for the future organization, structure, and funding of a poison prevention and control system.

THE DEFINITION, SCOPE, AND MAGNITUDE OF POISONING

The Committee’s operational definition of poisoning subsumes “damaging physiological effects of ingestion, inhalation, or other exposure to a range of pharmaceuticals, illicit drugs, and chemicals, including pesticides, heavy metals, gases/vapors, and common household substances, such as bleach and ammonia” (Centers for Disease Control and Prevention, 2004, p. 233). The Committee’s approach to defining poisoning is addressed in Box ES-2. A broad clinical definition of human poisoning, as noted above, captures any toxin-related injury. However, each agency that collects data or provides services in this arena has evolved its own particular definitional boundaries of the poisoning problem. Furthermore, definitions of a poisoning and its place among other medical diagnoses vary from the 9th to the 10th revisions of the International Classification of Diseases, the system that drives health data categorization at both the federal and state levels. Finally, the network of poison control centers has evolved its own operational definition of what constitutes an “exposure” to a poisonous substance. As a result, the Committee adopted an operational definition of poisoning that could be used to analyze the available datasets to better understand the magnitude of the poison problem (see Chapter 3 for expanded discussion of this question).

The Committee estimates that more than 4 million poisoning episodes (actual or suspected exposures) occur in the United States annually, with approximately 300,000 cases leading to hospitalization. The poisoning death rate increased by 56 percent between 1990 and 2001 (Centers for Disease Control and Prevention, 2004). In 2001, poisoning was the second leading cause of injury-related mortality, accounting for an estimated 30,800 deaths annually. A conservative estimate of the economic burden of poisoning not including costs related to alcohol deaths is $12.6 billion per year (2002 dollars), based on the societal lifetime cost of injury.

Poisoning is a public health problem across the entire lifespan. It is well recognized that unintentional exposure to hazardous household substances (including medications found in the home) occurs mainly among preschool-aged children; the majority of these exposures can be treated in the home and the associated mortality rate is low. It is less well appreciated that the burden of unintentional drug overdose and suicide deaths is more likely to occur among adolescents and young adults, and that the elderly are at high risk for poisoning due to scenarios such as mixing medications or taking the wrong dosage. Finally, new concerns about biological and chemical terrorist acts have elevated poisoning to a national



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