Poisonings among Arizona Residents, 2011

Resources for the development of this report were provided through funding to the Arizona Department of
Health Services from the Centers for Disease Control and Prevention, Cooperative Agreement 5U17CE00202301, Core Violence and Injury Prevention Program.
Permission to quote from or reproduce materials from this publication is granted when acknowledgment is
made.

Prepared by: Brenna V. Rabel, MPH
150 North 18th Avenue, Suite 320
Phoenix, AZ 85007
Office of Injury Prevention
Bureau of Women’s and Children’s Health
Arizona Department of Health Services
November 2012

Table of Contents
Executive Summary................................................................................................................ 3
Overview of Poisonings Among Arizona Residents.................................................................. 4
Poison Control Centers Serving Arizona .................................................................................. 5
Five-Year Trends in Poisonings Among Arizona Residents, 2007-2011 ..................................... 6
Mortality ......................................................................................................................................6
Non-Fatal Inpatient Hospitalizations ...........................................................................................9
Poisoning-Related Mortality, 2011 ....................................................................................... 11
Non-Fatal Poisoning-Related Inpatient Hospitalizations, 2011 .............................................. 15
Non-Fatal Poisoning-Related Emergency Department Visits, 2011 ........................................ 20
Poisoning and Prescription Drug Overdoses as an Arizona Public Health Concern ................. 25
Poisoning Prevention Tips and Resources ............................................................................. 26

2

Executive Summary
Poisoning was the leading cause of injury-related mortality among Arizona residents in 2011; among injury
deaths of all manners, 1,144 (25 percent) were attributable to poisoning. Males aged 45 through 54 years had
the highest rate of poisoning-related deaths with 38.3 deaths per 100,000 residents. Poisoning mortality rates
were highest among American Indians (24.6 deaths per 100,000 residents) and non-Hispanic Whites (21.8
deaths per 100,000 residents). Seventy-seven percent of the poisoning-related deaths in 2011 were due to
unintentional injuries (n=880); 16 percent were due to suicide (n=187); and seven percent were of an
undetermined manner of death (n=77). The poisons most commonly specified on death certificates in 2011
were alcohol (16 percent, n=186), Oxycodone or Hydrocodone (15 percent, n=175), and heroin (10 percent,
n=120). Among counties with at least 20 poisoning-related deaths in 2011, Navajo County had the highest
fatality rate (35.1 deaths per 100,000 residents).
In 2011, there were 6,930 non-fatal inpatient hospitalizations due to poisonings. Adult females had the highest
rates of non-fatal poisoning-related inpatient hospitalizations. Females 45 through 54 years of age had a rate
of 167.7 cases per 100,000 residents, and females 35 through 44 years of age had a rate of 163.6 cases per
100,000 residents. African-American residents had the highest age-adjusted poisoning-related rate of non-fatal
inpatient hospitalizations in 2011 (135.0 per 100,000) followed very closely by white, non-Hispanic Arizona
residents (134.7 cases per 100,000 residents). Unintentional poisoning accounted for 47 percent of non-fatal
inpatient hospitalizations (n=3,280), and self-inflicted poisonings comprised an additional 44 percent
(n=3,076). Hospital charges for non-fatal poisoning-related inpatient hospitalizations totaled more than $127
million in 2011, and Arizona residents spent a total of 13,822 days hospitalized for these injuries. Gila County
had the highest age-adjusted rate of inpatient hospitalizations due to non-fatal poisonings (156.0
hospitalizations per 100,000 residents).
In 2011, there were 12,516 non-fatal poisoning-related emergency department visits among Arizona residents.
The highest age-specific rates of non-fatal poisoning-related emergency department visits for both males and
females were among children younger than five years of age (412.5 visits per 100,000 residents and 396.5 per
100,000 residents, respectively). Fifty-two percent of the non-fatal poisoning-related emergency department
visits were the result of unintentional poisonings (n=6,464), and 34 percent of the visits resulted from selfinflicted injuries (n=4,299).
The data presented in this report show that poisoning is a public health problem that impacts the lives of
thousands of Arizona residents each year. These injuries can occur throughout the life span, and like so many
injuries, poisonings are predictable and preventable. Understanding the circumstances of poisonings is an
important step towards educating and empowering communities and implementing prevention strategies.

3

Overview of Poisonings among Arizona Residents
Fatalities and injuries resulting from poisonings are significant problems in Arizona. Beginning in 2007,
poisoning-related deaths surpassed motor-vehicle crashes as the leading injury-related cause of death among
Arizonans.1 As this report shows, the burden of poisoning-related injuries has increased in recent years,
accounting for a greater percentage of injury-related morbidity and mortality. Figure 1 presents an overview of
the number of poisoning-related events by outcome and illustrates the limitations of currently available data
sources and the inability to enumerate the true number of poisonings.

Figure 1. Poisoning Outcomes Pyramid, Arizona 2011

1,144 Deaths

6,930 Non-fatal Inpatient
Hospitalizations

12,516 Non-fatal Emergency
Department Visits

??? Poisonings treated in physician's offices,
other outpatient facilities, at home, via Poison
Control Center, or not treated

This report presents a comprehensive picture of poisoning-related injuries among Arizona residents in 2011, as
well as poisoning trends during the five years since 2007. To help better understand the data, information
about poison control centers are also presented. For additional information about data sources and methods
used, please refer to the Methodology section of this report. To learn about preventing poisonings, please
refer to the Prevention Tips and Resources section of this report.

1

Please refer to the Methodology Section for a description of the types of poisonings included in this report; these numbers may not match
other publications.

4

Poison Control Centers Serving Arizona
Poison Control Centers (PCCs) are widely considered to be a cost-effective tool for reducing healthcare costs
resulting from poisoning events. It has been estimated that for every dollar invested in a PCC, seven dollars of
medical care can be avoided.2 Because of the clear benefit to citizens, the state of Arizona has mandated the
existence of a PCC since 1980. Per Arizona Revised Statutes 36-1161 through 36-1163, the Arizona Department
of Health Services is responsible for establishing a poison and drug information system consisting of two
poison control centers. While the poison control centers are charged with serving as a resource for poison
identification and treatment, it is also tasked with educating the public about poisoning prevention.
As of October 2011, two of the nation’s 57 nationally recognized PCCs were located in Arizona. The Arizona
Poison and Drug Information Center (APDIC) is affiliated with the University of Arizona College of Pharmacy
located in Tucson. The Banner Good Samaritan Poison & Drug Information Center (BGSPDIC) is located in
Phoenix. The BGSPDIC serves Maricopa County, including the metropolitan Phoenix area. The APDIC serves the
remainder of the state. While the BGSPDIC serves a smaller geographic area, it covers about 60 percent of the
state’s residents.
Similar to other nationally recognized PCCs, both Arizona centers are accessed by calling the National Poison
Control Center toll-free telephone number: 1-800-222-1222. Calls to this number are routed to the appropriate
PCC based on geography. Because calls are routed based on the telephone number from which the call is
placed, individuals with an Arizona telephone area code will speak to either BGSPDIC or APDIC, even if they are
calling from outside Arizona. Individuals are encouraged to call PCCs with any concerns, whether or not an
incident has occurred. While providing information and medical advice about poisonings, both of Arizona’s
centers provide additional services to residents, including drug information and identification, medical
consultation with clinicians, and poisoning prevention education and outreach.
In 2011, the APDIC documented 24,183 calls for human exposures to toxins and poisons, out of 51,332 total
calls (47 percent). Twenty-one of these cases resulted in death and 33 percent (n=7,932) of the calls were
managed in a healthcare facility.
In 2011, the BGSPDIC documented 48,002 calls for human exposures to toxins and poisons, out of more than
98,578 total calls (43 percent). Twenty-four percent of the calls for poison exposures were managed in a
healthcare facility, and 73 percent of calls were managed at home.
The availability of a 24-hour poison control center allows many people who may have sought emergency care
to be treated in their own homes, resulting in financial savings for themselves and the healthcare facilities they
may have otherwise visited. BGSPDIC estimates that 29,000 callers may have sought medical treatment at an
emergency department in 2010 if they had not been able to consult with the poison control center and care
for themselves at home.3
A survey of patients who called a PCC found that 79 percent of the patients surveyed would have used the
local emergency medical services in the absence of a poison control hotline, at an estimated cost of more
than five times the operating costs of the PCC.4

2

Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: A benefit-cost analysis. Ann Emerg
Med February 1997; 29:239-245.
3
Banner Good Samaritan Poison & Drug Information Center 2010 Summary, accessed Oct. 23th, 2012 at
www.bannerhealth.com/Locations/Arizona/Banner+Good+Samaritan+Poison+and+Drug+Information+Center/About+Us/By+the+Numbers.ht
m
4
Kearney TE, Olson KR, Bero LA, Heard SE, Blanc PD. Health Care Cost Effects of Public Use of a Regional Poison Control Center. West
J Med 1995; 162:499-504.

5

Five-Year Trends in Poisonings among Arizona Residents, 2007-2011
Mortality
While injuries account for approximately 10 percent of deaths among Arizonans each year, the types of injury
have changed over time. Since 2007, the proportion of poisoning-related deaths has increased from 22 percent
of all injury-related deaths (n=1,028) to 25 percent of injury-related deaths in 2011 (n=1,144). Over this fiveyear period, the number of injury-related deaths has decreased slightly, and the increase in poisoning-related
deaths was offset by substantial decreases in motor vehicle traffic fatalities. Figure 1 shows the distribution of
injury-related deaths by mechanism of injury over the five year period from 2007 through 2011.

Figure 1. Proportion of Injury-Related Fatalities by Mechanism of Injury
Arizona, 2007-2011
100%
90%

22%

23%

7%

7%

27%

26%

25%

7%

8%

7%

19%

20%

21%

16%

15%

16%

80%
70%
60%

20%

20%

50%
40%

21%

18%

16%

17%

17%

17%

17%

16%

16%

14%

13%

14%

2007 (n=4,672)

2008 (n=4,553)

2009 (n=4,423)

2010 (n=4,499)

2011 (n=4,546)

30%
20%
10%
0%
Other Causes

Fall

Motor Vehicle Traffic

Firearm

Suffocation

Poison

Between 2007 and 2011, the age-adjusted poisoning-related mortality rate increased 12 percent for Arizona
residents. This overall increase is almost entirely attributable to the rate of unintentional poisoning deaths,
which has increased by 20 percent since 2007. Suicide-related poisonings have remained somewhat stable
over time, and in fact have decreased by 12 percent since 2007. Figure 2 shows the age-adjusted poisoningrelated mortality rates by manner of death for Arizona residents from 2007 to 2011.

6

Figure 2. Age-Adjusted Poisoning-Related Mortality Rates per 100,000 Residents by Intent, Arizona
2007-2011
16
14

14.2

13.7

12

14.0

12.1

11.7
10
8
6
4
3.3

3.3

3.2

2

2.9

2.9

0
2007

2008

2009
Unintentional

2010

2011

Suicide

Between 2007 and 2011, the age-adjusted poisoning-related mortality rates increased for both males and
females, though the rates for males were consistently higher than those for females. Figure 3 shows the ageadjusted poisoning-related mortality rates by sex for Arizona residents from 2007 to 2011.

Figure 3. Age-Adjusted Poisoning-Related Mortality Rates per 100,000 Residents by Sex, Arizona
2007-2011
25

22.4

22.0
20.1

21.0

20.0

20
15

12.1

12.6

14.1

15.0

15.1

10
5
0
2007

2008

2009
Male
Female

2010

2011

While rates increased among American Indians by 48 percent over the 5-year period, the 2011 rate (24.6 per
100,000) nevertheless represents a 23 percent decrease from 2010, when the mortality rate for this group was
at its highest. Conversely, poisoning-related fatality rates among African American Arizonans decreased 24
percent. Figure 4 shows the age-adjusted poisoning-related mortality rates by race/ethnicity for Arizona
residents from 2007 to 2011. Due to small numbers, age-adjusted poisoning-related fatality rates have not

7

been presented for Asian residents. Age-adjusted mortality rates could not be calculated for the 29 poisoningrelated deaths among Arizonans of other or unknown race/ethnicities because a denominator could not be
characterized.
Figure 4. Age-Adjusted Poison-Related Mortality Rates per 100,000 Residents by Race/Ethnicity, Arizona
2007-2011
35
32.0

30
25
20
15

18.0
16.6

10

9.6

24.5

25.2

20.9

20.7
18.9
17.6

24.6
21.8

21.6
13.9

16.3

13.6
10.3

10.5

9.0
6.3

5
0
2007

2008

White, Non-Hispanic

Hispanic, All races

2009

2010
American Indian

2011
Black/African American

Source: WISQARS for 2007-2010 rates, Arizona Vital Statistics for 2011

While the trend is not supported in all counties, the age-adjusted rate of poisoning-related fatalities in Arizona
increased between 2007 and 2011. Table 1 shows the age-adjusted fatality rate per 100,000 residents for
poisoning-related deaths by county of residence from 2007 to 2011. Ten of the state’s 15 counties had at least
one year in which there were fewer than 20 deaths, making those counties’ rates unstable over time.
Table 1. Age-Adjusted Fatality Rate per 100,000 Residents for PoisoningRelated Deaths by County of Residence, Arizona 2007-2011
2007
2008
2009
2010
2011
Apache*
24.4
23.2
23.1
28.8
23.3
Cochise*
16.8
13.0
17.3
16.6
9.4
Coconino*
9.7
18.6
18.4
18.6
21.0
Gila*
18.6
18.0
27.1
21.2
25.4
Graham*
22.0
14.7
16.5
17.5
19.9
Greenlee*
20.7
10.1
50.1
11.4
16.2
La Paz*
8.2
20.0
25.2
58.4
14.0
Maricopa
16.2
16.0
16.7
16.6
16.7
Mohave
13.7
21.3
31.1
32.0
28.3
Navajo*
16.7
16.5
26.0
25.8
35.1
Pima
17.2
17.7
20.8
22.6
20.7
Pinal
15.5
13.6
13.4
16.3
13.0
Santa Cruz*
4.9
6.7
18.5
7.7
5.5
Yavapai
18.3
20.5
21.1
27.8
31.0
Yuma*
16.3
12.3
13.0
14.0
12.2
Statewide Total
16.1
16.4
18.1
18.7
18.1
*Rates are unstable for counties indicated, as they had fewer than 20 deaths in at least one year.

8

Non-Fatal Inpatient Hospitalizations
Between 2007 and 2011, the age-adjusted rate of non-fatal poisoning-related inpatient hospitalizations among
Arizona residents increased 32 percent, from 82.4 cases per 100,000 residents in 2007 to 108.4 cases in 2011.
While the increase was still apparent when hospitalizations were divided by injury intent, cases resulting from
unintentional poisonings increased more than cases of self-inflicted poisoning (a 55 percent increase and a 17
percent increase, respectively). It’s important to note, however, that there were 573 cases (about 8 percent of
all poisoning-related hospitalizations) in which the manner was undetermined. Figure 5 shows the ageadjusted poisoning-related rates for non-fatal inpatient hospitalizations by injury intent for Arizona residents
from 2007 to 2011.
Figure 5. Age-Adjusted Poisoning-Related Non-fatal Inpatient Hospitalization Rates per 100,000 residents by
Manner, Arizona 2011
60.0
50.0

51.6

48.3

47.3

42.3

40.0

49.3
50.1

39.7

36.0
30.0

52.3

32.3

20.0
10.0
0.0
2007

2008

2009
Unintentional

2010

2011

Suicide

While age-adjusted poisoning-related mortality rates were consistently higher among males, similar rates for
non-fatal poisoning-related inpatient hospitalizations were higher for females then for males. Rates increased
among both males and females during the five years from 2007 through 2011, with a 36 percent increase in
the rate among males and a 28 percent increase in the rate among females. Figure 6 shows the age-adjusted
rates by sex for non-fatal poisoning-related inpatient hospitalizations from 2007 through 2011.

9

Figure 6. Age-Adjusted Non-fatal Poisoning-Related Inpatient Hospitalization Rates per 100,000
Residents by Sex, Arizona 2007-2011
140
120

105.4
91.9

100
80

73

118.8

111.5
99.5

117.5
99.1

89.2
78.5

60
40
20
0
2007

2008

2009
Males

2010

2011

Females

The age-adjusted rate of non-fatal poisoning-related inpatient hospitalizations in Arizona increased between
2007 and 2011 among almost all counties with at least 20 hospitalizations in a given year. Yuma County is the
exception; the 2011 non-fatal hospitalization rate of 38.9 per 100,000 residents is a 27 percent decrease from
2007, when it was 53.3 per 100,000. Despite its relatively small population, Gila County had a poisoningrelated hospitalization rate consistently higher than the remainder of the state. Table 2 shows the ageadjusted fatality rate per 100,000 residents for non-fatal poisoning-related inpatient hospitalizations by county
of residence from 2007 to 2011. Four of the state’s 15 counties had at least one year in which there were
fewer than 20 events, making the rate for that county unstable over time.
Table 2. Age-Adjusted Rate per 100,000 Residents for Non-Fatal PoisoningRelated Inpatient Hospitalizations by County of Residence, Arizona 2007-2011
2007
2008
2009
2010
2011
Apache*
26.8
45.4
55.7
58.4
43.0
Cochise
36.2
53.1
68.3
66.7
73.7
Coconino
60.4
63.1
59.2
73.8
85.2
Gila
92.4
97.8
101.3
129.6
156.0
Graham
114.1
139.2
187.6
157.4
88.4
Greenlee*
54.3
89.9
76.3
37.0
127.2
La Paz*
46.8
39.9
113.5
52.8
68.1
Maricopa
85.4
94.6
102.5
114.5
117.3
Mohave
101.0
104.3
124.9
112.8
123.2
Navajo
56.8
76.6
83.3
95.2
103.9
Pima
92.9
103.6
107.0
116.8
109.6
Pinal
83.1
90.9
117.0
109.3
92.3
Santa Cruz*
31.5
44.2
47.6
48.9
59.3
Yavapai
75.5
74.2
78.3
105.3
85.4
Yuma
53.3
67.4
68.8
67.9
38.9
Statewide Total
82.4
91.9
100.3
109.2
108.4
*Rates are unstable for counties indicated, as they had fewer than 20 cases in at least one year.

10

Poisoning-Related Mortality, 2011
There were 1,144 deaths among Arizona residents attributed to poisoning in 2011. Fifty-eight percent of
deaths were among males (n=660), and 42 percent were among females (n=484). In 2011, the age-adjusted
poisoning mortality rate among Arizona females was 15.1 deaths per 100,000 residents; the rate among males
was 39 percent higher (21.0 deaths per 100,000 residents). When looking at poisoning deaths by age group,
males had higher mortality rates than females in each age group, though the ratio of deaths among males and
females varied. Adults 45 through 54 years of age had the highest rate of fatalities among both males and
females, although young adult males between 25 and 34 years of age had a notably high rate. Young adults in
this age group had the highest ratio of deaths among males versus females. Deaths among males 15 through
24 years outnumbered those among females in that age group by a factor of 2. Figure 8 shows the poisoningrelated mortality rates per 100,000 Arizona residents by age group and sex.

Figure 8. Poisoning Mortality Rates per 100,000 Residents by Age Group and Sex, Arizona 2011
45
38.3

40
35

32.4

33.2

32.2

30

27.3
25.3

26.1

25
19.8

20

16.3

15
10

8.2 7.7

7

5
0.1 0
0
0-14 yrs

15-24 yrs

25-34 yrs

35-44 yrs

Males (n=660)

45-54 yrs

55-64 yrs

65+ yrs

Female (n=484)

American Indian residents had the highest age-adjusted poisoning-related mortality rate in 2011 (24.6 deaths
per 100,000 residents), followed closely by White, non-Hispanic residents (21.8 deaths per 100,000 residents).
Hispanic Arizonans had the lowest stable poisoning-related mortality rate in 2011 with 10.3 deaths per
100,000 residents. Though Asian residents had a very low mortality rate, the rate is not stable due to the low
number of deaths. Figure 9 shows the age-adjusted poisoning-related mortality rates by race/ethnicity for
Arizona residents in 2011.

11

Figure 9. Age-Adjusted Poisoning-Related Mortality Rate per 100,000 Residents by Race/Ethnicity, Arizona
2011
30
24.6

25

21.8
18.1

20
13.6

15

10.3
10
5

2.6

0

There were 25 deaths among individuals of other or unknown race/ethnicity.

As in previous years, the majority of poisoning-related deaths were determined to be unintentional. In 2011,
77 percent of poisoning-related deaths among Arizona residents were unintentional (n=880). With 187
suicides, 2011 had the lowest percentage of poisoning-related suicide deaths in any year from 2007 through
2011. Figure 10 shows the proportion of poisoning-related deaths by manner in each year from 2007 through
2011.

Figure 10. Proportion of Poisoning-Related Fatalities by Intent,
Arizona, 2007-2011
100%

8%

7%

7%

6%

8%

18%

21%

20%

18%

16%

73%

72%

74%

75%

76%

2007 (n=1,007)

2008 (n=1,044)

2009 (n=1,175)

2010 (n=1,176)

2011 (n=1,144)

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Unintentional

Suicide

Homicide

Undetermined

Every poisoning-related fatality has its own circumstances, including the type of poison used. Multiple drugs
may be listed as contributing to a single death. Table 3 lists the poisons most commonly specified on the 2011
death certificates. Because some death certificates may simply state that the cause of death was a “drug

12

overdose” or “combined drug intoxication”, the figures listed below may be an underestimate of the number
of deaths involving a particular substance.
Table 3. Poisons Commonly Listed on Death Certificates, Arizona 2007-2011
Poisons*

Alcohol
Benzodiazepines
Carbon Monoxide
Carisoprodol
Cocaine
Diphenhydramine
Fentanyl
Helium
Heroin
Methadone
Methamphetamine
Morphine
Oxycodone/Hydrocodone
Serotonin-Norepinephrine
Reuptake Inhibitors (SNRIs)
Selective Serotonin Reuptake
Inhibitors (SSRIs)
Tramadol

2007
(n=1,007)
#
%
155
15%
54
5%
36
4%
10
1%
125
12%
22
2%
22
2%
5
<1%
56
6%
79
8%
104
10%
81
8%
119
12%

2008
(n=1,044)
#
%
186
18%
97
9%
41
4%
15
1%
87
8%
30
3%
37
4%
6
1%
67
6%
105
10%
91
9%
115
11%
162
16%

2009
(n=1,175)
#
%
155
15%
54
5%
36
4%
10
1%
125
12%
22
2%
22
2%
5
<1%
56
6%
79
8%
104
10%
81
8%
119
12%

2010
(n=1,176)
#
%
186
18%
97
9%
41
4%
15
1%
87
8%
30
3%
37
4%
6
1%
67
6%
105
10%
91
9%
115
11%
162
16%

2011
(n=1,144)
#
%
186
16%
99
9%
16
1%
12
1%
59
5%
18
2%
21
2%
10
1%
120
10%
53
5%
116
10%
101
9%
175
15%

10

1%

11

1%

10

1%

11

1%

14

1%

44

4%

55

5%

44

4%

55

5%

49

4%

13

1%

10

1%

13

1%

10

1%

15

1%

*More than one poison may have been identified for each death

In the past, poisoning-related deaths were known to be unevenly distributed throughout the week. If deaths
were distributed evenly among days and months, each day would contain 14.3 percent of the deaths and each
month would contain 8.3 percent of the deaths. In 2011, Saturdays, Sundays, and Mondays had the highest
number of deaths, 15 percent each, n=175, 174, 173, respectively), and Tuesdays had the lowest number of
deaths, accounting for 12.9 percent (n=152). However, these differences are not statistically significant.
Poisoning fatalities were distributed among residents of Arizona’s counties as shown in Figure 14. While this
report does not examine the distribution of mortality across counties by type of substance, results of such an
analysis from New Mexico suggest that unintentional deaths resulting from illegal drugs were more prevalent
in urbanized areas, and deaths from prescription drugs were more common in suburban or rural settings.5

Poisoning Fatalities by Manner
There were 880 unintentional poisoning deaths in 2011 (76 percent), 64 percent were among males (n=563),
and 36 percent were among females (n=317). In 2011, only 1 unintentional poisoning-related death occurred
among children 4 years and younger; there were no deaths among children ages 5 through 14 years. There
were 187 poisoning-related suicides in 2011 (16 percent), 62 percent of which were among females (n=116).
There were no poisoning-related suicides among either sex below the age of 15 years.
In 2011, Males aged 45 through 54 years had the highest mortality rate for unintentional poisoning-related
deaths (32.3 deaths per 100,000 residents), although young adult males ages 25 through 34 had high mortality
rates (29.5 deaths per 100,000 residents). Females had higher poisoning-related suicide rates in all age groups,
5

CDC. Unintentional Deaths from Drug Poisoning by Urbanization of Area – New Mexico, 1994-2003. MMWR 2005; 54(35):870-873.

13

and the highest rate was among females 55 through 64 years of age (8.9 suicides per 100,000 residents).
Figure 11 shows the death rates for poisonings by age group, manner, and sex per 100,000 Arizona residents in
2011.

Figure 11. Age-specific Poisoning-Related Mortality Rates per 100,000 Residents by Age, Sex, and
Manner, Arizona 2011 (n=1,067*)
85+

1.5

7.9

75-84

1.9

65-74

5.7

55-64

13.6

45-54
25-34

5.9 2.5

2.3

4

8.9

4.3

5.6

4.8

6.8

1.8

2.8

32.3
17.1

26.9

12.3

29.5

15-24

5.7

18.3

< 14

0.6 1.4
0.2

60.0

50.0

40.0

Unintentional Males

30.0

20.0

Unintentional Females

4.5

3.9 1.6 1.9

21.8

23.0

35-44

0

10.0

0.0

Self-Inflicted Males

0
10.0

20.0

Self-Inflicted Females

*Does not include 77 deaths due to undetermined manner

Figure 12 shows the poisons most commonly specified on the 2011 death certificates for both manners of
poisoning-related fatalities. Because there were so many more unintentional deaths than suicides, the poisons
are shown in percent rather than count. Given that more than one poison may be listed on a death certificate,
the percent values will not add up to 100. Because some death certificates may simply state that the cause of
death was a “drug overdose” or “combined drug intoxication”, the figures listed below may be an
underestimate of the number of deaths involving a particular substance.

Figure 12. Poisons Commonly Listed on Death Certificates (%), by Drug Type, Arizona 2011*
25%
20%

20%19%
15%

15%
10%

14%14%
8%
6%

12%

10%
5%

6% 7%

5%

6%

1% 1%

6%
4%

4%
1% 2%2% 1%2% 1%1% 1% 1% 1%

0%

Unintentional (n=880)

Suicide (n=187)

*More than one poison may have been listed for each death

14

Non-Fatal Poisoning-Related Inpatient Hospitalizations, 2011
There were 6,930 non-fatal inpatient hospitalizations among Arizona residents attributed to poisoning in 2011,
and an age-adjusted rate of 108.4 per 100,000 residents. Forty-five percent of the events were among males
(n=3,140), and 55 percent were among females (n=3,790). Unintentional and self-inflicted poisonings
accounted for 92 percent of non-fatal poisoning-related inpatient hospitalizations, but neither category
accounted for a majority of cases. Forty-seven percent of inpatient hospitalizations were attributed to
unintentional poisonings (n=3,280), 44 percent resulted from self-inflicted poisonings (n=3,076), poisonings of
undetermined intent accounted for eight percent of hospitalizations (n=573), and there was one visit due to
poisoning-related assaults or other intents (legal intervention).
Except for children and infants up to four years of age and adults over 85 years, females had higher rates of
non-fatal inpatient hospitalizations than males across the lifespan. The 45 through 54 year age group had the
highest rate among both males and females. Figure 13 shows the non-fatal poisoning-related inpatient
hospitalization rates per 100,000 Arizona residents by age group and sex.

20

19.3

10.8

40

26.7
23.1

60

39.6

45.4

80

72.3

69.4

100

91.0

99.4

120

98.3

118.4

154

167.7
110.1

126.2

140

135.8
145.5

117.9

160

126.9

180

149.4

163.6

Figure 13. Non-fatal Poisoning-Related Inpatient Hospitalization Rates per 100,000 residents, by
Sex, Arizona 2011

0
<1

1-4
years

5-14
years

15-24
years

25-34
years

Males (n=3,140)

35-44
years

45-54
years

55-64
years

65-74
years

75-84
years

85+
years

Females (n=3,790)

African-American residents had the highest age-adjusted poisoning-related rate of non-fatal inpatient
hospitalizations in 2011 (135.0 per 100,000) followed very closely by white, non-Hispanic Arizona residents
(134.7 cases per 100,000 residents). Asian residents had the lowest poisoning-related rate of non-fatal
inpatient hospitalizations in 2011 with 22.2 cases per 100,000 residents. Figure 14 shows the age-adjusted
non-fatal poisoning-related inpatient hospitalization rates by race/ethnicity for Arizona residents in 2011.

15

Figure 14. Age-Adjusted Non-Fatal Poisoning-Related Inpatient Hospitalization Rate per 100,000 by
Race/Ethnicity, Arizona 2011
160
135.0

140

134.7

120

108.4

100

87.4

80

60.9

60
40

22.2

20
0
Black/African
American
(n=351)

White, nonHispanic
(n=5,110)

American
Indian (n=312)

Hispanic
(n=1,019)

Asian (n=42)

All ethnicities
(n=6,930)

There were 96 hospitalizations among individuals of other or unknown race/ethnicity.

Gila County had the highest rate of inpatient hospitalizations for non-fatal poisonings in 2011, with 156 cases
per 100,000 county residents. However, Mohave County was the only county to rank among the five counties
with the highest rate of poisonings for both fatalities and non-fatal hospitalizations. The number and rate of
non-fatal poisoning-related inpatient hospitalizations were distributed among residents of Arizona’s counties
as shown in Figure 15.

Figure 15. Age-adjusted Non-Fatal Poisoning-Related Inpatient Hospitalization Rates per 100,000
residents by County, Arizona 2011
180

156.0

160
140

127.2

117.3 123.2

120
100
73.7

80
60
40

43.0

85.2

88.4
68.1

103.9 109.6

92.3

85.4
59.3
38.9

20
0

*Rates are unstable due to low counts (n<20); Does not include 1 case with unknown county information

16

Among all manners of non-fatal poisoning-related inpatient hospitalization, 95 percent were due to overdoses
of a drug or medication. This percentage includes both prescription and non-prescription drugs. Unfortunately,
the lack of specificity in the data on drug type makes further analysis impossible for 2011 data.

Figure 16. Non-fatal Poisoning-Related Inpatient Hospitalizations by Poison Type, Arizona 2011 (n=6,930)

1% (n=97)
95% (n=6,569)
361, 5%
4% (n=243)

<1% (n=21)
Drug-related (Rx and non-Rx)
Household/environmental/agricultural poisons

Beverage alcohol
Carbon monoxide/motor vehicle exhaust

In 2011, the average non-fatal poisoning-related inpatient hospitalization totaled $28,722 in hospital charges
and lasted for 3 days (median = $19,277, 2 days). Arizona residents spent a total of 13,822 days in the hospital
for non-fatal poisoning-related events. The longest hospital stay for a non-fatal case was 195 days. Hospital
charges for non-fatal inpatient hospitalizations due to poisonings totaled over $127 million for Arizona
residents in 2011. The single most costly hospitalization totaled $553,651 in hospital charges. Fifty-seven
percent of hospital fees for non-fatal poisoning-related inpatient hospitalizations were reportedly paid by
Medicare or the Arizona Health Care Cost Containment System (AHCCCS), (3,958 cases; more than $114.8
million). Hospital charges do not reflect hospital reimbursement rates, nor do they include charges or costs
related to emergency medical services, outpatient care, rehabilitation, legal fees, or lost work or school time.

Non-Fatal Poisoning-Related Inpatient Hospitalizations by Manner
There were 3,280 non-fatal inpatient hospitalizations among Arizona residents attributed to unintentional
poisoning in 2011 (47 percent) and 3,076 hospitalizations attributed to intentional self-inflicted poisoning (45
percent). Because the vast majority of hospitalizations fall into one of these two categories, the following
section will focus on unintentional and self-inflicted non-fatal poisoning-related hospitalizations. Figure 17
shows the distribution of non-fatal poisoning-related inpatient hospitalizations by manner.

17

Figure 17. Non-Fatal Poisoning-Related Inpatient Hospitalizations by Manner, Arizona 2011
(n=6,930)

<1% (n=1)

8% (n=573)

47% (3,280)
Unintentional
Self-inflicted
Assault
Undetermined
45% (n=3,076

Unintentional poisoning-related hospitalizations were evenly distributed between males and females (50
percent each) whereas females represented a greater percentage of self-inflicted poisoning-related
hospitalizations (61 percent, n=1,866). Female residents aged 35 through 44 years had the highest rate of selfinflicted non-fatal poisoning-related inpatient hospitalizations of any age group (96.2 per 100,000) in 2011.
Male residents 85 and older had the highest rate of unintentional poisoning-related hospitalization (94.7 per
100,000). In general, the highest rates of self-inflicted poisoning-related hospitalizations were among adults
and teenagers aged 15-54, whereas unintentional poisonings were highest among the oldest age groups.
Unsurprisingly, there were no self-inflicted poisoning-related hospitalizations among children under 5 years of
age. Figure 18 shows the non-fatal poisoning-related inpatient hospitalization rates per 100,000 Arizona
residents by age group and sex, separated by manner.

Figure 18. Age-specific Non-Fatal Poisoning-Related Inpatient Hospitalization Rates per 100,000
Residents by Age, Sex, and Manner, Arizona 2011 (n=6,356)
85+

78.7

94.7

75-84

70.2

65-74

69.8

55-64

87.9

45-54

15.5

53.0

10.1

25-34

44.5

15-24

29.5

5-14

29.3

<1

Unintentional Males

100.0

64.4
60.8

59.2

62.1

4.9 7.1

2.6 13.2

44.4

50.0

78.7
96.2

53.4

53.2

23.1
150.0

53.2

52.8

38.5

1-4

17.5
25.4

73.5
54.7

200.0

15.1

55.2
69.0

72.9

35-44

10.5

87.9
89.7

0.0

24.5 0.0
0.0

Unintentional Females

50.0

100.0

Self-Inflicted Males

150.0

200.0

Self-Inflicted Females

18

African American Arizona residents had the highest age-adjusted non-fatal unintentional poisoning-related
inpatient hospitalization rate in 2011 (77.3 cases per 100,000 residents), followed by White, non-Hispanic
residents (59.6 cases per 100,000 residents). Conversely, White, non-Hispanic residents had the highest ageadjusted non-fatal self-inflicted poisoning-related hospitalization rate (63.5 per 100,000 residents) followed by
African Americans (45.6 per 100,000 residents). Asian residents had the lowest age-adjusted non-fatal
inpatient hospitalization rates for both manners of poisoning. Figure 19 shows the age-adjusted non-fatal
unintentional poisoning-related inpatient hospitalization rates by race/ethnicity for Arizona residents in 2011.

Figure 19. Age-Adjusted Non-Fatal Poisoning-Related Inpatient Hospitalizations Rates per 100,000
Residents by Race/Ethnicity and Manner, Arizona 2011
90
80
70
60
50
40
30
20
10
0

77.3
63.5
59.6
50.149.3

45.6

41.138.9

32.0
24.8
10.8 10.7

Black/African
American

White, nonHispanic

American
Indian

Unintentional (n=3,280)

Hispanic

Asian

Total

Self-Inflicted (n=3,076)

There were 96 hospitalizations among individuals of other or unknown race/ethnicity.

Gila County had the highest non-fatal inpatient hospitalization rates for both unintentional and self-inflicted
poisonings (62.0 per 100,000 residents and 74.9 per 100,000 residents, respectively). Although Greenlee’s
hospitalization rate for self-inflicted injuries appears high, the overall count for that county is too low to
calculate a reliable rate. Non-fatal poisoning-related inpatient hospitalizations were distributed among
residents of Arizona’s counties as shown in Figure 20.

Figure 20. Age-Adjusted Non-Fatal Poisoning-Related Inpatient Hospitalizations by County and
Manner, Arizona 2011
160
74.9

140

93.9

120

51.1 64.7

100

43.2
41.1 48.5

80
60
40
20
0

51.1

20.3

42.6

41.9
29.9

25.7

22.9
62.0

17.9 25.6 27.8

52.3

33.3 24.8
16.6

Unintentional (n=3,280)

56.7 46.0 44.9 49.2
42.4

24.6

39.5
13.1

Self-Inflicted )n=3,076)

*Rates are unstable due to low counts (n<20)

19

Non-Fatal Poisoning-Related Emergency Department Visits, 2011
There were 12,516 non-fatal emergency department visits among Arizona residents attributed to non-fatal
poisoning in 2011. Forty-five percent of the visits were among males (n=5,682), and 55 percent were among
females (n=6,833). Except for children under five years, females had higher rates of non-fatal emergency
department visits than males. Children one through four years of age one had the highest rate of emergency
department visits among both sexes and the 15 to 24 year age group had the highest rate among adult
females. One study has shown that a substantial proportion of young children brought to an urban tertiarycare emergency department with apparent life-threatening events had positive toxicology screenings, even
when parents denied medicating the child.6 Though the rate of non-fatal poisoning events among Arizona’s
young children is very high, the results of that study suggest that the rate may be higher still if all young
children presenting in the emergency department with an apparent life-threat were screened for potential
poisons. Figure 21 shows the non-fatal poisoning-related emergency department visits rates per 100,000
Arizona residents by age group and sex.

Figure 21. Age-Specific Rates of Non-Fatal Poisoning-Related Emergency Department Visits by Age
and Sex, Arizona 2011 (n=12,515*)
450

412.5
396.5

400

354.0

350

309.3
281.7

300

252.8
250
200

226.7
193.4
164.3

209.9
178.4

150

153.9

108.3

81.7
64.5

100

145.9
105.9
87.8
80.1 77.0
76.3
69.4

50
0
<1yr

1-4yr

5-14yr 15-24yr 25-34
Males (n=5,682)

35-44

45-54

55-64

65-74

75-84

85+

Females (n=6,833)

*Excludes one individual of unknown sex

White, non-Hispanic Arizonans had the highest age-adjusted rate of non-fatal poisoning-related emergency
department visits (241.5 per 100,000 residents, n=8,277) followed closely by African American Arizonans
(240.2 per 100,000 residents, n=690). As with inpatient hospitalizations, the lowest rate was among Asian
Americans (49.2 per 100,000 residents). Figure 22 shows the rate distribution of emergency department visits
in 2011.

6

Pitetti RD, Whitman E, Zaylor A. Accidental and Nonaccidental Poisonings as a Cause of Apparent Life-Threatening Events in Infants.
Pediatrics 2008; 122:e539-e362.

20

Figure 22. Age-Adjusted Non-Fatal Poisoning-Related Emergency Department Visit Rates per
100,000 Residents by Race/Ethnicity, Arizona 2011 (n=12,516)
300
241.5

250

240.2
196.9

200
144.0

150

139.1

100
49.2

50
0
White, nonHispanic
(n=8,277)

Black/African
American
American
Indian (n=537)
(n=690)

Hispanic
(n=2,735)

Asian (n=100) All ethnicities
(n=12,516)

Mohave County had the highest rate of non-fatal poisoning-related emergency department visits in 2011
(329.1 visits per 100,000 residents, n=581), followed closely by Yavapai County (327.5 per 100,000 residents,
n=581). It is notable that although several counties had unstable rates for deaths and hospitalizations, all
Arizona counties had enough emergency department visits to generate rates that are stable and comparable
to others. Non-fatal poisoning-related emergency department visits were distributed among residents of
Arizona’s counties as shown in Figure 23.

Figure 23. Age-Adjusted Non-Fatal Poisoning-Related Emergency Department Visits by County,
Arizona 2011 (n=12,513*)
350
300

156.0
203.9

200

327.5

278.0

256.0

250

150

329.1

307.7

249.0

246.9
184.0

197.3

176.6 172.9

186.4

43.0

100
50
0

*Excludes 3 individuals with unknown county information

As with hospitalizations, the vast majority of non-fatal poisoning-related emergency department visits were
due to drugs (86 percent, n=10,733). Because of the number of unspecified drugs in the data, however, we are
unable to show specifically whether these were predominantly prescription or non-prescription drugs. The
distribution of emergency visits by poison type is shown in Figure 24.

21

Figure 24. Non-Fatal Poisoning-Related Emergency Department Visits by Poison Type, Arizona 2011
(n=12,516)
1% (n=137)

86% (n=10,733)
14% (n=1,783)

10% (n=1,301)

3% (n=345)
Drug-related (Rx and non-Rx)
Beverage alcohol
Household/environmental/agricultural poison (solid/liquid substances)
Gases/Vapors (including Carbon monoxide)

In 2011, the average non-fatal poisoning-related emergency department visit resulted in $4,502 in hospital
charges (median=$4,000). Hospital charges for non-fatal emergency department visits due to poisonings
among Arizona residents totaled more than $56.3 million in 2011. Fifty-four percent of those hospital charges
were reportedly paid by Medicare or the Arizona Health Care Cost Containment System (AHCCCS) (6,765 visits;
more than $30.2 million). The single most costly emergency department visit resulted in $52,176 in hospital
charges. Hospital charges do not reflect hospital reimbursement rates, nor do they include charges or costs
related to emergency medical services, rehabilitation, legal fees, or lost work or school time.

Non-Fatal Poisoning-Related Emergency Department Visits by Manner
Unlike the distribution among inpatient hospitalizations, a slight majority of non-fatal poisoning-related
emergency department visits were identified as being unintentional injuries (52 percent, n=6,464). Thirty-four
percent of emergency department visits were attributed to self-inflicted poisonings (n=4,299), poisonings of
undetermined intent accounted for 14 percent of visits (n=1,739), and there were 14 visits from poisonings
due to assaults or other intents (legal intervention). Figure 25 shows the distribution of non-fatal emergency
department visits by manner.

Figure 25. Non-Fatal Poisoning-Related Emergency Department Visits by Manner, Arizona 2011
(n=12,516)
14% (n=1,739)
<1% (n=14)
52% (n=6,464)

Unintentional
Self-inflicted
Assault/Other
Undetermined

34% (n=4,299)

22

Children younger than five years of age had the highest rates of non-fatal unintentional poisoning-related
emergency department visits among both males and females (403.0 per 100,000 residents and 384.4 per
100,000 residents, respectively). Females had higher rates of non-fatal, unintentional poisoning-related
emergency department visits among Arizona residents in each age group 25 years and older. Females in all age
groups had higher rates of self-inflicted poisoning-related visits, with the highest rate being among females
aged 15 through 24 (190.5 per 100,000). This age group also represented the highest rate among males (113.6
per 100,000 residents). Figure 26 shows the non-fatal poisoning-related emergency department visit rates per
100,000 Arizona residents by age group and sex, separated by manner.

Figure 26. Non-fatal Poisoning-Related Emergency Department Visit Rates per 100,000 Residents by
Age Group, Manner, and Sex, Arizona 2011
85+

83.2 71.1 5.3 1.5

75-84

89.0 64.5 6.2 9.1

65-74

63.0 55.5 8.8 9.5
78.8 61.2 28.2 47.5

55-64
45-54

93.8 68.5 52.4 88.7

35-44

96.7 72.3 73.2 122.1

25-34

105.4

15-24

113.3

5-14

37.0
384.4

1-4

161.9
800.0

Unintentional Males

137.7
113.6
190.5

130.6
43.8

403.0

<1
1,000.0

94.7 85.7

600.0

400.0

Unintentional Females

200.0

10.8 35.0
0.5
0

186.7
0.0

Self-Inflicted Males

0.6

200.0

400.0

Self-Inflicted Females

As with inpatient hospitalizations, the highest rates of non-fatal emergency department visits were among
African American and White residents for both unintentional (115.9 per 100,000 residents and 120.9 per
100,000 residents, respectively) and self-inflicted (90.2 per 100,000 residents and 86.2 per 100,000 residents,
respectively) poisonings. It is important to note that American Indians are known to be under-represented in
emergency department data, and therefore the rates presented here are most likely an underrepresentation
of non-fatal poisoning-related visits for that race group. Figure 27 shows the distribution of emergency
department visits by race/ethnicity and manner.

23

Figure 27. Age-Adjusted Non-Fatal Poisoning-Related Emergency Department Visit Rates per
100,000 Residents by Race/Ethnicity and Manner, Arizona 2011
140

120.9

115.9

120

100.1

90.2

100

86.2

80

32.0
69.0

61.9

60

40.3

43.6

40

26.2

20

18.2

0
Black/African White, nonAmerican
Hispanic

American
Indian

Unintentional (n=6,464)

Hispanic

Asian

Total

Self-Inflicted (n=4,299)

There were 96 hospitalizations among individuals of other or unknown race/ethnicity.

Mohave and Yavapai Counties had the highest non-fatal emergency department visit rates for both
unintentional poisonings (168.3 per 100,000 residents and 140.1 per 100,000 residents, respectively). Yavapai
also had the highest non-fatal emergency department visit rate for self-inflicted poisoning (143.7 per 100,000
residents) followed closely by Graham County (139.4 per 100,000 residents). Non-fatal poisoning-related
emergency department visits were distributed among residents of Arizona’s counties as shown in Figure 28.

Figure 28. Age-Adjusted Non-Fatal Poisoning-Related Emergency Department Visits by County and
Manner, Arizona 2011
300

143.7

109.4

250
96.4 79.6

200

81.3

139.4
111.3

57.3

55.9 64.4 58.5
57.1

50.8 66.2

150
49.0
100
50

168.3
60.8

100.0 108.1 118.8 92.4

66.2

111.0 95.1

99.4 102.1 99.9 87.6

140.1

110.5

0

Unintentional (n=6,464))

Self-Inflicted (n=4,299)

*Rates are unstable due to low counts (n<20)

24

Poisoning and Prescription Drug Overdoses as an Arizona Public Health Concern
Deaths


Between 2007 and 2011, the age-adjusted poisoning-related mortality rate increased 12 percent for Arizona
residents, due largely to increases in unintentional poisoning rates.



In 2011, poisoning was the leading cause of injury-related deaths (25 percent) accounting for more deaths
among Arizonans than car crashes, falls, or firearm injuries.



Prescription drugs, often combined with alcohol, were responsible for many poison-related deaths. The poisons
most commonly specified on death certificates in 2011 were alcohol (16 percent, n=186), Oxycodone or
Hydrocodone (15 percent, n=175), and benzodiazepines (9 percent, n=99). Heroin was listed in 10 percent of
cases (n=120).



In 2011, as in previous years, poisoning-related fatality rates were highest among American Indian (24.6 per
100,000 residents) and White, non-Hispanic Arizonans (21.8 per 100,000 residents).

Non-Fatal Hospitalizations and Emergency Department Visits


Between 2007 and 2011, the age-adjusted rate of non-fatal poisoning-related inpatient hospitalizations among
Arizona residents increased 32 percent, from 82.4 cases per 100,000 residents in 2007 to 108.4 cases in 2011.



Adult women had the highest rates of non-fatal poisoning-related inpatient hospitalizations. Females 45 through
54 years of age had a rate of 167.7 cases per 100,000 residents, and females 35 through 44 years of age had a
rate of 163.6 cases per 100,000 residents.



In 2011, there were 12,516 non-fatal poisoning-related emergency department visits among Arizona residents.



The highest rates of emergency department visits were among male and female children one through four years
of age (412.5 per 100,000 for males, 369.5 per 100,000 for females).



Hospital charges for non-fatal poisoning-related inpatient hospitalizations totaled more than $127 million in
2011, and Arizona residents spent a total of 13,822 days hospitalized for non-fatal poisonings.



Hospital charges for non-fatal poisoning-related emergency department visits totaled over $56.3 million in 2011.

Arizona’s Response




Arizona has multi-faceted strategies in place to address each of the White House’s four approaches to countering
prescription drug abuse:
o Patient and provider education: Arizona has two nationally affiliated poison control centers providing
education and drug exposure response throughout the state.
o Prescription monitoring: Arizona’s Controlled Substances Prescription Monitoring Program is managed
by the Arizona State Board of Pharmacy. Dispensing pharmacies and practitioners are required under
Arizona law to report information on Schedule II, III, and IV prescriptions to the database.
(http://www.azpharmacy.gov/CS-Rx_Monitoring/aboutpmp.asp)
o Drug disposal: Since 2008, sites throughout Arizona have offered drug drop-off services as both
individual and ongoing events. These efforts have been expanded in 2012 under the Prescription Drug
Reduction Initiative.
o Law enforcement against improper prescribing: The federal Drug Enforcement Agency actively targets
doctors improperly prescribing potentially addictive medications in Arizona. In 2009, the Phoenix DEA’s
Tactical Diversion Squad charged a Golden Valley doctor with 14 felony charges for operating a ‘pill mill’.
(http://www.azcentral.com/news/articles/2009/07/14/20090714rxdrugbust.html)
Arizona’s Early Childhood home visitors provide education to young families, teaching them to avoid accidental
poisoning and providing resources to mitigate the harm.

25

Poisoning Prevention Tips and Resources
Call 1-800-222-1222 to be connected to a local Poison Control Center.
You can prevent poisonings!
 Store household cleaners in their original containers, away from children
o Pills, vitamins, antifreeze, nail polish remover, or insecticide may look similar to
children’s candy or beverages. Teach children not to eat or drink something without first
asking an adult.
o Teach children to identify medication, and don’t refer to pills as ‘candy’
 Identify poisonous plants around your home and remove from children’s reach
o Visit the Cornell University Department of Animal Science website on poisonous plants
at http://www.ansci.cornell.edu/plants or contact your local PCC to learn about
poisonous plants
 Read the label and follow directions for using household products or medications
 Check with your doctor or pharmacist to prevent dangerous medication interactions
 Properly discard unused, unneeded, or expired medication
o Look for drug disposal events in your community. These provide a safe, easy way to
responsibly get rid of unneeded medication. Such events may be sponsored by local
hospitals, pharmacies, police or fire departments.
o Only flush drugs down the toilet if the label specifically says to do so
 Ask your pharmacist if you’re unsure about proper disposal
o To dispose of all other medications:
 Remove the medication from the original packaging
 Crush the pills and mix them with kitty litter, coffee grounds, or sand
 Seal the mixture in a plastic bag and dispose of it with your household trash
 Properly discard unused or unneeded household poisons and their containers
o Check with your city or county for hazardous waste collection events and locations.
o Household poisons can include paints and solvents, auto fluids, household cleaners,
pesticide, and pool chemicals
 Participate in National Poison Prevention Week, held annually during the 3rd week of March
o The federal Health Resources and Services Administration (HRSA) provides an Event
Planner Kit to help your agency or business get involved. Visit
www.poisonprevention.org for more information.
Visit Arizona’s Poison Control Centers on the internet at:
Arizona Poison and Drug Information Center, Tucson, Arizona
http://www.pharmacy.arizona.edu/outreach/poison/index.php
Banner Good Samaritan Poison and Drug Information Center, Phoenix, Arizona
http://www.bannerhealth.com/Locations/Arizona/Banner+Poison+Control+Center/_Banner+Poison+Co
ntrol+Center.htm

Methodology
Mortality data for 2007 through 2011 were compiled from the death certificates registered with the Arizona
Department of Health Services Office of Vital Registration. Any death record for an Arizona resident assigned an
th
International Classification of Diseases, 10 Revision (ICD-10) code for poisoning as the underlying cause of death
was included in the count. Poisonings due to envenomation by animals, plants, or insects (X20 – X29) were
excluded from this report. Table 7 shows the ICD-10 codes included in this report.

Table 7. International Classification of Diseases, 10th Revision (ICD-10)
Codes Used in This Report
ICD-10 Code
X40
X41
X42
X43
X44
X45
X46
X47
X48
X49
X60
X61
X62
X63
X64
X65
X66
X67
X68
X69
X85
X86
X87
X88
X89
X90
Y10
Y11
Y12
Y13
Y14
Y15

ICD-10 Code Description
Unintentional poisoning by non-opioid analgesics, including aspirin and ibuprofen
Unintentional poisoning by sedative or hypnotic drugs, including antidepressants and
barbiturates
Unintentional poisoning by narcotic or hallucinogenic drugs, including marijuana, heroin,
and methadone
Unintentional poisoning by drugs acting on the autonomic nervous system
Unintentional poisoning by other and unspecified drugs
Unintentional poisoning by alcohol meant for ingestion
Unintentional poisoning by organic solvents
Unintentional poisoning by other gases, including carbon monoxide and motor vehicle
exhaust
Unintentional poisoning by pesticides or herbicides
Unintentional poisoning by other and unspecified chemicals
Suicide by poisoning using non-opioid analgesics, including aspirin and ibuprofen
Suicide by poisoning using sedative or hypnotic drugs, including antidepressants and
barbiturates
Suicide by poisoning using narcotic or hallucinogenic drugs, including marijuana, heroin,
and methadone
Suicide by poisoning using drugs acting on the autonomic nervous system
Suicide by poisoning using other and unspecified drugs
Suicide by poisoning using alcohol meant for ingestion
Suicide by poisoning using organic solvents
Suicide by poisoning using other gases, including carbon monoxide and motor vehicle
exhaust
Suicide by poisoning using pesticides or herbicides
Suicide by poisoning using other and unspecified chemicals
Homicide by poisoning using drugs or a biological substance
Homicide by poisoning using corrosive gas
Homicide by poisoning using pesticide
Homicide by poisoning using gas or vapors
Homicide by poisoning using other specified chemicals
Homicide by poisoning using unspecified chemicals
Poisoning by non-opioid analgesics, including aspirin and ibuprofen, undetermined intent
Poisoning by sedative or hypnotic drugs, including antidepressants and barbiturates,
undetermined intent
Poisoning by narcotic or hallucinogenic drugs, including marijuana, heroin, and methadone,
undetermined intent
Poisoning by drugs acting on the autonomic nervous system, undetermined intent
Poisoning by other and unspecified drugs, undetermined intent
Poisoning by alcohol meant for ingestion, undetermined intent

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Y16
Y17

Poisoning by organic solvents, undetermined intent
Poisoning by other gases, including carbon monoxide or motor vehicle exhaust,
undetermined intent
Poisoning by pesticides or herbicides, undetermined intent
Poisoning by other and unspecified chemicals, undetermined intent

Y18
Y19

Inpatient hospitalization discharge data and emergency department discharge data from 2007 through 2011 were
compiled from the Arizona Hospital Discharge Database at the Arizona Department of Health Services. The
discharge database contains information from private, acute-care facilities in the state of Arizona, and do not
include visits to federal facilities, such as Veterans’ Affairs Hospitals or Indian Health Services facilities. The
discharge databases do not contain data from urgent care facilities, private physician practices, or medical clinics.
Hospital discharge data include hospital transfers and readmissions. Therefore, a single injured individual may be
counted more than once. These data should be interpreted as episodes of medical treatment, not individual
injuries.

Additionally, the data do not allow for analysis of the combined effect of two or more poisonous
agents.
th

Records for Arizona residents assigned an International Classification of Diseases, 9 Revision, Clinical Modification
(ICD-9-CM) External Cause of Injury Code (E-Code) for poisoning as the primary cause of injury were included in
this report. The following E-Code ranges were included: E850 – E858, E860 – E869, E950 – E952, E962, E972, E980
– E982. Table 15 lists the general categories of poisonings included in these ICD-9-CM E-Codes. Poisonings due to
envenomation by animals, plants, or insects (E905.0 – E905.9) were excluded from this report, as were cases in
which medications caused an adverse reaction after therapeutic use (E930 – E949). Medications were counted as
poisoning events only if they were administered incorrectly or with the intent to harm. This could include the
administration of the wrong drug, or an incorrect dose of a prescribed medication.

Table 15. International Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9-CM) Codes Used in This Report
ICD-9-CM Codes
E850 – E858
E860 – E869
E950 – E952
E962
E972
E980 – E982

ICD-9-CM Category Description
Unintentional poisoning by drugs, medicinal substances, and biologicals
Unintentional poisoning by other solid and liquid substances, gases, and vapors
Suicide and self-inflicted poisoning by solid or liquid substances, gases in domestic use, and
other gases or vapors
Assault by poisoning
Injury due to legal intervention by gas, including poisoning by gas
Poisoning by solid or liquid substances, gases in domestic use, and other gases,
undetermined whether unintentionally or purposely inflicted

Rates for 2007 through 2009 and 2011 were calculated using Arizona population data compiled by the Arizona
Department of Health Services’ Bureau of Public Health Statistics, available on the internet at:
www.azdhs.gov/plan/menu/info/pd.htm. Rates for 2010 were calculated using the 2010 United States Decennial
Census figures for Arizona (Summary File 1), available on the internet from the U.S. Census Bureau’s American
FactFinder: http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml.
To help compare groups over time, rates have been age-adjusted. Age-adjusting is a statistical procedure used to
remove the effect of age differences between populations. All age-adjusted rates in this report were computed
using the ‘direct’ method in which the age-specific rates for a given year are weighted by the age distribution of
the 2000 standard population. For information on how to calculate an age-adjusted rate, or to see the 2000
standard age distribution, visit the National Cancer Institute Surveillance Epidemiology and End Results (SEER)
program at http://seer.cancer.gov/seerstat/tutorials/aarates/definition.html.

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