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Acetaminophen overdose: analysis of 2018 US nationwide emergency database

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Abstract

Introduction

Recognized risk factors for acetaminophen overdose include alcohol, opioids, and mood disorders. The aim of this study is to assess additional risk factors for acetaminophen overdose evaluated in the emergency department (ED).

Methods

A retrospective study was performed using the 2018 US Nationwide Emergency Department Sample (NEDS). All adult ED visits for acetaminophen overdose were included in the study group and those without it were taken as control. STATA, 16.1 was used to perform multivariable logistic regression analysis and adjusted odds ratios (ORadj) were reported.

Results

We identified 27,792 ED visits for acetaminophen overdose. Relative to non-acetaminophen ED visits, this group was younger (median age 32 vs 47 years; p < 0.0001), more often female (66.1% vs 57.0%; p < 0.0001), had higher ED charges ($3,506 vs $2,714; p < 0.0001), higher proportion of alcohol-related disorders (15.8% vs 3.5%; p < 0.0001), anxiety disorders (30.2% vs 8.3%; p < 0.0001), cannabis use (8.7% vs 1.4%; p < 0.0001), hematology/oncology diagnoses (13.3% vs 10.9%; p < 0.0001), mood disorders (52.4% vs 7.9%; p < 0.0001), opioid-related disorders (4.1% vs 1.0%; p < 0.0001), and suicide attempt/ideation (12.2% vs 1.1%; p < 0.0001). Multivariable analysis showed alcohol-related disorders (ORadj 2.67), anxiety disorders (ORadj 1.24), cannabis (ORadj 1.63), females (ORadj 1.45), Income Q3 (ORadj 1.09), hematology/oncology diagnoses (ORadj 1.40), mood disorders (ORadj 10.07), opioid-related disorders (ORadj 1.20), and suicide attempt/ideation (ORadj 1.68) were associated with acetaminophen overdose.

Conclusion

In addition to previously recognized risks, our study demonstrated that cannabis use and hematologic/oncologic comorbidities were more common among acetaminophen-overdose ED visits. These new findings are concerning because of rapid legalization of cannabis and the increasing incidence of cancer worldwide. Additional investigation into these risks should be a priority for clinicians, policymakers, and researchers.

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References

  1. Gunnell D, Murray V, Hawton K (2000) Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav 30(4):313–326

    Article  CAS  PubMed  Google Scholar 

  2. Gummin DD et al (2021) (2020) Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol 59(12):1282–1501

    Article  Google Scholar 

  3. Rumack BH (1983) Acetaminophen overdose. Am J Med. https://doi.org/10.1016/0002-9343(83)90240-1

    Article  PubMed  Google Scholar 

  4. Roche SP, Rogers ML, Pridemore WA (2018) A cross-national study of the population-level association between alcohol consumption and suicide rates. Drug Alcohol Depend 188:16–23

    Article  PubMed  Google Scholar 

  5. Rizk MM, Herzog S, Dugad S, Stanley B (2021) Suicide risk and addiction: the impact of alcohol and opioid use disorders. Curr Addict Rep 8:194–207

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stockler M, Vardy J, Pillai A, Warr D (2004) Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial. J Clin Oncol 22(16):3389–3394. https://doi.org/10.1200/JCO.2004.09.122

    Article  CAS  PubMed  Google Scholar 

  7. Budnitz DS, Lovegrove MC, Crosby AE (2011) Emergency department visits for overdoses of acetaminophen-containing products. Am J Prev Med 40(6):585–592. https://doi.org/10.1016/j.amepre.2011.02.026

    Article  PubMed  Google Scholar 

  8. Bond GR, Ho M, Woodward RW (2012) Trends in hepatic injury associated with unintentional overdose of paracetamol (Acetaminophen) in products with and without opioid: an analysis using the National Poison Data System of the American Association of Poison Control Centers, 2000–7. Drug Saf. https://doi.org/10.2165/11595890-000000000-00000

    Article  PubMed  Google Scholar 

  9. Willy M, Kelly JP, Nourjah P, Kaufman DW, Budnitz DS, Staffa J (2009) Emergency department visits attributed to selected analgesics, United States, 2004–2005. Pharmacoepidemiol Drug Saf 18(3):188–195. https://doi.org/10.1002/pds.1691

    Article  PubMed  Google Scholar 

  10. Hu X, Ma J, Jemal A, Zhao J, Nogueira L, Ji X, Yabroff KR, Han X (2023) Suicide Risk Among Individuals Diagnosed With Cancer in the US, 2000–2016. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2022.51863

    Article  PubMed  PubMed Central  Google Scholar 

  11. Anguiano L, Mayer DK, Piven ML, Rosenstein D (2012) A literature review of suicide in cancer patients. Cancer Nurs 35(4):E14-26. https://doi.org/10.1097/NCC.0b013e31822fc76c

    Article  PubMed  Google Scholar 

  12. Borini P, Guimarães RC, Borini SB (2004) Possible hepatotoxicity of chronic marijuana usage. Sao Paulo Med J. https://doi.org/10.1590/s1516-31802004000300007

    Article  PubMed  Google Scholar 

  13. Abdel-Salam OME, Metwaly S, Sleem AA et al (2013) Cannabis sativa exacerbates hepatic injury caused by acetaminophen or carbon tetrachloride in rats. Comp Clin Pathol 22:209–218. https://doi.org/10.1007/s00580-011-1388-z

    Article  Google Scholar 

  14. Cousins MM, Jannausch ML, Coughlin LN, Jagsi R, Ilgen MA (2021) Prevalence of cannabis use among individuals with a history of cancer in the United States. Cancer. https://doi.org/10.1002/cncr.33646

    Article  PubMed  Google Scholar 

  15. https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRSubstance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report

  16. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19–5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

  17. Corroon JM Jr, Mischley LK, Sexton M (2017) Cannabis as a substitute for prescription drugs - a cross-sectional study. J Pain Res 2(10):989–998. https://doi.org/10.2147/JPR.S134330

    Article  Google Scholar 

  18. Altyar A, Kordi L, Skrepnek G (2015) Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA. BMJ Open. https://doi.org/10.1136/bmjopen-2014-007368

    Article  PubMed  PubMed Central  Google Scholar 

  19. Li C, Martin BC (2011) Trends in emergency department visits attributable to acetaminophen overdoses in the United States: 1993–2007. Pharmacoepidemiol Drug Saf 20(8):810–818. https://doi.org/10.1002/pds.2103

    Article  PubMed  Google Scholar 

  20. Jiang T, Nagy D, Rosellini AJ, Horváth-Puhó E, Keyes KM, Lash TL, Galea S, Sørensen HT, Gradus JL (2021) Suicide prediction among men and women with depression: A population-based study. J Psychiatr Res 142:275–282. https://doi.org/10.1016/j.jpsychires.2021.08.003

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zyoud SH, Awang R, Sulaiman SA, Al-Jabi SW (2010) A cross-sectional observation of the factors associated with deliberate self-poisoning with acetaminophen: impact of gender differences and psychiatric intervention. Hum Psychopharmacol 6:500–508. https://doi.org/10.1002/hup.1140

    Article  Google Scholar 

  22. Gyamlani GG, Parikh CR (2002) Acetaminophen toxicity: suicidal vs accidental. Crit Care. https://doi.org/10.1186/cc1475

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kjartansdottir I, Bergmann OM, Arnadottir RS, Björnsson ES (2012) Paracetamol intoxications: a retrospective population-based study in Iceland. Scand J Gastroenterol 47(11):1344–1352. https://doi.org/10.3109/00365521.2012.703236

    Article  CAS  PubMed  Google Scholar 

  24. Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, Law GR (2021) Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug Alcohol Depend. https://doi.org/10.1016/j.drugalcdep.2021.109150

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, McKyer ELJ, Ahmed HU, Ma P (2020) Epidemiology of mental health problems in COVID-19: a review. Fresh 23(9):636

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Cook County Health, 1950 West Polk Street, Chicago, IL, 60612, USA

    Faria Sami

  2. Department of Emergency Medicine, Division of Medical Toxicology, Cook County Health, Chicago, USA

    Sarah Berg

  3. Division of Rheumatology, Cook County Health, Chicago, USA

    Augustine M. Manadan

  4. Department of Emergency Medicine, Cook County Health, Chicago, USA

    Mark B. Mycyk

Authors
  1. Faria Sami
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  2. Sarah Berg
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  3. Augustine M. Manadan
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  4. Mark B. Mycyk
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Contributions

All authors contributed equally to this work. FS and SB drafted and wrote the manuscript. AMM designed and conducted the analysis. MBM was the principal investigator and supervised the project, proofread and edited for final submission. All authors discussed the results and implications and commented on the manuscript at all stages. All authors contributed extensively to the work presented in this paper.

Corresponding author

Correspondence to Faria Sami.

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Conflict of interest

All the authors confirm that the article or any part of this article has not been published and is not under consideration for publication elsewhere. There are no financial or other relationships that could lead to a conflict of interest to disclose.

Ethical approval and informed consent

This study utilizes de-identifiable data publicly available (online at https://www.hcup-us.ahrq.gov) US National Emergency Database and does not require IRB approval.

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Not applicable.

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Sami, F., Berg, S., Manadan, A.M. et al. Acetaminophen overdose: analysis of 2018 US nationwide emergency database. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03555-1

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