Over-the-counter drug poisoning among pediatric and adolescent patients presenting to emergency departments: a nationwide analysis of the COVID-19 impact

Introduction Over-the-counter drug consumption rose markedly during the COVID-19 pandemic, raising concerns about a parallel increase in pediatric and adolescent over-the-counter drug poisoning. Whether such an increase occurred, and how it compared with prescription drug poisoning, remains unclear. Our objective is to compare over-the-counter and prescription drug poisoning patterns among patients aged 18 years or younger before, during, and after the COVID-19 pandemic. Given the rise in over-the-counter drug consumption during the pandemic, we examined whether this was reflected in pediatric and adolescent emergency department visits for drug poisoning.Methods This retrospective analysis of the Emergency Department-based Injury In-depth Surveillance system (January 2017–December 2023) included all pediatric and adolescent patients aged ≤18 years presenting with drug poisoning, across pre-pandemic (January 2017–February 2020), pandemic (March 2020–March 2022), and post-pandemic (April 2022–December 2023) periods. Monthly incidence rate ratios (IRR) were estimated using Poisson regression with monthly emergency department visits as the offset to account for unequal period lengths, refitted as negative binomial when over-dispersion was present. Interrupted time series analysis evaluated changes in over-the-counter drug poisoning trends.Results Of 5,907 drug poisoning cases, the incidence rate of OTC drug poisoning increased modestly (IRR for pandemic versus pre-pandemic 1.64, 95% CI 0.98–2.76; post-pandemic versus pre-pandemic 2.10, 95% CI 1.22–3.61), whereas prescription drug poisoning rose more steeply (IRR 2.62, 95% CI 1.56–4.37; and 3.41, 95% CI 1.99–5.86, respectively). OTC drugs accounted for 31.1% of cases, with the proportion declining from 33.6% to 29.9% and 29.3% (P = 0.004), while tranquilizer (22.7% to 37.0%) and antidepressant (7.3% to 10.0%) poisoning increasedConclusion Among pediatric and adolescent patients, OTC drug poisoning declined while prescription drug poisoning rose significantly across the three periods. The pandemic-related increase in drug poisoning reflected prescription rather than OTC drugs.