Intentional substance exposures at school rise among younger children

Reports of intentional substance exposures at school are climbing fastest among the youngest students, even as high school–aged adolescents continue to bear the greatest burden of serious outcomes, according to a 25-year analysis of US poison center data published in the American Journal of Emergency Medicine.¹ From 2000 to 2024, the rate of these exposures rose 287% among children aged 6 to 10 years and 112% among those aged 11 to 13 years, while the rate among adolescents aged 14 to 18 years declined slightly.¹

"One of the most striking findings was how the age pattern changed over time," said Hannah L. Hays, MD, study co-author and medical director of the Central Ohio Poison Center at Nationwide Children's Hospital.² Hays noted that the middle school rate overtook the high school rate around 2015 and said the findings point to a need for earlier prevention, alongside ready access to clinical and mental health support for older adolescents.²

Poison center data on intentional school exposures in children aged 6 to 18 years

Investigators conducted a retrospective cohort study of National Poison Data System records for children aged 6 to 18 years whose exposure site was coded as school and whose reason for exposure was intentional misuse, abuse, suspected self-harm or suicidal intent, or unknown intentional.¹ US Census Bureau estimates were used to calculate population-based rates.¹

The analysis captured 122,700 exposures; 45.9% involved high school–aged adolescents, 56.7% involved males, and 91.3% involved a single substance.¹ The overall rate rose 77.5%, from 7.5 to 13.3 per 100,000 children, with a transient decline in 2020 and 2021 corresponding to COVID-19–related school closures.¹ Rates increased from 3.1 to 11.9 per 100,000 among elementary school–aged children and from 10.0 to 21.3 among middle school–aged children, but fell 4.2% (10.1 to 9.7) among high school–aged adolescents.¹

Intent and substance type in school exposures differ by age group

Intentional misuse accounted for 62.2% of exposures, followed by abuse (23.6%) and suspected self-harm or suicidal intent (14.2%).¹ Misuse represented 94.8% of elementary school exposures but 40.0% of high school exposures, where abuse (37.0%) and suspected self-harm (23.0%) were more common.¹

Among elementary school–aged children, the leading categories were cosmetics and personal care products (15.3%), arts, crafts, and office supplies (15.2%), and plants (14.6%); ethanol-based hand sanitizers made up nearly half of all cosmetic and personal care product exposures.¹ In high school students, analgesics (15.4%), stimulants and street drugs (11.6%), and sedative-hypnotics and antipsychotics (9.6%) predominated.¹

Serious medical outcomes concentrated among high school–aged adolescents

Overall, 10.0% of exposures resulted in a serious medical outcome, including 741 with a major effect and 2 deaths, both involving opioids.¹ Compared with younger children, high school–aged adolescents were more likely to have a serious medical outcome (risk ratio [RR], 5.00; 95% CI, 4.78–5.22) or medical admission (RR, 4.38; 95% CI, 4.13–4.65).¹ Abuse (RR, 4.51; 95% CI, 4.35–4.68) and suspected self-harm (RR, 2.33; 95% CI, 2.24–2.43) were each associated with serious outcomes, and pharmaceutical exposures carried roughly 10-fold higher risk of a serious outcome and 14-fold higher risk of medical admission than nonpharmaceutical exposures.¹

Implications for pediatric substance use and suicide prevention

The findings reverse the declining trend reported in earlier poison center analyses, which covered intentional misuse and abuse ingestions at all locations and excluded self-harm.³ National survey data indicate that roughly 1 in 5 US high school students report being offered, sold, or given an illegal drug on school property in the past year.⁴ The authors recommend restricting medication access, stocking naloxone in schools, and training staff in its use.¹

Gary A. Smith, MD, DrPH, senior author and director of the Center for Injury Research and Policy at Nationwide Children's Hospital, said the trends call for coordinated prevention and early identification that pair substance use education with mental health screening, supported by collaboration among educators, clinicians, poison centers, and public health professionals.²

Limitations of poison center surveillance data

Poison center data likely underestimate the true burden, as not all exposures are reported and events in school cafeterias or nurse offices are not coded as school-based.¹ Data are self-reported, intent may be misclassified, repeat individuals cannot be identified, and dose was not analyzed; the observational design also precludes causal inference.¹

References

1. Bienfang A, Hays HL, Badeti J, et al. Intentional substance exposures at school reported to United States poison centers, 2000–2024. Am J Emerg Med. 2026;110:197-209. doi:10.1016/j.ajem.2026.08.031

2. Nationwide Children's Hospital. Study shows rising rates of reported intentional substance exposures at school among elementary- and middle-school-aged children. Newswise. September 28, 2026. Accessed October 9, 2026. https://www.newswise.com/articles/study-shows-rising-rates-of-reported-intentional-substance-exposures-at-school-among-elementary-and-middle-school-aged-children

3. Hughes AR, Grusing S, Lin A, et al. Trends in intentional abuse and misuse ingestions in school-aged children and adolescents reported to US poison centers from 2000-2020. Clin Toxicol (Phila). 2023;61(1):64-71. doi:10.1080/15563650.2022.2120818

4. Brener ND, Mpofu JJ, Krause KH, et al. Overview and methods for the Youth Risk Behavior Surveillance System — United States, 2023. MMWR Suppl. 2024;73(4):1-12.