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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 4th January 2012

Time for a final look at the American Association of Poison Control Centers (AAPCC) 2010 Annual Report of the National Poison Data System (NPDS). Previous entries looked at the specific deaths due to plants, the issue of whether some poisons attract more attention and a general review of what the report says about plant poisonings.

Today, I want to look at some of the plant derived substances that get reported in other categories.

There is one category I won’t be looking at; Street Drugs and Stimulants. It is clear that the NPDS is not collecting data on all deaths due to illegal drugs. The Centre for Disease Control  recently published a ‘Data Brief’ showing that over 41,000 people died, in 2008, from drug poisoning of all forms (prescribed, misuse of prescribed drugs and illegal drugs). The NPDS annual report deals with only 1,366 fatalities, in total, so there is little to be gained from delving into what it says about substances like heroin.

Equally, the report does not include every poisoning and death in the case of alcohol. It gives only 9,307 single exposures for ‘Ethanol (Beverages)’ resulting in 21 deaths. But it is interesting to note the 575 single exposures to methanol, the industrial alcohol often added to illegally produced drinks, especially as they result in 12 deaths, an indication of the higher lethality of methanol over ethanol.

But excluding the psychoactives, there are some other substances worth noting.

These days, cyanide is not exclusively plant-derived but the report shows 145 single exposures resulting in 8 deaths. It gives 28 single exposures for strychnine other than in the form of a rodenticide but none of these proved fatal. I don’t know of any other reason for having strychnine, these days, apart from as a rat poison so those 28 cases are an intriguing mystery.

Capsicum peppers come in two separate categories. When ‘used for food’ they produced 4,682 single exposures with nearly just over 2,000 having ‘Minor’ or ‘Moderate’ outcomes but there were no ‘Major’ outcomes or deaths. Only 285 required treatment in a healthcare facility. Pepper also appears in the category ‘Lacrimators: Capsicum Defense Sprays’ and here 3,748 single exposures to pepper spray produced 649 requiring treatment in a healthcare facility, one of which produced a ‘Major’ outcome. That makes the use of pepper spray against campus protesters even more troubling.

Heavy metals such as arsenic, lead, and thallium resulted in 4 deaths, twice as many as were due to plant poisoning.

5,912 single exposures to mushrooms were reported with 23 having ‘Major’ outcomes and one death.

There were 86,419 single exposures to rodenticides of which 39,333 involved under fives. (The comparable figure for plant exposures with under fives was 34,363) In total, 129 had ‘Major’ outcomes and there were 21 deaths. One of those resulted from a strychnine based product. It is not easy to determine how many of these deaths were deliberate self-harming.

Self-harm also seems to be the main cause of the 62 deaths attributed, in whole or in part, to ‘Acetylsalicylic Acid Alone’ with 9,734 single exposures. Though now synthesised directly, aspirin was, of course, first obtained from the bark of the willow tree, Salix alba.

Though there were only 254 single exposures to colchicine, the gout ‘remedy’ derived from Colchicum autumnale, bare naked ladies, but 5 resulted in death and another 8 deaths occurred where colchicine had been ingested with other substances. Again, deliberate self-harm was the dominant reason with 8 cases but there were three attributed to ‘therapeutic error’ and 1 due to deliberate abuse. The final case, involving a 43-year old male, was given as ‘Malicious’ in intent.

Talking of herbal or ‘alternative’ remedies, there was 1 death from an unidentified botanical remedy and, bizarrely, 1 death attributed to a homeopathic substance. From the individual death listing this seems to be a misattribution because the cause of death was laetrile an ‘alternative’ treatment for cancer known to be capable of causing cyanide poisoning.

There were 138 single exposures to ergot alkaloids resulting in 2 ‘Major’ outcomes and no deaths. No information on how these poisonings came about can be derived from the NPDS report.

Like street drugs and alcohol, the report is, clearly, not recording all harm done by tobacco but it is interesting to see that, of the 8,500 single exposures recorded, 7,434 incidents involved under fives.

Overall, the NPDS annual report is interesting but should not be over-interpreted because it does not detail all poisoning incidents. What it does seem to show is that children are far more at risk from a carelessly placed pack of painkillers or cigarettes or a bottle of domestic cleaner than they are from plants.