and included ethanol, benzodiazepines, dextromethorphan alone, and marijuana. These 5 agents remained the most commonly reported across the study period for all US regions (West, Midwest, South Northeast, and US territories). Over a recent 10-year period, common cough preparations remain the most commonly reported intentional abuse ingestion among all years and regions for adolescents.

Toxic Christmas and New Year Holiday Plants...or Are They

Background: Poinsettia (Euphorbia pulcherrima), holly (Ilex opaca) and mistletoe (Phoradendron flavescens) adorn homes during the Christmas and New Year holiday season and create the potential for curious children to sample their colorful leaves and enticing berries. This study was aimed to review the American Association of Poison Control Centers National Poison Data System (AAPCC NPDS) to describe the epidemiologic profile of ingestion of these plants and to determine whether there was associated morbidity and mortality. Methods: All plant ingestion exposures reported to American poison centers (PCs) from 2000-2009 were analyzed to identify all exposures to E. pulcherrima, I. opaca and P. flavescens. The data analysis included ingestions by age, gender, patient management site, symptoms, intention and outcome. Results: The AAPCC NPDS database included 668,111 plant ingestions during 2000 to 2009. E. pulcherrima (19,862; 3.0%), I. opaca (5,432; 0.8%) and P. flavescens (1,138; 0.2%) exposures accounted for 26,632 (4.0%) of all plant ingestion exposures. Children younger than six years were responsible for majority of ingestions (88.0%). Ingestions were more likely to occur unintentionally (P < 0.001). Most cases (96.1%) were asymptomatic. When clinical effects developed (1,046 cases), the most frequent reported signs were gastrointestinal in nature (59.8%) including abdominal pain, diarrhea and/or vomiting. Moreover, the development of gastrointestinal signs was higher in patients who ingested P. flavescens compared to the other two species. Most exposures (96.1%) were managed at home with the guidance from PC experts. When the outcome was known, the majority of exposures (89.2%) experienced no adverse effects. Moderate effects occurred in only 28 ingestions (0.1%), and one major effect was recorded in a patient who ingested poinsettia. Conclusion: These holiday plants were associated with extremely low morbidity and no mortality. Home management along with expert guidance can be adequate intervention in the majority of these exposures.

Risk of major morbidity and death in older adults with suicidal intent: a cross-sectional analysis from the National Poison Data System, 2000-2009.

To describe suicide-related exposures in older persons according to sex, age, and substance category reported to U.S. poison control centers (PCCs) and report the crude relative risk (RR) of major effects and death from pharmaceuticals and nonpharmaceutical substances after single- and multiple-substance exposures. Cross-sectional analysis of American Association of Poison Control Centers National Poison Data System (NPDS) data. Calls to U.S. PCCs. NPDS cases involving individuals aged 60 and older with an exposure to a pharmaceutical or nonpharmaceutical substance and suicide as the reason (n=46,494). Major effect and death probabilities for single- and multiple-substance exposures to pharmaceuticals and nonpharmaceuticals were determined. In the NPDS, a major effect is defined as symptoms or signs that are life-threatening or resulted in significant residual disability or disfigurement. Crude RRs of major effects or death were estimated for single and multiple pharmaceutical substances in comparison with nonpharmaceutical substances. Single-substance exposures occurred in 53.3% of cases. Overall, 92.3% involved pharmaceuticals and 64.4% involved women. In the total sample, 12.7% (5,895/46,494) of exposures resulted in major effect, and 1.9% (884/46,494) resulted in death. The crude RR of major effects in single-substance pharmaceutical exposures was significantly lower than with nonpharmaceutical exposures (RR=0.54, 95% confidence interval (CI)=0.49-0.59), as was death (RR=0.25, 95% CI=0.20-0.30). For multiple-substance exposures, the crude RR of major effects from pharmaceuticals was similar to that for nonpharmaceuticals (RR=0.92, 95% CI=0.80-1.06), whereas the crude RR of death from pharmaceuticals was significantly lower (RR=0.55, 95% CI=0.40-0.77). These findings can inform suicide prevention strategies that focus on decreasing at-risk older adults' access to dangerous medications and chemicals in the home.

Evaluation of Quetiapine Abuse and Misuse Reported to Poison Centers

There are case reports of abuse of quetiapine, but no studies address quetiapine abuse or misuse. Most literature on the population that abuses quetiapine describes an older age group with previous substance abuse history, many of whom are in jail. The objective of this study was to evaluate national poison center data on misuse/abuse of quetiapine. A retrospective study of American Association of Poison Control Centers National Poison Data System data from 2005 to 2011 on single substance quetiapine exposures coded as intentional misuse or abuse and followed to known outcome was performed. Data were evaluated for age, toxicity, management sites, treatments, and medical outcomes. There were 3116 cases meeting inclusion criteria; reason was misuse in 1948 cases and abuse in 1168 cases. The median age was 23 years. Misuse was reported most often in adults, whereas abuse occurred most frequently in adolescents. The male-to-female ratio was 1.7 for abuse and 1.0 for misuse. There were no deaths. Moderate or major toxicity occurred in 23.7% and 27.1% of misuse and abuse cases, respectively. Seventy-six percent were treated in the emergency department and/or received medical admission. Misuse was more common than abuse, except in adolescents for whom abuse was more frequent. Although outcomes were generally good, significant toxicity occurred in 25% of cases and more than 75% of the patients were treated in the emergency department and/or received medical admission. The consequences of nonmedical use of quetiapine are serious in some patients.

Association of Unintentional Pediatric Exposures With Decriminalization of Marijuana in the United States

We compare state trends in unintentional pediatric marijuana exposures, as measured by call volume to US poison centers, by state marijuana legislation status. A retrospective review of the American Association of Poison Control Centers National Poison Data System was performed from January 1, 2005, to December 31, 2011. States were classified as nonlegal if they have not passed legislation, transitional if they enacted legislation between 2005 and 2011, and decriminalized if laws passed before 2005. Our hypotheses were that decriminalized and transitional states would experience a significant increase in call volume, with more symptomatic exposures and more health care admissions than nonlegal states. There were 985 unintentional marijuana exposures reported from 2005 through 2011 in children aged 9 years and younger: 496 in nonlegal states, 93 in transitional states, and 396 in decriminalized states. There was a slight male predominance, and the median age ranged from 1.5 to 2.0 years. Clinical effects varied, with neurologic effects the most frequent. More exposures in decriminalized states required health care evaluation and had moderate to major clinical effects and critical care admissions compared with exposures from nonlegal states. The call rate in nonlegal states to poison centers did not change from 2005 to 2011. The call rate in decriminalized states increased by 30.3% calls per year, and transitional states had a trend toward an increase of 11.5% per year. Although the number of pediatric exposures to marijuana reported to the National Poison Data System was low, the rate of exposure increased from 2005 to 2011 in states that had passed marijuana legislation.

Unintentional Pediatric Exposures to Central Alpha-2 Agonists Reported to the National Poison Data System

To investigate national trends in unintentional pediatric exposures to 3 common alpha-2 agonists: clonidine, guanfacine, and tizanidine. Secondary objectives were to describe outcomes, symptoms, treatments, and death. Retrospective chart review from the American Association of Poison Control Centers National Poison Data System from January 2000 to December 2011 for unintentional exposure to clonidine, guanfacine, and tizanidine in children ≤ 12 years of age. From 2000-2011, there was a significant increase (5.9% per year, CI 3.6, 8.2) in unintentional pediatric exposures to National Poison Data System for central alpha-2 agonists. There were 27,825 clonidine exposures (67.3% male, median age: 4 years), 6143 guanfacine exposures (69.8% male, median age: 6 years), and 856 tizanidine exposures (51.9% male, median age: 2 years). Guanfacine had the greatest proportional increase among the medications. Clonidine was associated with the most respiratory (799, 2.9%) and central nervous system symptoms (12,612, 45.3%), as well as the most episodes of bradycardia (2847, 10.2%) and hypotension (2365, 8.5%). Seven-hundred twenty-eight (2.0%) patients were intubated, and 141 patients (0.5%) were administered vasopressors. There were 7 cardiac arrests and 3 deaths from clonidine. The number of unintentional pediatric exposures to alpha-2 agonists increased from 2000-2011. Clonidine exposures were the most commonly reported, more symptomatic, and associated with 3 deaths. Despite central nervous system depression, bradycardia, and hypotension being common, the need for intubation and vasopressors was rare.

Overdoses and Ingestions of Second-Generation Antipsychotics in Children and Adolescents

We reviewed the available published data on intentional or unintentional secondgeneration antipsychotic overdoses in children and adolescents. The prescribing of secondgeneration antipsychotics has continued to increase over the past decade for children, adolescents, and adults. The authors reviewed the existing literature to determine the circumstances, presenting problems, treatment, and outcomes of youths who were exposed to nontherapeutic doses of these medications. A systematic English-language Medline search of all reports (1989-2005) and a review of the bibliographies of all articles obtained was done to identify papers reporting an overdose or ingestion of a second-generation antipsychotic. Data were reviewed on clozapine, risperidone, olanzapine, ziprasidone, quetiapine, and aripiprazole. The annual reports of the American Association of Poison Control Centers National Data Collection System were reviewed from 1990 to 2003, the most recent report currently available. All fatalities in children and youths under 18 years of age were included. The literature review identified 40 reports that included 63 patients, ranging in age from 1 day to 17 years of age. The clinical presentations included drowsiness, lethargy, agitation, irritability, combativeness, and tachycardia. There were 11 fatalities in the cases reviewed, 1 from clozapine overdose, 3 from risperidone overdose, 2 from olanzapine overdose, and 5 from quetiapine overdose. All other cases reported no significant sequelae and resolved without any reported clinical consequences. Duration of overdose symptoms ranged from 24 hours to 7 days. One case of clozapine intoxication showed resolution of symptoms in 6 hours and, in another case of olanzapine overdose, symptoms resolved in 13 days. The most frequently employed treatments included intubation, gastric lavage, activated charcoal, intravenous fluids, artificial respiration, and restraints or sedatives. There is a need for future case reports to include serum medication level, weight of patient, coingestants, the health of the patient at baseline, relevant laboratory and toxicology studies and a standardized scale to rate the level of consciousness, such as the Glasgow Coma Scale. The existing pharmacovigilance data reports indicate these medications are relatively safe when taken in overdose, particularly when coingestants are not involved.

American mistletoe exposures

American mistletoe is generally considered to be extremely toxic. Although there are no data to support this contention, both the lay public and medical professionals often respond very aggressively after ingestion of any portion of this plant. To determine if American mistletoe is deserving of this reputation, the outcomes of 1,754 exposures to this plant were examined. All mistletoe data extracted from the American Association of Poison Control Centers national data collection system for the period of 1985 to 1992 were analyzed according to patient age, gastrointestinal decontamination therapy, patient outcome, and geographic region of the exposure. Pediatric exposures accounted for 92.1% of the cases, and 94.7% of the reported cases were accidental exposures. Of all cases, 99.2% had an outcome associated with no morbidity, and there were no fatalities. Apparently, patient outcome was not influenced by the use of gastrointestinal decontamination techniques—96.2% of treated patients remained asymptomatic versus 96.3% of patients who received no therapy. The accidental ingestion of American mistletoe is not associated with profound toxicity.

Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States

Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]

1991 Annual report of the American Association of Poison Control Centers National Data Collection System

1991 Annual report of the American Association of Poison Control Centers National Data Collection System

Lomotil Overdose

To the Editor.— I was amazed and disappointed to read the concluding paragraph of Dr Wasserman's Letter to the Editor, `Lomotil Overdose,'1 wherein he states that Lomotil (diphenoxylate/atropine) intoxications "are rarely seen" now. The 1990 Annual Report of The American Association of Poison Control Centers National Data Collection System2 lists 1654 cases of diphenoxylate-atropine poisonings which include 1004 cases (61% approximately) involving children less than 6 years old, and two deaths. Talking about loperamide Dr Wasserman asks, "Will Imodium prove to be less dangerous to infants and young children than Lomotil? So far it seems that way."

1990 Annual report of the American Association of Poison Control Centers National Data Collection System

1990 Annual report of the American Association of Poison Control Centers National Data Collection System

1989 Annual report of the American Association of Poison Control Centers National Data Collection System

1989 Annual report of the American Association of Poison Control Centers National Data Collection System

1988 Annual report of the American Association of Poison Control Centers National Data Collection System

1988 Annual report of the American Association of Poison Control Centers National Data Collection System

1987 Annual report of the American Association of Poison Control Centers National Data Collection System

1987 Annual report of the American Association of Poison Control Centers National Data Collection System

Interpretation and uses of data collected in poison control centres in the United States.

Clinical toxicology and poison control have not benefited from the same epidemiological and demographical scrutiny that other health care disciplines have, because of the lack of a meaningful, appropriate database from which to undertake those analyses. Since the creation of the American Association of Poison Control Centers National Data Collection System in 1982 many of the former obstacles of data collection have been overcome. A system has been devised which apparently meets the needs of busy regional poison control centres willing to participate in data collection, and thus provide a large database of human poisoning experience. The data collected by poison control centres and maintained in the National Data Collection System afford a new, powerful tool with which to address issues of demography, epidemiology, risk assessment, product surveillance and regulatory affairs. While the system affords these potentials, certain limitations of the data must be understood so that the data are not misinterpreted. Additionally, we have attempted to identify strengths of the system as well as areas in need of improvement and refinement.