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Originally Published PMPN March 2001

Life or Death Packaging

National Poison Prevention Week encourages action to prevent childhood deaths resulting from drug poisoning.

National Poison Prevention Week takes place this month, on March 18–24. In the approximately 40 years of its existence, it has contributed to a reduction in childhood deaths from poisoning, whether from drugs or other products found in the home.

Since the event's goal is to eliminate poisoning altogether, there is still work to be done, and that includes educating children and adults about the proper role of child-resistant (CR) packaging. At an October 2000 meeting of the American Society for Testing and Materials (ASTM; West Conshohocken, PA) Committee D10.31 on CR Packaging, the group decided on assisting in this effort.

William W. Bradley
Chairman, Poison Prevention Week Council

William W. Bradley, chairman of the Poison Prevention Week Council, is one person at the forefront of this initiative. In addition to his role on the council, he is vice president of technical affairs for the Consumer Healthcare Products Association (CHPA; Washington, DC), and a member of the ASTM CR packaging committee. He spoke to PMP News's senior editor Erik Swain about how to raise awareness of the role of packaging in drug poisoning prevention.

Q: How did ASTM Committee D10.31 on CR Packaging come to be involved with Poison Prevention Week?

A: In a discussion on whether CR packaging (CRP) was the first line of defense against childhood poisoning, some members of the committee felt that educational efforts had failed, and that without CRP there would not have been the significant reduction in such poisoning. From historical data, I noted that the downward trend in accidental childhood poisoning began about the time National Poison Prevention Week began, and has continued until the present.

Public education does indeed have a significant effect on preventing childhood poisoning. In the 10 years between the start of National Poison Prevention Week and the regulatory requirement for CRP, childhood deaths from accidental poisoning dropped by more than 50%. Poison control centers have also saved lives by providing first-aid advice by phone. Add in CRP, and the total reduction since 1962 is about 95%. Some of the CR-protocol testing companies on D10.31 thought they might be able to help in the educational effort.

Q: What sort of role will the committee take in Poison Prevention Week?

A: The committee will not take an official role, but its testing-company members will try to incorporate poison prevention education in applying the CRP test protocol with both children and seniors. Some proposals include "coloring pages" for children to take home, carrying a message such as "Keep poisons locked up and out of sight." A flyer for seniors could encourage them to try the new senior-friendly packaging. The American Association of Poison Control Centers (AAPCC; Washington, DC) will help develop the materials. By targeting children (and their parents) and seniors, this program should be effective with the right target audiences.

Q: How common is drug-related poisoning compared with nondrug-related poisoning? How large a factor is packaging in drug-related poisoning?

A: According to the AAPCC, there were 24 poisoning fatalities in 1999 among children 5 or under, the target age for National Poison Prevention Week. Nine of them were related to pharmaceuticals, 8 to nonpharmaceu-ticals, and 7 due to carbon monoxide. The database does not routinely capture information about packaging, so we can only observe the trends and try to relate them to the packaging changes such as CRP and the change to unit-dose packaging for iron products.

Q: What is packaging's proper role in the prevention of drug poisoning? Do adults expect too much from child-resistant packaging?

A: CR packaging plays an important role in reducing childhood poisoning. Even in cases where it doesn't prevent a child from opening it, the greater difficulty of breaking into a CR package often creates enough delay to allow parents to intervene. CR packaging also serves to alert adults that the product may be dangerous to young children, so they may be more cautious than otherwise. Some adults do, however, expect too much from CR packaging. As we repeatedly emphasize, it is not child-proof, and parents should not expect the packaging to be the sole protection for their children. Potentially harmful products must be kept out of reach of children, preferably out of sight and, better yet, locked away.

Q: What sort of education is needed regarding the role of drug packaging?

A: Parents and caregivers, including grandparents, need to properly use CR packaging. It won't work if the closure is not properly replaced, or if the medication is transferred to a non-CR package. Many of the reported poisonings occur in grandparents' homes, where drugs are often transferred to reminder packs or containers that are easier to open. This is the reason for the senior-friendly part of the newest CR test protocol, which encourages more-responsible use of CR packaging by seniors. Household chemicals should not be stored under the kitchen sink, and child-protective latches or locks should be used on the cabinet doors where they are stored.

Q: Will education suffice in accomplishing a reduction of drug poisonings, or are steps such as changes in package design or protocol testing necessary?

A: Education has already accomplished a significant reduction in drug (and other) poisoning. Combined with CR packaging, it has been even more successful. But our goal is to completely eliminate childhood poisoning. There are still about 20 deaths of children under the age of 5 each year due to unintentional poisoning. And there are more than 1 million calls every year to the nation's poison centers about possible exposures of children to poisoning. (An "exposure" means that the child might have been exposed to a harmful substance.) So, the problem is still widespread, even as we save more lives.

We must continually teach parents to use CR packaging properly and responsibly, but not to rely on the packaging to protect their children. It takes only moments of guardian inattention for a child to be poisoned. The slogan of National Poison Prevention Week is "Children act fast . . . So do poisons." Parents and caregivers always need to remember that.

Q: How long might it take before the ASTM committee's efforts have an impact?

A: Poisoning data are collected by the AAPCC and reported each September for the previous year. So, while I would expect some positive effect immediately, it wouldn't be known until the next year. Hundreds of groups across the nation participate in National Poison Prevention Week, and the Poison Prevention Week Council believes that every added effort multiplies the educational effectiveness of that week. An encouraging factor of the ASTM committee's efforts is that it will be an ongoing project, which will keep the issue of childhood poisoning fresh throughout the year.

For a free packet of poison prevention publications, send a postcard to Poison Prevention Week Council, P.O. Box 1543, Washington, DC 20013; call 301/504-0580, ext. 1184; or visit http://www.poisonprevention.org. For local poison prevention information and phone stickers with the emergency phone number, call your poison center. The number is on the Web at http://www.aapcc.org and inside the front cover of your phone book.

Copyright ©2001 Pharmaceutical & Medical Packaging News