Benzodiazepines Use, Misuse, Abuse and Poisoning Karen E. Simone, PharmD, DABAT Northern New England Poison Center simonk@mmc.org 207-662-7221

Contents Poison Center Overview Types of Hotline Calls Benzodiazepine Perspective

Northern New England Poison Center Certified by the American Association of Poison Control Centers (AAPCC) in November 2004 Staff Hotline Outreach Surveillance Research Funding: Maine Medical Center/MaineHealth; Fletcher Allen Health Care; States of Maine, New Hampshire and Vermont; Health Resources and Services Administration; United Ways of Greater Portland, York, Kennebec Valley; Denver Health (surveillance projects)

Types of Calls – Poisoning Reasons Unintentional General, environmental, misuse, therapeutic error, occupational, good poisoning, bite/sting Intentional Abuse, misuse, suicide attempt Other Malicious, tampering/contamination, withdrawal Adverse effect Drug, chemical, other Unknown This is over 220 call per day. The Center now receives over 200 calls per day. Animal exposures are mostly dogs, some cats, then birds, ferrets and other unusual creatures. Confirmed non-exposures: example – mom thinks child swallowed a watch battery, then during conversation with the poison center, finds it. This is now confirmed non-exposure. (the child never swallowed the battery.)

Types of Calls – Question Types Substance Abuse Identification, effects, drug screens, withdrawal Medication Pharmacology, adverse effects, interactions, withdrawal Toxicology General, environmental, food poisoning, pregnancy/lactation Prevention/safety Plants, lectures/health fairs, printed materials Occupation Safety, monitoring Medical/legal/other Drug, chemical, other This is over 220 call per day. The Center now receives over 200 calls per day. Animal exposures are mostly dogs, some cats, then birds, ferrets and other unusual creatures. Confirmed non-exposures: example – mom thinks child swallowed a watch battery, then during conversation with the poison center, finds it. This is now confirmed non-exposure. (the child never swallowed the battery.)

Benzodiazepines Poisoning Victims Age and Gender

Human poisonings, known ages

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Benzodiazepines Poisoning Victims Reason by Age

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Reason for Unintentional Benzodiazepine Animal Poisoning Accessed medicine from: Floor Trash container Medicine bottle (chewed) Mom’s or Dad’s Grandma’s Sitter’s Effects: vomiting, wobbly legs, unsteady on paws

Reason for Unintentional Benzodiazepine Child Poisoning Similar to pet, also note: Therapeutic error (parent’s anti-anxiety instead of child’s attention deficit medication) Accessed from drug-dealing situation Accessed from pill reminder Other medications sometimes involved Effects: ataxia, lethargy, slurred speech, dizziness, vomiting, (respiratory depression if other medications involved)

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

How frequent? Which ones? Benzodiazepines How frequent? Which ones?

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Human poisonings, known ages, known reasons

Substance Abuse Questions Benzodiazepines Substance Abuse Questions