Intentional substance exposures at school reported to United States poison centers, 2000-2024

The objective of this study was to investigate the characteristics and trends of intentional substance exposures at school among children 6-18 years old reported to United States (US) poison centers.

Using a retrospective cohort study design, National Poison Data System data from 2000 to 2024 were analyzed. National population estimates from the US Census Bureau were used to calculate population-based rates, including age- and sex-specific rates, of exposure per 100,000 US population. Analyses included descriptive statistics and calculation of risk ratios (RRs) with 95% confidence intervals (CIs).

From 2000 to 2024, US poison centers received reports of 122,700 intentional exposures that occurred at school among children 6-18 years old. Exposures most commonly involved high school-aged children (45.9%), males (56.7%), or a single substance (91.3%). Although most intentional exposures did not receive treatment at a healthcare facility (64.2%), 23.2% were treated/evaluated and released, and 5.3% resulted in admission to a non-critical care or critical care unit. Almost half (48.2%) of intentional substance exposures were not followed (judged to be a non-toxic exposure or to have minimal clinical effects possible), while 21.8% were associated with a minor effect and 20.0% with no effect. However, 10.0% had a serious medical outcome, including 0.7% (n = 741) with a major effect; there were two deaths. More than half of the intentional exposures occurring at school were attributable to intentional misuse (62.2%), followed by abuse (23.6%) and suspected self-harm or suicidal intent (14.2%). Exposures among high school-aged children were more likely to be associated with a serious medical outcome (RR: 5.00, 95% CI: 4.78-5.22), abuse (RR: 2.99, 95% CI: 2.92-3.06), or suspected self-harm or suicidal intent (RR: 3.28, 95% CI: 3.17-3.39) than those among elementary school- and middle school-aged children. Abuse was more likely to be associated with a serious medical outcome (RR: 4.51, 95% CI: 4.35-4.68) than non-abuse-related intentional exposures. Likewise, suspected self-harm or suicidal intent-related exposures were more likely to be associated with a serious medical outcome (RR: 2.33, 95% CI: 2.24-2.43) than exposures not related to suspected self-harm or suicidal intent. The rate of intentional exposures at school per 100,000 US children 6-18 years old fluctuated over time and increased overall by 77.5% from 7.5 in 2000 to 13.3 in 2024, including a transient sharp decline in 2020 and 2021 coinciding with the COVID-19 pandemic. The rate increased by 287.4% from 3.1 in 2000 to 11.9 in 2024 among elementary school-aged children, 111.9% from 10.0 in 2000 to 21.3 in 2024 among middle school-aged children, but decreased by 4.2% from 10.1 in 2000 to 9.7 in 2024 among high school-aged children. The exposure rate of middle school-aged children surpassed that of high school-aged children in about 2015.

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.