Over-the-counter medications encountered in the postmortem pediatric population from 2010-2020

In forensic toxicology, the pediatric population requires special focus when evaluating positive findings because of the many toxicokinetic and toxicodynamic differences (e.g., metabolic capabilities, body size, etc.) between the pediatric and adult populations. In particular, the administration of over-the-counter (OTC) medications needs careful consideration, as dosages given to the pediatric population (0 days-18 years), particularly those given to individuals <5 years of age, tend to be lower than those given to individuals closer to adulthood. Postmortem pediatric data from 11 years (2010-2020) was compiled. A total of 1413 positive cases contained one or more of the following common OTC medications: antihistamines (brompheniramine, chlorpheniramine, diphenhydramine, doxylamine and pheniramine), pain relievers (acetaminophen, naproxen, ibuprofen and salicylates), cold/flu medications (dextro/levomethorphan, guaifenesin, ephedrine and pseudoephedrine), gastrointestinal aids (dicyclomine and loperamide) and/or sleep aids (melatonin). Antihistamines, cold/flu medications and pain relievers are the most common classes of drugs encountered in the postmortem pediatric population. To evaluate trends, three main age groups were created: ≤5 years old (5 U, birth-5 years old), middle childhood (MC, 6-11 years old), and early adolescence (EA, 12-18 years old). When considering the data, it must be noted that many of these drugs may be co-administered in single and/or multi-drug formulations. In addition, some drugs may have a variety of uses, e.g. antihistamines may also be used as sleep aids. Of note, the prevalence of cases involving those aged 6-11 years old was far less than their younger and older pediatric counterparts. With the widespread availability of OTC medications, unintentional overdoses, recreational misuse and suicidal overdoses can occur in the vulnerable, pediatric population.

A cross-sectional examination of medicinal substance abuse and use of nonmedicinal substances among Canadian youth: findings from the 2012-2013 Youth Smoking Survey

BACKGROUND

Medicinal substance abuse is prevalent in Canada; however, little is known about patterns of abuse among young people. In this study, we sought to characterize the abuse of medicinal substances, such as prescription medications and selected over-the-counter substances, as well as that of licit and illicit nonmedicinal substances, using a nationally representative sample of young people.

METHODS

Cross-sectional, nationally representative data for children in grades 7-12 were obtained from Health Canada's 2012-2013 Youth Smoking Survey (n = 38 667). Multinomial regression analyses were conducted to examine subgroup differences in medicinal substance abuse and comorbid abuse of both medicinal and nonmedicinal substances.

RESULTS

About 5% of youth reported abusing medicinal substances in the previous year. Dextromethorphan, a substance found in many cough and cold syrups, was the most widely abused (2.9%), followed by pain medications (2.6%), sleeping medications (1.8%), stimulants (1.7%) and sedatives (1.0%). Abuse of nonmedicinal substances aside from tobacco and alcohol was reported by 21.3% of the population, and abuse of any substances was detected in 23.0% of the surveyed population. Girls at each grade level reported higher rates of abuse of medicinal substances than boys. Regional differences were seen with regard to the types of substances abused across Canada.

INTERPRETATION

A substantial minority of Canadian youth report abusing medicinal substances, including over-the-counter medications (e.g., cough syrup) and prescriptions medications (e.g., pain medication). In contrast to nonmedicinal substances, girls were more likely than boys to report abuse of medicinal substances.