US emergency department visits for acute harms from over-the-counter cough and cold medications, 2017-2019

Abstract

Background and purpose: Characterization of emergency department (ED) visits for acute harms related to use of over-the-counter cough and cold medications (CCMs) by patient demographics, intent of CCM use, concurrent substance use, and clinical manifestations can help guide prevention of medication harms.

Methods: Public health surveillance data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were used to estimate numbers and population rates of ED visits from 2017 to 2019.

Results: Based on 1396 surveillance cases, there were an estimated 26 735 (95% CI, 21 679-31 791) US ED visits for CCM-related harms annually, accounting for 1.3% (95% CI, 1.2-1.5%) of all ED visits for medication adverse events. Three fifths (61.4%, 95% CI, 55.6-67.2%) of these visits were attributed to non-therapeutic CCM use (nonmedical use, self-harm, unsupervised pediatric exposures). Most visits by children aged <4 years (74.0%, 95% CI, 59.7-88.3%) were for unsupervised CCM exposures. Proportion hospitalized was higher for visits for self-harm (76.5%, 95% CI, 68.9-84.2%) than for visits for nonmedical use (30.3%, 95% CI, 21.1-39.6%) and therapeutic use (8.8%, 95% CI, 5.9-11.8%). Overall, estimated population rates of ED visits for CCM-related harms were higher for patients aged 12-34 years (16.5 per 100 000, 95% CI, 13.0-20.0) compared with patients aged <12 years (5.1 per 100 000, 95% CI, 3.6-6.5) and ≥ 35 years (4.3 per 100 000, 95% CI, 3.4-5.1). Concurrent use of other medications, illicit drugs, or alcohol was frequent in ED visits for nonmedical use (61.3%) and self-harm (75.9%).

Conclusions: Continued national surveillance of CCM-related harms can assess progress toward safer use.

Keywords: adverse drug event; cough and cold medication; medication safety; nonmedical drug use; unsupervised exposure.

Figure 1:. Estimated Rate and Proportion of Emergency Department (ED) Visits for Over-the-Counter (OTC) Cough and Cold Medication (CCM)-Related Harms, by Age Group and Intent of Use, 2017-2019

Abbreviations: CCM = cough and cold medication; ED = emergency department. Estimates of ED visits for medication harms are from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, Centers for Disease Control and Prevention; population estimates are from the US Census Bureau. Non-therapeutic use includes unsupervised exposures by patients aged ≤10 years, self-harm, and nonmedical use (i.e., abuse [clinician diagnosis of abuse or documentation of recreational use], misuse [using medication for symptom relief, but not using medication as directed], and overdoses without documentation of therapeutic intent, misuse, abuse, or self-harm). “% of ED visits for medication harms related to CCMs” corresponds to the proportion of ED visits for CCM-related harms in the specified age group of all ED visits for medication harms in that age group. The estimated proportion of ED visits for medication harms that were related to CCMs for each age group is shown with corresponding 95% confidence intervals. The estimated numbers of ED visits for harms attributed to therapeutic CCM use among patients aged <4 years and non- therapeutic CCM use among patients aged 55-64 years and ≥65 years were based on <20 cases and are therefore considered statistically unstable.

Figure 2:. Estimated Rate of Emergency Department (ED) Visits for Harms Related to Non-therapeutic Use of Over-the-Counter (OTC) Cough and Cold Medications (CCMs), by Age Group and Type of Non-therapeutic Use, 2017-2019

Abbreviations: CCM = cough and cold medication; ED = emergency department. Estimates of ED visits for medication harms are from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, Centers for Disease Control and Prevention; population estimates are from the US Census Bureau. Nonmedical use includes abuse (clinician diagnosis of abuse or documentation of recreational use), misuse (using medication for symptom relief, but not using medication as directed), and overdoses without documentation of therapeutic intent, misuse, abuse, or self-harm. The estimated numbers of ED visits for harms attributed to nonmedical CCM use among patients aged <4 years, 4-11 years, 55-64 years, and ≥65 years, and CCM-related self-harm among patients aged 4-11 years, 55-64 years, and ≥65 years were based on <20 cases and are therefore considered statistically unstable. There were no cases involving self-harm among children aged <4 years or unsupervised exposures among patients aged >11 years. The coefficient of variation for the estimate of nonmedical CCM use among patients aged 35-44 years is >30% and may be considered statistically unstable.

Figure 3:. Annual National Estimates of Emergency Department (ED) Visits for Over-the-Counter (OTC) Cough and Cold Medication (CCM)-related Harms, by Concurrent Substances, 2017-2019

Abbreviations: CCM = cough and cold medication; ED = emergency department; OTC = over-the-counter. Estimates of ED visits for medication harms are from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project, Centers for Disease Control and Prevention. Nonmedical use includes abuse (clinician diagnosis of abuse or documentation of recreational use), misuse (using medication for symptom relief, but not using medication as directed), and overdoses without documentation of therapeutic intent, misuse, abuse, or self-harm. Illicit drugs include specified illicit substances (e.g., heroin, cocaine), as well as unspecified opioids and unspecified amphetamines (e.g., documentation of opioid ingestion, but unclear whether prescription opioids or illicit opioids were taken). The estimated number of ED visits for harms attributed to therapeutic CCM use involving illicit drugs or alcohol (+/− other medications) is based on <20 cases and is therefore considered statistically unstable. ED visits for unsupervised pediatric CCM exposures are not shown (1,164 estimated visits annually).