October 21, 2015—the date when Doc and Marty come to the future from 1985 in the movie Back to the Future II. I remember watching those movies repeatedly when I was little, and marveling about the differences between 1985 life and the imagined 2015 life. 2015 is here, and needless to say, a lot has changed in 30 years, including in the toxicology and poison center world.
People are poisoned with some different substances now than they were back in 1985. The biggest change has to do with the increase in number of different prescription medications nowadays. There are many medications on the market (and thus in people’s homes) today that had not been invented yet in 1985. Some of these medications are safer than their 1985 counterparts (more on that later) but these days nearly 70% of Americans are on at least 1 prescription drug. More drugs in homes = more chances for those medications to be taken the wrong way, in the wrong amounts, by the wrong person, or any combination thereof.
Look at the comparison of the top 5 substances reported to US poison centers in 1985 compared with 2013 (latest full year we have data for); back in the day the majority of poisonings were exposures to chemicals and household substances whereas today the majority are drugs and medications.
1985 (% total poisoings)
- Cleaning substances 9.6%
- Analgesics 9.1%
- Plants 8.4%
- Cosmetics/personal care products 5.9%
- Chemicals 5.1%
2013 (% total poisonings)
- Analgesics 14%
- Cosmetics/personal care products 9.5%
- Household cleaning substances 9.3%
- Sedative/hypnotics and antipsychotic medications 7.3%
- Antidepressant medications 5.2%
Some household substances have been reformulated since 1985 to be safer. For example, in 1985, nearly 30% of pesticide exposures reported to the nation’s poison centers were the organophosphate type. Organophosphate insecticides are nasty chemicals that affect the body the same way as nerve gas does (e.g. Sarin gas). Today, well over 30% of pesticide exposures reported to poison centers are regarding the much less toxic pyrethroid insecticides.
There are some newer, safer medications that are now more commonly prescribed over their more toxic old-school counterparts. For example, most antidepressants that are prescribed today are the less toxic SSRI (selective serotonin reuptake inhibitors), compared to Tricylclic Antidepressants and MAOIs (monoamine oxidase inhibitors) which were the only things available back in 1985.
Not all changes have been for the better, however. Some 2015 products and practices are more dangerous—for example
- The concentrated liquid inside Laundry Pods is much more toxic than traditional liquid laundry soap
- Powerful, tiny button batteries are in everything from toys to greeting cards pose a much greater risk when swallowed by a child compared to a good ole AA or AAA battery
- Some dangerous and powerful medications, such as opioid analgesics, are prescribed in much higher numbers than they have been in the past
One huge change in the way poisonings are managed has to do with inducing vomiting. In 1985, it was considered routine to administer syrup of ipecac to induce vomiting after an unintentional ingestion (Ipecac was given in 15% of all exposures reported to poison centers in 1985). The logic seems sound—if someone has swallowed something potentially harmful, just bring it right back up. However, research in the past 30 years has shown that inducing vomiting does not improve outcomes, and in fact often causes more harm than good (read more here). Nowadays it is NEVER recommended to induce vomiting, by ipecac or any other means.
In 1985, the IPC was a much smaller poison center that only covered the Chicagoland area. Annual call volume was about 30,000-40,000 cases per year—now the IPC serves all 102 counties in Illinois and manages more than 80,000 helpline cases per year.
Some other differences
- Pediatric exposures accounted for the majority of cases (over 2/3 in 1985). Now adult and adolescent cases exceed pediatric ones. Increased safety of household products and child safety packaging have helped decrease serious pediatric poisoning, and unintentional exposures in adults have been on the rise.
- Retrieving important data to manage cases was time consuming (a problem when time is of the essence in dealing with emergencies). The database of poisons the IPC uses was still on microfiche in 1985. All the cases were documented on paper longhand—about the only time saver for the staff was ink stamps (see pic below). Now the poisoning information database is online, and it is easily searchable. We use electronic medical record software with shortcuts to quickly document and handle our cases. This means speedier assistance!
- In 1985 the IPC was staffed by a handful of pharmacists and some medical students. Now IPC staff are health care professionals (physicians, nurses, pharmacists) that are specially trained in toxicology. Our specialists today take a certification exam provided by the American Association of Poison Control Centers which confirms that the specialists are experts in all areas of toxicology.
- Back in 1985, about 13-14% of calls were from health care providers. In 2015, we are expecting that over 30% of all cases will come from nurses and physicians regarding patients who are in a Health Care Facility. Our specialists are recognized as the toxicology consultants for the state’s clinicians.
- In 1985, the only way to obtain poison information was to call us on the telephone. Now the IPC has a variety of info available via the IPC website and blog, and an active social media presence. We are hopeful that in the next year we will have the funding to allow for texting and/or web chat.
- The IPC now has a comprehensive public education program including a free Poison Prevention Education Course and Resource Center.
One thing that hasn’t changed is that you can call the IPC 24 hours a day, 7 days a week in the event of an exposure to a potentially harmful substance. Put 1-800-222-1222 in your cell phone, you never know when you might need us!
- Seriously scary poisons that used to be in Grandpa’s shed…and maybe still are!
- The State of Poison Centers: Is it the End or the Beginning?
- Ultra-Toxic Poisons May Be Lurking Right Under Your Nose
- A Day in the Life of a Poison Center
- May S.O.I. R.I.P. (May Syrup of Ipecac Rest in Peace)