Poison Center advises on edibles, pain relievers, household products, more

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.

Poisonings remain a leading cause of death and injury in the United States, but professionals staff poison centers, including the Upstate New York Poison Center, around the clock to offer prevention advice and treatment guidance. Today I'm talking with one of those professionals about the stats for 2024.

Dr. Willie Eggleston is a toxicologist and Doctor of Pharmacy at Upstate, at the Upstate New York Poison Center.

Welcome back to "The Informed Patient," Dr. Eggleston.

Willie Eggleston, PharmD: Thank you so much for having me.

Host Amber Smith: You're probably still working on the annual report, but can you say how many calls the poison center received in 2024 and how that compares with previous years?

Willie Eggleston, PharmD: Yeah, so we're still kind of finalizing those numbers for the year, but we were well above the 50,000 mark again this year for calls, so similar to previous years. We've continued to be able to serve our community as a resource, both folks calling from home, as well as calling us from hospitals, urgent cares, a whole variety of settings.

Host Amber Smith: And how many counties do the calls come from?

Willie Eggleston, PharmD: So we cover 54 counties here in New York. We split the state with our colleagues in the New York City area. The New York City Poison Center covers the five boroughs, covers Long Island, and then we cover everything north of Westchester County.

So, most of the parts of Upstate that you're familiar with, chances are if you're calling a poison center, you're getting in touch with us here in Syracuse.

Host Amber Smith: And are days or nights more busy? And what about weekdays versus weekends?

Willie Eggleston, PharmD: It can vary from day to day, but certainly most of the time our busiest hours are in the morning, when people are getting ready for school, getting their morning medications out of the way.

Mistakes happen, errors happen, kids get into things that they shouldn't, so we typically get a little bit of bump in calls in our mornings. And then most of our calls come in the late afternoon and evening hours, getting kids ready for bed, getting evening medications out of the way, folks showing up at the hospital with drug toxicities or overdose symptoms.

So the bulk of our calls do happen in those late afternoon to evening hours, but we tend to stay pretty busy all day long and all night long.

Host Amber Smith: Well, what were the most common exposure substances in 2024 for adults and children, based on the calls to the Upstate New York Poison Center?

Willie Eggleston, PharmD: The most common things that we continue to see are the things that we see every year.

It's the stuff that is in your home, and that folks have easy access to. So it's cosmetics, it's household cleaning supplies, it's pain medications, over-the-counter ones like ibuprofen, which you might know as Motrin, acetaminophen, which you may know as Tylenol. And so it's those things that we find around the house that kids can get into easily remain our most common calls.

Certainly when we look into other, smaller groups of folks, folks who are coming in for drug toxicities or for self-harm, we still see those common over-the-counter things, but we also see things like antidepressants, antipsychotics and other prescription pain medications.

But certainly, when we look at most of our data, it's the stuff you find around your house that is the most common for folks to get into.

Host Amber Smith: Across the nation, I've heard that poison centers saw a dramatic increase in children exposed to illicit fentanyl. Did the Upstate New York Poison Center see that as well?

Willie Eggleston, PharmD: So it still remains a really small number of our cases. When we see news stories and stuff that talk about dramatic increases, we're talking from a baseline that's very small, so certainly it's still a big danger, and it's something we want folks to be aware of.

But it's not the most common thing that we're seeing kids get into, and it's certainly not the most frequent call we're getting that's resulting in kids being in the hospital.

For example, we see a whole lot more of cannabis exposures in kids here in New York, and that continues to be a trend here in 2024. In 2024 alone, we had almost 200 kids in our region of New York get into edible cannabis, and that makes up about 35% of all the marijuana-related calls that our center receives, so it's a huge piece of that problem. And it's one that we continue to try to encourage, whether it's prescription medications, illicit fentanyl, cannabinoids, marijuana, edibles, all those things that we have in our home, it's important that we keep them locked in a safe place where kids can't get access.

Host Amber Smith: So these edibles becoming more of an issue, is that because marijuana's become legal and maybe more people have edibles at home than used to?

Willie Eggleston, PharmD: Yeah, certainly that's a big part of it, right? We know that by making it more broadly available, more people are interested in using it, and we have seen some positive trends. When we look at our data over the last three years, there were about 200 kids who got into edible cannabis products in our region in 2022. There were more than 250 in 2023, and we're back down to about two hundred in 2024. So I think a lot of the efforts that we're continuing to make, to educate folks on the risks, to talk about the importance of safe storage, I think those are having a positive impact, but we've still got a lot of work to do.

We're going to continue to remind parents, grandparents, people with small kids in the home, that just because it looks like a candy doesn't mean you should be storing it any different than your other medicines in the house.

Host Amber Smith: So how would a parent know that their child got a hold of an edible?

Willie Eggleston, PharmD: So the most common symptoms for a child are really, really profound sleepiness, like to the point where you can't wake them up. So if they go down for a nap, and you find they're unusually difficult to wake up, if they're acting different than their normal self, they're way sleepier than they would be at a time of day, that's where we would want someone to get checked out, potentially, for those symptoms. And certainly you have questions about those symptoms, folks can always reach us here at the poison center, 24 hours a day, seven days a week, and we're happy to help.

Host Amber Smith: Can you tell me how is that treated if someone arrives at the emergency department with their child saying, "I think they got into my edibles," what happens? How do they take care of the baby?

Willie Eggleston, PharmD: Once they're in the hospital, the best part about this is, most of these kids have a really positive outcome. They go home, and they live a normal life after that edible marijuana leaves their system.

But the symptoms they experience while the edible is in their system are very different than adults'. They can be severe, they can be life-threatening, and so we do want to make sure that for kids who do get into these products, they get to a hospital, and they're in a place where we can keep a close eye on their breathing and provide oxygen if necessary, or other ways to support them through that process while their body gets rid of the marijuana.

And once it's gone, like I said, they tend to do very, very well and go home and have a normal life. But it's really important that folks recognize that if this does happen, if you call us here at the poison center, we are likely to recommend that you go into a hospital to get checked out. And the reason for that is you just don't have the skills and equipment in your house to watch for the things that we need to watch for when a kid gets into edibles.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Willie Eggleston. He's a toxicologist and assistant professor at the Upstate New York Poison Center, which you can reach at 1-800-222-1222. We're looking back at what happened in 2024..

What about calls about energy drinks? Are you getting many of those?

Willie Eggleston, PharmD: We don't get too many of those. On occasion, we'll get a call about someone excessively using them and coming into the hospital with an abnormally fast heart rate or just feeling generally unwell.

But for the most part, folks who are getting exposed to energy drinks kind of have a good idea of what they're doing and what they're taking, and so we don't get a ton of calls about energy drinks. But it is important to recognize that the amount of caffeine in there is high, and if you are particularly sensitive to caffeine, we want to be careful with that. And if you are experiencing any symptoms from an energy drink, like abnormal heartbeat or anything like that, in addition to calling us here at the poison center, certainly you would want to get that checked out.

Host Amber Smith: What about e-cigarettes? Are exposures to children still an issue with e-cigarettes?

Willie Eggleston, PharmD: So thankfully e-cigarettes have kind of continued a downward trend, and we're hoping that cannabis and edible cannabis is on the same path. E-cigarettes, while they do remain available, and while we do continue to get calls, we have seen those trends decline over the last several years as we've really aggressively tried to educate folks on the dangers and risks of those, so we have seen those drop off significantly. And we're hopeful thatwe can have a similar impact here with edible marijuana products, moving into 2025.

Host Amber Smith: Well, let's talk about any other emerging concerns. I've heard in other communities about pink cocaine.

Willie Eggleston, PharmD: So there have been some interesting new drugs that have made their way onto the market in 2024. Pink cocaine and Diamond Shruumz are two examples of those.

Pink cocaine is just a mix. You never know truly what it is, but in most cases it tends to be a mix of different stimulant drugs. There very rarely is any cocaine in pink cocaine, and it's pink because it's got food dye added to it. We have not had many cases here in New York. We've only had calls mainly with questions about the product, and nationally there have not been that many cases as of yet, but this is a very new trend, so it's one where both us here at the Upstate New York Poison Center and our national colleagues at the American Association of Poison Control Centers are keeping a close eye on cases.

Diamond Shruumz, another product that became popular over the summer, are food products; they're chocolate bars, they're gummies, and they containextracts from hallucinogenic mushrooms, so mushrooms that might make you see things that aren't there, hear things that aren't there. And so these products take compounds, chemicals from those mushrooms and add them into the food. And they're used for what folks call microdosing. So taking small amounts of these hallucinogens for perceived positive effects.

These food products contained all sorts of things, and we saw symptoms from some mild sleepiness all the way up to seizures and deaths. Here in New York, we had eight cases related to this. Nationally, our colleagues at America's Poison Centers were able to identify about 200 more, and they worked closely with the CDC (Centers for Disease Control and Prevention) to keep an eye on this outbreak and to trend this data.

We're trying to take a similar approach with pink cocaine to keep a close eye on this. And as I said, right now, it's a small issue. It's not a big issue. But it's one we like to keep an eye on that trend and make sure it doesn't make its way onto an upward trajectory.

Host Amber Smith: One of the things that's become popular isthe weight-loss drugs that it seems like so many people are taking. Are you seeing abuse of those or are you getting any calls about them?

Willie Eggleston, PharmD: Weight-loss drugs are a popular item in 2024, and predominantly, a class of weight-loss drugs that are called GLP-1 drugs. And so these are drugs that you might have heard of, like Ozempic and Wegovy.

And what these drugs do is, they are very effective at helping folks to lose weight in a healthy way, when they are prescribed at appropriate doses and when they are gotten from appropriate sources, like a pharmacy.

But we realize there's been a shortage of these drugs. They've been challenging to get, so people have turned to other sources. They've looked at compounding these products. They've gone to online pharmacies and online prescribers to try to get access to these products. And so people aren't always getting the right directions, the right dose. They're getting something that's not from the company that typically makes it.

And so we see people screw up the dosing and get not anything that's life-threatening, but they get very uncomfortable side effects. It's nausea and vomiting, and it lasts for several days.

Here at the Upstate New York Poison Center, we had 130 calls this past year related to these GLP-1 weight-loss drugs, some of them from compounded pharmacies, some of them from the companies, but typically they are dosing errors that result in really uncomfortable side effects. And nationally, since 2019, poison centers have seen a 1,500% increase in calls related to these drugs. Like I said, it's not necessarily going to cause you significant harm if you screw up the dose, but it's going to make you very uncomfortable for several days. And so we encourage folks when they are being prescribed these, have conversations with your doctor, have conversations with your pharmacist, and certainly they can always call us if they have questions.

Host Amber Smith: Well, Dr. Eggleston, thank you so much for making time for this interview.

Willie Eggleston, PharmD: Of course. Thank you so much for having me back.

Host Amber Smith: My guest has been Dr. Willie Eggleston. He's a toxicologist and Doctor of Pharmacy at Upstate, at the Upstate New York Poison Center, which has a phone number that's answered around the clock at 1-800-222-1222.

"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 with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Find our archive of previous episodes at upstate.edu/informed.

If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube or wherever you tune in.

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