A survey of adolescents' knowledge regarding toxicity of over-the-counter medications

With prior research suggesting that up to 17% of adolescents believe that acetaminophen (APAP) cannot cause death at any dose, this study surveyed adolescents regarding their knowledge of over-the-counter (OTC) medication toxicity.

A convenience sample of 13- to 18-year-olds presenting to the acute care clinic or ED at 2 teaching hospitals were given a survey requesting demographic data and information regarding common OTC medications. The respondents were asked to identify those OTC medications found at home, those they thought poisonous or lethal when taken in overdose, and those they thought contain alcohol. They also were asked to indicate whether they ever had made a suicidal overdose gesture.

There were 203 of 210 (96% response rate) surveys completed. Recognition of the potential for overdose lethality with specific OTC medications was limited: aspirin (63%), APAP (57%), antihistamines (46%), iron (24%), camphor (22%), methyl salicylate (21%), and bismuth subsalicylate (19%). Additionally, adolescents commonly believed many OTC medications generally considered nonlethal would be fatal in an overdose: ibuprofen (51%), decongestants (45%), guaifenesin (29%), mouthwash (25%), kaolin-pectin (22%), antacids (21%), and vitamin C (12%). More than half of the respondents correctly identified agents that normally contain alcohol. Also, of the 5 respondents who previously made suicidal gestures, 4 indicated the ingested item could kill them, reflecting serious intent.

Surveyed adolescents possess poor knowledge of the lethal potential of OTC medications; the fact that many adolescents believe several of these OTC medications are benign is concerning. Emergency physicians should adjust their assessments of individual overdose patients' suicidal intents accordingly.