Reported cases of intentional substance exposures at school have surged among elementary and middle school students, while high school adolescents faced more severe medical outcomes.
RT’s Three Key Takeaways:
- Surging Younger Pediatric Rates: Reports of intentional substance exposures at school increased by 287% among elementary-school-aged children and 112% among middle-school-aged children between 2000 and 2024.
- Severity in High School Youth: High-school-aged students accounted for 46% of all school-based intentional exposures and experienced the highest rates of serious clinical outcomes and hospital admissions.
- High Risks With Pharmaceuticals: Across all age groups, exposures involving pharmaceutical substances were roughly 10 times more likely to result in a serious medical outcome and 14 times more likely to require admission to an intensive or acute care unit.
Rates of intentional substance exposures occurring at school and reported to US poison centers increased significantly among elementary- and middle-school-aged children between 2000 and 2024, according to a study published in the American Journal of Emergency Medicine.
Investigators from the Center for Injury Research and Policy at the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center analyzed data from the National Poison Data System (NPDS). According to the findings, the overall rate of reported intentional substance exposures at school climbed 77.5% over the 25-year study period.
Shifting Age Patterns Over Time
The study revealed marked variation across age brackets. Intentional exposure rates increased 287% among elementary-school-aged children, moving from 3.1 to 11.9 reports per 100,000 children, while rates among middle-school-aged children rose 112%, from 10.0 to 21.3 reports per 100,000 children. In contrast, rates among high-school-aged adolescents decreased by 4%, according to researchers.
“One of the most striking findings was how the age pattern changed over time,” said Hannah Hays, MD, co-author of the study and medical director of the Central Ohio Poison Center, in a news release. “By about 2015, the reported exposure rate among middle-school-aged children had surpassed that among high-school-aged youth. At the same time, high-school-aged adolescents continued to experience the most serious medical outcomes. These findings tell us that prevention needs to begin earlier, while older adolescents also need ready access to clinical and mental health support.”
Clinical Severity and Exposure Intent
Despite the drop in overall exposure rates in older youth, high-school-aged teenagers accounted for nearly half (46%) of all intentional school exposures, according to the study. Investigators noted that this group experienced higher rates of hospital admissions and serious medical outcomes, which was partially driven by greater rates of substance abuse and suspected self-harm or suicidal intent.
According to poison center classifications, intentional misuse involves improper use for reasons other than seeking a psychotropic effect, whereas abuse refers to recreational use intended to produce an altered mental state. Across the study data:
- Intentional misuse accounted for 62% of school-based exposures, followed by abuse at 24%, and suspected self-harm or suicidal intent at 14%.
- Substance abuse was more than 4.5 times more likely to result in a serious medical outcome compared to non-abuse-related intentional exposures.
- Exposures related to suspected self-harm or suicidal intent were more than twice as likely to be associated with serious clinical outcomes than those without self-harm intent.
Pharmaceutical exposures presented acute risks for pediatric patients across every age group. According to the data, pharmaceutical ingestions were approximately 10 times more likely to result in a serious medical outcome and 14 times more likely to require admission to a critical care or non-critical inpatient unit compared to non-pharmaceutical substances.
Implications for Prevention and Clinical Response
The authors emphasized that these findings indicate a need for targeted interventions, safe medication storage protocols in educational facilities, and stronger coordination across healthcare and school systems.
“The increasing rate of reported intentional substance exposures at school among elementary school- and middle school-aged children, combined with the greater severity observed among high school-aged children, underscores the need for targeted and coordinated prevention and early identification strategies that integrate substance use education and mental health screening and intervention,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s, in a news release. “Collaboration among school officials and educators, clinicians, poison centers, and public health professionals is important for reducing intentional substance exposures in schools, especially those associated with suspected self-harm and suicidal intent and substance abuse.”
