In May, the journal Pediatrics published some alarming data: In the past decade, there has been a dramatic rise in the number of teens attempting to kill themselves with poison. The trend has been largely driven by increases in poisoning attempts by young girls.
Overall, the study, which drew from poison control center reports, estimated that in 2018, close to 60,000 girls ages 10 to 18 tried to poison themselves, twice as many as in 2008. Those figures were pulled from a larger dataset of more than a million self-poisonings recorded in people ages 10 to 25 years old between 2000 and 2018. Around 70 percent of those cases were girls and women.
In general, suicide attempts by poisoning are fatal less than 5 percent of the time. But a poisoning attempt is still a traumatic experience. And the growing occurrence, especially among young girls, is troubling.
Now, a new study from the same researchers, published in Clinical Toxicology, has analyzed the substances most commonly used in those poisonings.
What they found was that the most common poisons were over-the-counter drugs, like Tylenol or Advil (or generic versions of these drugs). Out of 1,677,435 cases of self-poisonings of people ages 10 to 25 from 2000 to 2018, 27.5 percent involved over-the-counter pain medications. Again, women and girls accounted for the vast majority of these poisoning cases.
Opioids were involved in just 4 percent of the cases, and their use in poisonings has been decreasing in recent years. Perhaps that’s because of the increased public awareness of their dangers, leading to better storage and efforts to reduce prescribing them. Household cleaners were only implicated in 1.8 percent of the cases.
Over-the-counter pain medicines were involved in 27.5 percent of the cases overall. But when the researchers looked at just “serious outcomes” — this includes needing medical treatment, or symptoms that don’t resolve quickly, or death — over the counter pain medicines were involved in 37.3 percent of the cases. There’s an important conclusion here: Over-the-counter medicines, when taken inappropriately, can be more dangerous than many might think.
“Some of the more commonly accessible medicines were able to produce some of the most serious outcomes among young people,” John Ackerman, a study co-author and Suicide Prevention Coordinator at Nationwide Children’s Hospital, says.
The study results are good reminder: Parents should talk to their kids “about the access they might have to the medications of friends and family,” Ackerman says. And they should “ask about mental health and thoughts of suicide, [and] whether they are having an emotional crisis.”
Researchers are unsure what’s driving these trends
It’s not just poisonings. Data, across the board, shows that more and more teens are experiencing mental distress.
Between 2009 and 2017, the number of high schoolers who contemplated suicide reportedly increased by 25 percent. Deaths by suicide among teens increased by 33 percent in that time period as well. Suicide is now the second-leading cause of death among teens, after accidents (traffic, poisoning, drowning, etc.).
Let me stress that teen suicide deaths are still rare; just 10 out of 100,000 teens ages 15 through 19 die this way. But even a single death is one too many. And all the attempts, anguish, and depression that can lead to it needs to be dealt with, too.
While adolescent girls tend to poison themselves in suicide attempts more often than adolescent boys, boys tend to turn to more lethal means, like firearms. The result is that while girls attempt to take their lives more often, boys die in higher numbers.
Experts are unsure of the exact cause of these unsettling trends: Hypotheses include stressful fallout from the recession, the changing way teens interact with each other in digital spaces, increasing social isolation, stressors of the opioid crisis trickling down to kids, suicide contagion, the fact that teens can more easily look up how to kill themselves online, and others. There does not seem to be one single cause, though the trend does seem to have started around 2011.
“The reason why we don’t know why kids are doing this is because suicide isn’t a single diagnosis; it’s an outcome that many, many paths can lead to,” Mitch Prinstein, the director of clinical psychology at the University of North Carolina Chapel Hill, told me in April.
Regardless, just because the causes of the trends are unknown doesn’t mean we’re powerless to help.
We don’t need to know the exact causes of these trends to be able to help
For parents of troubled teens — or perhaps just parents in general — one consideration is whether medicines in the home should be locked up. It’s tricky, Ackerman says, because allowing some kids to manage their medicine use can be an important developmental milestone. Kids need to learn how to safely manage their own medication eventually.
“There needs to be a developmental path for a young person to take ownership of their medication use,” he says. “I’m not saying ‘lock it up’ until they’re 18, no matter what. But treat it like a driving privilege, or something that carries significant responsibility. It needs to be taught, practiced, and earned over time. Until a parent is confident that the child can manage their medication use, it should be stored and locked.”
The researchers say there aren’t great guidelines around how families should deal with keeping kids away from over-the-counter drugs or prescriptions that belong to other family members. “We have guidelines if you have opiates in your house,” Henry Spiller, director of the Central Ohio Poison Center and a study co-author, says. But, he adds, there really isn’t anything addressing how to store blood pressure medicine, for example, or what to do with the family’s stash of ibuprofen.
Ackerman suggests one commonsense idea is to not let kids have access to any bottle that contains hundreds of pills; use smaller ones that contain just a few.
Research also indicates it would be helpful to change how certain over-the-counter drugs are packaged. In the UK, when a popular over-the-counter painkiller was repackaged in blister packs (where pills have to be popped out one by one) instead of bottles (which make it easy to pour out many pills at once), it resulted in fewer overdose deaths from that drug.
“Most of the time when you add time between an intense suicidal crisis and an access to means, you’re going to show a reduction in suicidal behavior,” Ackerman says. It simply takes longer to open blister packs. And time can save lives.
Among teens, the new study also finds that self-poisonings seem to be more prevalent during the school year, and the risks seem to be greater in rural areas than urban areas.
The new study is also a reminder: Our mental health care system doesn’t do a great job reaching everyone in need. Training more teachers and school staff to spot the signs of suicide among teens could help as well. And there are some clinicians trying to innovate with web-based therapies (you can read more about those). But this new data, again, underscores there’s a mental health crisis unfurling.
“Based on the sheer numbers, you don’t have enough psychologists, social workers, counselors, other therapists, to actually physically address the need that is clearly out there,” Ackerman said in a previous conversation. “Even if you had everyone in the mental health workforce dealing with treating suicide and life-threatening behaviors, you would not be able to fully address the need.”