20-Year review of symptomatic pediatric metamfetamine exposures

Metamfetamine has long been the primary illicit stimulant in the western United States and has become increasingly available in the South, the Midwest, and more recently in the Northeast. With increasing prevalence, we sought to examine whether symptomatic pediatric exposures to metamfetamine have changed over the past 20 years.

We analyzed the National Poison Data System® database for pediatric (<6 years old) single substance exposures to metamfetamine (generic code 0201127) from 1 January 2004 to 31 December 2023. Inclusion criteria were single substance oral exposures with symptoms (National Poison Data System® outcomes = mild, moderate, major, or death). Definitions of "severe toxicity" and "substantial toxicity" are based on coded clinical effects. We report rates of symptomatology, clinical interventions, medical outcomes, ingestion location, and overall frequency of exposure. Exposures were further analyzed by geographic location based on United States Environmental Protection Agency regions: West (regions 8, 9, & 10), Midwest (regions 5 & 7), South (regions 4 & 6), Northeast (regions 1, 2, & 3).

We identified 2,862 cases over the 20-year study period with the majority (61%, n = 1,626) of children 2 years of age or younger, and with most exposures occurring at home (80%, n = 2,153). There was a 267% increase over the 20-year study period; however, the proportion of exposures reported with severe toxicity was similar.

Reported pediatric exposures to metamfetamine increased over the study period. Clinical effects and interventions were consistent with stimulant toxicity. The West accounted for the majority of cases, however, the South and the Midwest had the largest increase of cases over the study period.

Reported cases of symptomatic pediatric exposures to metamfetamine have increased over the past two decades and are associated with severe clinical effects.