Intentional pediatric nonprescription cold/cough and analgesic/antipyretic exposure trends amid the COVID-19 pandemic

Publications Category : Emergency Medicine, Epidemiology, Internal Medicine, Pediatrics, Pharmacology

Author(s): Sara Karami, Christian Angelo Ventura, Ellen Pinnow, Jody Green, Ajoa Asonye, Ibrahim Ibrahim, Lynda McCulley, Gerald Dal Pan, Esther H Zhou

Project Description : The objective of this study is to examine US Poison Center intentional pediatric nonprescription analgesics/antipyretic and cold/cough exposure trends involving abuse/misuse and suspected suicide amid the COVID-19 pandemic. Methods Using descriptive and interrupted time-series analyses, we assessed monthly pediatric (6–17 years) exposure case rates involving nonprescription analgesic/antipyretic drugs containing paracetamol (acetaminophen), ibuprofen, acetylsalicylic acid, and naproxen, and cold/cough drugs containing dextromethorphan, guaifenesin, pseudoephedrine, and phenylephrine, before (1/1/2015–2/29/2020) and during (4/1/2020–4/30/2023) the COVID-19 pandemic. Statins served as a control. Results Nearly half of pediatric intentional cough/cold (40–56%) and analgesic/antipyretic (51–62%) cases involved a single substance, unlike the control (22%). Most cases entailed intentional-suspected suicide exposures (cold/cough 55–78%; analgesic/antipyretic 89–92%; control 96%) followed by intentional-abuse/misuse (cold/cough 17–40%; analgesic/antipyretic 6–8%; control 3%). Cases commonly involved adolescents, 13–17 years (cold/cough 88–93%; analgesic/antipyretic 90–92%; control 88%) and females (cold/cough 56–71%; analgesic/antipyretic 84–85%; control 82%). Paracetamol intentional-abuse/misuse and dextromethorphan suspected suicide case rates declined immediately following the pandemic’s onset (March 2020), among adolescents. Case rates for guaifenesin, paracetamol, and ibuprofen intentional-suspected suicides exceeded pre-pandemic levels and exhibited statistically significant increased trend changes for adolescents (0.016, 0.246, and 0.116 cases per million population per month, respectively); and for guaifenesin for female (0.03 cases per million population). Male and female intentional-abuse/misuse case rates trends for some study drugs also increased; primarily for adolescents. Conclusion Some analgesic/antipyretic and cold/cough intentional-suspected suicide case rates notably increased during the pandemic for adolescents, particularly females. This surge aligns with periods of increased psychological stress, suicidal ideation/attempts, and certain nonprescription drug exposures potentially attributed to the COVID-19 pandemic.