(COLUMBUS, Ohio) – A new study found that rates of intentional substance exposures at school reported to U.S. poison centers increased substantially among elementary- and middle-school-aged children from 2000 through 2024, while high-school-aged adolescents continued to experience the highest rates of serious medical outcomes and hospital admissions. Researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center analyzed calls to U.S. poison centers and found that the overall rate of reported intentional substance exposures at school increased 77.5% from 2000 to 2024.
In a study published in American Journal of Emergency Medicine , researchers found the increase was 287% among elementary-school-aged children (from 3.1 to 11.9 reports per 100,000 children) and 112% among middle-school-aged children (from 10 to 21.3 per 100,000 children). In contrast, the rate among high-school-aged children decreased by 4% over the study period.
“One of the most striking findings was how the age pattern changed over time,” said Hannah Hays, MD , co-author of the study and medical director of the Central Ohio Poison Center. “By about 2015, the reported exposure rate among middle-school-aged children had surpassed that among high-school-aged youth. At the same time, high-school-aged adolescents continued to experience the most serious medical outcomes. These findings tell us that prevention needs to begin earlier, while older adolescents also need ready access to clinical and mental health support.”
Overall, high-school-aged teenagers accounted for almost half (46%) of intentional substance exposures at school. The higher rates of serious medical outcomes and hospital admissions in this age group are partially explained by their higher rates of substance abuse and suspected self-harm or suicidal intent.
Leading substance categories differed by age group as well.
More than half of the intentional exposures occurring at school were attributable to intentional misuse (62%), followed by abuse (24%) and suspected self-harm or suicidal intent (14%). Substance abuse was more than four-and-a-half times more likely to be associated with a serious medical outcome than non-abuse-related intentional exposures. Likewise, suspected self-harm or suicidal intent-related exposures were more than two times more likely to be associated with a serious medical outcome than exposures not related to suspected self-harm or suicidal intent. In poison center data, “intentional misuse” refers to improper use for a reason other than seeking a high or other psychotropic effect; recreational use with the intent of seeking a high or other psychotropic effect is categorized separately as “abuse.”
Pharmaceutical exposures in the high school group were associated with substantially greater clinical severity. Across all age groups, exposures involving pharmaceuticals were about 10 times more likely to result in a serious medical outcome and 14 times more likely to result in admission to a non-critical or critical care unit than non-pharmaceutical substance exposures.
This study highlights the need for age-specific prevention interventions and clinical response strategies – safe storage not only in the home, but in school settings as well. Prevention efforts that begin in early childhood and availability of intensive clinical and mental health resources for older adolescents, who continue to experience the greatest morbidity, are crucial.
“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,” said Gary Smith, MD, DrPH , senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s. “Collaboration among school officials and educators, clinicians, poison centers, and public health professionals is important for reducing intentional substance exposures in schools, especially those associated with suspected self-harm and suicidal intent and substance abuse.”
Save the national Poison Help Line number (1-800-222-1222) in your phone and post it in a visible place in your home. The Poison Help Line provides free, confidential advice from experts, 24 hours per day, seven days per week.
If you or someone you know is struggling or in crisis, help is available. 988 offers 24/7 judgment-free support for mental health, substance use, and more. Text, call, or chat 988.
Data for this study were obtained from the National Poison Data System (NPDS), which is maintained by America’s Poison Centers. Poison centers receive phone calls through the national Poison Help Line (1-800-222-1222) and document information about the exposure, which is reported to the NPDS.
The Center for Injury Research and Policy (CIRP) of the Abigail Wexner Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org . Follow CIRP on Instagram @CIRPatNCH .
The Central Ohio Poison Center (COPC) provides state-of-the-art poison prevention, assessment, and treatment to residents in 64 of Ohio’s 88 counties. The center’s services are available to the public, medical professionals, industry, and human service agencies. COPC handles more than 42,000 poison exposure calls annually, and confidential, free emergency poisoning treatment advice is available 24 hours per day, seven days per week. To learn more about COPC, visit www.bepoisonsmart.org . Follow COPC on Facebook Facebook.com/CentralOhioPoisonCenter .
About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2026-27 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research .
The American Journal of Emergency Medicine
Data/statistical analysis
People
Intentional substance exposures at school reported to United States poison centers, 2000–2024