Intentional substance exposures at school rise sharply among younger children

A new study found that rates of intentional substance exposures at school reported to U.S. poison centers increased substantially among elementary- and middle-school-aged children from 2000 through 2024, while high-school-aged adolescents continued to experience the highest rates of serious medical outcomes and hospital admissions. Researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children's Hospital and the Central Ohio Poison Center analyzed calls to U.S. poison centers and found that the overall rate of reported intentional substance exposures at school increased 77.5% from 2000 to 2024.

In a study published in American Journal of Emergency Medicine, researchers found the increase was 287% among elementary-school-aged children (from 3.1 to 11.9 reports per 100,000 children) and 112% among middle-school-aged children (from 10 to 21.3 per 100,000 children). In contrast, the rate among high-school-aged children decreased by 4% over the study period.

One of the most striking findings was how the age pattern changed over time. By about 2015, the reported exposure rate among middle-school-aged children had surpassed that among high-school-aged youth. At the same time, high-school-aged adolescents continued to experience the most serious medical outcomes. These findings tell us that prevention needs to begin earlier, while older adolescents also need ready access to clinical and mental health support."

Hannah Hays, MD, co-author of the study and medical director, Central Ohio Poison Center

Overall, high-school-aged teenagers accounted for almost half (46%) of intentional substance exposures at school. The higher rates of serious medical outcomes and hospital admissions in this age group are partially explained by their higher rates of substance abuse and suspected self-harm or suicidal intent.

Leading substance categories differed by age group as well.

• Elementary school (6–10 years): cosmetics/personal care products (15%), arts/crafts/office supplies (15%), plants (15%), and foreign bodies/toys/miscellaneous (14%).
• Middle school (11–13 years): cosmetics/personal care products (13%), arts/crafts/office supplies (11%), foreign bodies/toys/miscellaneous (8%), and analgesics (8%).
• High school (14–18 years): analgesics (15%), stimulants and street drugs (12%), sedative/hypnotic/antipsychotic medications (10%), and cough and cold preparations (9%).

More than half of the intentional exposures occurring at school were attributable to intentional misuse (62%), followed by abuse (24%) and suspected self-harm or suicidal intent (14%). Substance abuse was more than four-and-a-half times more likely to be associated with a serious medical outcome than non-abuse-related intentional exposures. Likewise, suspected self-harm or suicidal intent-related exposures were more than two times more likely to be associated with a serious medical outcome than exposures not related to suspected self-harm or suicidal intent. In poison center data, "intentional misuse" refers to improper use for a reason other than seeking a high or other psychotropic effect; recreational use with the intent of seeking a high or other psychotropic effect is categorized separately as "abuse."

Pharmaceutical exposures in the high school group were associated with substantially greater clinical severity. Across all age groups, exposures involving pharmaceuticals were about 10 times more likely to result in a serious medical outcome and 14 times more likely to result in admission to a non-critical or critical care unit than non-pharmaceutical substance exposures.

This study highlights the need for age-specific prevention interventions and clinical response strategies – safe storage not only in the home, but in school settings as well. Prevention efforts that begin in early childhood and availability of intensive clinical and mental health resources for older adolescents, who continue to experience the greatest morbidity, are crucial.

"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," said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's. "Collaboration among school officials and educators, clinicians, poison centers, and public health professionals is important for reducing intentional substance exposures in schools, especially those associated with suspected self-harm and suicidal intent and substance abuse."

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Data for this study were obtained from the National Poison Data System (NPDS), which is maintained by America's Poison Centers. Poison centers receive phone calls through the national Poison Help Line (1-800-222-1222) and document information about the exposure, which is reported to the NPDS.