Last year's calls reveal troubling new cases among kids

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The Upstate New York Poison Center celebrated 65 years of service in 2022, and today we're going to talk about the trends from last year with Michele Calliva. She's the administrative director at the poison center.

Welcome back to "The Informed Patient," Ms. Caliva.

Michele Caliva: Thank you.

Host Amber Smith: The Upstate New York Poison Center helped nearly 50,000 cases, relating to a variety of poisons, in 2022. How does that number compare to the numbers before COVID or in the first couple years of the pandemic?

Michele Caliva: It really matches up.

I would have to say, consistently, we get somewhere between 50,000 and 60,000 calls annually, so we're on track from last year.

Host Amber Smith: Well, let's talk about the trends you've noticed.

Michele Caliva: Sure. So probably the most startling and concerning trend is around cannabis exposure, and we are very concerned about cannabis exposure in young children who inadvertently eat edibles.

That's the trend we've been watching very closely. And I can give you an example. In 2021, we had just over 300 cannabis-related cases; in 2022, 700; and I just ran the numbers year to date. We've already had 91 cases in January, and if we do the math, that puts us over a thousand by the end of the year.

Host Amber Smith: So that's really exploded. And these are marijuana edibles, which are now legal in New York, right?

Michele Caliva: So it's any form of cannabis. But again, the biggest one has been the edibles, so children can inadvertently get exposed to it. It can be a cookie, a brownie, or it can be gummies or whatever formulation it is, and they don't know the difference. So they eat them, and it has a real bad outcome in little ones.

Host Amber Smith: So this is happening at these numbers because these cannabis edibles look like candy or look like some innocent thing to ingest?

Michele Caliva: Yes. I mean, if you have a bag of edibles sitting on a counter, a little 5-year-old isn't going to know that that's different than the gummies that Mom or Dad normally give them. So there's definitely product confusion, I mean, in, I say less than 5, but it can happen across the board. We had a case of an older woman that ate a chocolate chip cookie, not realizing that it had cannabis, and had THC (marijuana's major psychoactive ingredient), in it.

Host Amber Smith: So it could be any age. But you see a lot of them are younger kids?

Michele Caliva: And I think it's because gummy bears are attractive to little people, and so our big push, we've been really, really promoting this, and we'll continue to promote it. And we do work with New York State Office of Cannabis Management, now poison center phone numbers are going to be on packaging. But we've been working them as well to get the message out that says if you have edibles in the home, which is OK, put it in a lockbox. Keep it up out of the way and out of reach. So treat it like you would medication.

Host Amber Smith: These lockboxes you can get in pharmacies?

Michele Caliva: You can purchase them, you can buy them online. They're easy enough to get ahold of. And we encourage parents that have any kind of medication, grandparents that have any kind of medication, to put meds in lockboxes, obviously, but let's add the edibles. And I probably should say, is there a big deal in little children? There is. The cannabis will cause varying degrees of CNS depression, so they get very, very drowsy.

And it's not just short-term, it's long-term. They can go hours and still be very lethargic, very, very drowsy. Maybe even a little bit scared, maybe a little bit agitated, and it can cause seizures. So these kids all go into the hospital.

And we encourage parents -- I mean, it's OK, you can have edibles in the house, but -- call us, because your little person really needs to be seen, needs medical attention. They cannot be managed at home.

Host Amber Smith: So CNS, that's central nervous system, that can look pretty scary to a parent.

Michele Caliva: Very scary. They can be very lethargic and not responding and completely different than what you'd expect a 3-year-old to look like, or a 5-year-old. You'd expect them to obviously be playful and normal, and they're not.

It really is quite scary in a little person.

Host Amber Smith: In terms of trends, let me ask you, what's happening with drug overdoses and deaths? Because we hear about, nationally, fentanyl being a drug that is being misused and showing up where people don't expect it to be. Are we seeing that in Central New York as well?

Michele Caliva: We are seeing it across the state, we're seeing it nationwide, certainly in Onondaga County, as well. What's really tragic here is that there are people dying. They have their heroin, they don't know that the fentanyl is in there, and they end up succumbing to the drug.

Fentanyl in combination with heroin is a really deadly combination. It causes respiratory depression, so it slows down breathing. It causes central nervous system depression, so they become unresponsive. And again, many times a person's intent isn't to use fentanyl. They don't know when they get the drug, when they purchase the drug, fentanyl's there.

In some communities, and here as well, we really encourage people to use fentanyl strips to see, you can test your product to see, if there's fentanyl in it or not. But again, some people don't have access to that or some people just might not even realize to do that or think to do that.

And so, sadly, we are seeing fentanyl-related deaths. Our numbers are fairly low in terms of straight-up fentanyl exposures because many times, again, the person doesn't know that it has fentanyl in it. And the provider that calls us, a health care facility, the nurse or the physician, might not realize that the patient had fentanyl.

But it's very disconcerting.

Host Amber Smith: Is that the drug that is reversed with naloxone?

Michele Caliva: So heroin is reversed, fentanyl is, any opioid is reversed with naloxone. So, again, everybody should be trained (to administer naloxone). You should have access to it. You should reach out to your harm-reduction agencies in the community and get trained.

They're still training. I heard about a training that's happening this week in Madison County and in Oneida County. There's definitely trainings that are going on for family members and for the general public. We should have naloxone ready and available. You never know when you're going to need it.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Michele Caliva from the Upstate New York Poison Center. And just a reminder, this is a free service, available 24 hours a day, at 1-800-222-1222.

Now, getting back to the stats from 2022, what were your busiest months, and why do you think they were your busiest months?

Michele Caliva: So we tend to always really be busy in January and May and July, and I am really not sure why. People often expect that we're going to be the busiest around the holidays, particularly for intentional overdoses. But those months have historically been busy. If I look back over data for 10 years, it's always January, May and July.

But what my staff is telling me is they're always busy. We are seeing, a real uptick in serious overdoses in cases, and one thing that we noticed this year that's really troublesome is that we're seeing intentional overdoses, where somebody is either misusing or intending to harm themselves in a younger age group, in that, middle school, high school age group, and we're really seeing a bump in that, which is another disconcerting trend from 2022.

Host Amber Smith: Is that suspected suicide attempts?

Michele Caliva: It is. Yes, again, in that school-age group, and I think that's another trend that's being seen across the country as well.

Host Amber Smith: I know it's 24 hours a day there, so do you get most phone calls during the daylight hours or overnight, in the evening?

Michele Caliva: So we get a lot of calls throughout the entire day, but we get a lot of our sickest calls, patients that, again, they're intentional overdoses or hospital-based calls. We get a lot of those in the evening and overnight, although we do get a share during the day, and we get a lot of the home calls more frequently, so the parent, Mom, the grandparent, the school nurse, calling during the day hours. Although, again, we get both, but I would say the overnight and the late evening are our sickest calls, the calls from the health care facilities.

Host Amber Smith: What were the top five poisonings for all age groups?

Michele Caliva: So it has been consistent. Again, if we look at the data for many, many years, it's acetaminophen. It's the active ingredient, for example, in Tylenol; Tylenol is a brand name. And for ibuprofen, so Motrin or Advil. We think that that's probably related to the fact that most people have it available and accessible.

Acetaminophen is very, very dangerous. it causes death to the liver if it's taken in an overdose, and it really makes people very, very sick. And we see it pretty consistently. And then bleach is still there as our No. 2. Household products: People are cleaning with bleach. We saw an uptick during COVID; that's continued.

And then our No. 3 was hand sanitizers. Again, I think a throwback to what we were all doing with COVID. So hand sanitizers are 70% alcohol. Really problematic if a little person gets into 70% alcohol, It's actually not good for any of us, but drinking hand sanitizer can lower the blood sugar level in little kids and can make them sick. So that's a problem.

And then we are seeing antidepressants. Very often, it's individuals that maybe have taken too much or have overdosed on their own medications. And then also some sedatives, so that would be like a benzodiazepine, so people might recognize the name Valium or Ativan. So those were our top five for all age cohorts, so that would be zero to 100

Host Amber Smith: So the medications that you mentioned, the over-the-counter pain relievers like acetaminophen and ibuprofen, the antidepressants and the benzodiazepines, are people accidentally or unintentionally just taking more than they're supposed to? Is that usually how that happens?

Michele Caliva: It's both, but it's also intentional. It's self-harm with those, or it is taking more than they should or using the project incorrectly.

Bleach, for example. It's taking your bleach and mixing it with your ammonia because you really, really want to get that bathroom floor clean. And that's a terrible combination. It actually produces, chlorine gas, which can make someone have difficulty breathing. Or taking your bleach and mixing it with an acid, and then you have chlorine gas. So it's both. It's inadvertent, or unintentional, and intentional.

Host Amber Smith: How does the top five poisonings change if you're looking just at children under 5?

Michele Caliva: So it does change. We don't see as much of the analgesic exposure, the pain medication. Laundry pods, still little kids getting into laundry pods and bleach; those tend to still occur. Hand sanitizer's still up there.

No. 3 is the liquid Tylenol. So it's a little child that accidentally ... well, they love the taste of bubblegum acetaminophen, right? So they pick it up and drink it.

Michele Caliva: It might be a parent that has given their child a dose of acetaminophen, and then the other parent comes along, doesn't know that and gives them a second dose. So that's part of the situation there.

And then No. 4, in July when our numbers go up, it's because of glow sticks. People have gone to a parade or fireworks. And the little kids break apart the glow stick and suck on it. The good news is, it's not a problem. The bad news is it really causes a bad taste in the mouth and kind of a stinging sensation. So it's a little disconcerting to them. So we see a lot of toys and silica gel and glow sticks and all of those kinds of products.

But glow sticks during July is, and I always say that. I'll hear there's a parade or fireworks, and I'll think, OK, the staff's going to get slammed with calls related to glow sticks.

And now, this is a little bit new. Dietary supplements, melatonin, we're seeing a lot more little children being given melatonin to sleep better at night. And so we are seeing more melatonin cases than we ever have. It's become a real trend to use melatonin to help them. So that might be, again, the little person helping themselves -- they come in gummies, as well -- so they may help themselves to the melatonin gummies.

Host Amber Smith: Well, in getting back to the cleaning products, the personal care products, is that because parents aren't putting 'them where kids can't reach them, mostly?

Michele Caliva: So, sometimes it's because you forget, and it's on the countertop, and sometimes little ones are clever enough to climb up and get them. It really depends.

Our biggest concern is when a cleaning product is put in a container that was intended for food. So sometimes pouring it into a cup, it's very confusing to a child, it looks like water. or putting it into a soda bottle or some sort of container that would normally be used for food. So sometimes it's that, sometimes it's just, you know, busy. We're all busy, and leaving a product on the counter or the kitchen table.

Host Amber Smith: Well, before we wrap up, do you want to share some poison prevention tips for parents?

Michele Caliva: Sure. I think it's a really good idea to take medications, but not in front of children because they see you eating, and they think they just want to replicate it. I also think it's a good idea to take your medicine over a sink so that if they drop, they drop into the sink. Taking medications where there's a chance that it could fall on the floor is dangerous because you don't know. You could drop something, it could be significant, and there are meds where it's one pill is deadly.

Remember that products that have those safety tops on it are harder for us adults to open than they are for little children. So it slows them down, but it doesn't keep them out, and they have little hands and have the dexterity, some of them do, to open those tops.

The number of times a parent will say, "We don't understand. It's got a safety childproof top." They're patient, they are so much more patient than we adults are.

Store cleaning products in their original container, as I mentioned, and then keep medicine locked up and away. Again, I can't stress enough, I think everybody should have a medication lockbox and be mindful when kids go to other people's houses who may not have these safety precautions in place. Nothing against grandparents; I am one. There's a tough house to be in because a grandparent may not have the childproofing, and there's some tough meds in some people's homes, dangerous meds for little ones.

And keep our phone number handy. We're 24/7. We're completely confidential. We don't keep track. We're just there to support you, and we're happy to help and answer any calls that anyone from the public has.

Host Amber Smith: And that number again, 1-800-222-1222. Michele Caliva, thank you so much for making time for this interview.

Michele Caliva: Thank you very much for having me.

Host Amber Smith: My guest has been Michele Caliva, the administrative director of the Upstate New York Poison Center. "The informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.