by Kim Krisberg
Earlier this year, federal officials put their foot down: New Hampshire could no longer use federal preparedness money to supports its poison control efforts. The directive sent state lawmakers scrambling to find extra funds so New Hampshire residents would still have access to the life-saving service. Without new money, New Hampshire callers to the Northern New England Poison Center would get a recording telling them to call 911 or go to the emergency room.
Fortunately, New Hampshire officials found enough funds to keep the service up and running for state residents this year; however, they'll confront the same problem again in the next budget cycle. Such ups and downs of funding are nothing new to Karen Simone and her colleagues, but it's most definitely taking a toll.
"People seem to make the assumption that the poison center will always be there," said Simone, a clinical toxicologist and director of the Northern New England Poison Center, which serves Maine, Vermont and New Hampshire. "They seem to think that any doctor or emergency room can handle this and it's a shock when I say your average ER doctor doesn't know how to (handle these cases)."
Simone tells me that her poison center used to have enough staff to help every caller at a more leisurely pace — to answer every question without having to rush. But due to overall funding cuts, typical daytime staff has been cut from three or four people to one or two, and callers have to triage themselves according to a phone tree. Occasionally, the center has to shut down its nonemergency line for hours at a time because it just doesn't have the capacity to handle every call. Previously, the center never had to shut down any of its phone lines, Simone said.
The Northern New England Poison Center managed more than 66,000 calls from Maine between July 2010 and June 2011; more than 5,500 calls from New Hampshire between January 2011 and March 2011; and more than 11,300 Vermont calls between March 2011 and August 2011.
"It's kind of like you pay now or you pay later," said Simone, who added that her time is increasingly being spent on trying to find funds to keep the center afloat. "If you give a little bit of money to poison control centers...you'll save about $14 for every dollar spent down the road. You can choose not to spend that $1 on poison centers, but that dollar will be spent."
The value of investing in poison control
The AAPCC report, which quantifies the value of investing in the nation's 57 poison centers, found that such centers save Americans more than $1.8 billion every year in medical costs and lost productivity — that's a $13.39 return on investment for every dollar invested. In 2011, however, poison centers experienced a 36 percent cut in federal funding in addition to cuts at the state level. The report states:
Poison center professionals serve as primary health care providers for the home management of suspected poisonings and as toxicology consultants for health care providers and hospitals. In less than a few minutes, callers are connected to specially trained individuals knowledgeable of the treatment, prevention and safety measures that should be taken to prevent injury from a number of hazardous materials. This rapid early intervention often limits morbidity and prevents mortality.
According to the report: Three dollars in medical costs are saved for every $1 invested in poison center outreach, education and in raising awareness of the poison center hotline; poison centers save families more than $47 million every year in out-of-pocket medical costs, as well as more than $214 million in annual Medicaid spending and more than $176 million in Medicare spending; and more than $171 million annually is saved in emergency department visits and more than $518 million in hospitalizations. In 2010, the country's poison centers received about 4 million calls, about 2.4 million of which were about poison exposures.
Richard Dart, AAPCC's immediate past president and director of the Rocky Mountain Poison and Drug Center in Denver, noted in an association news release that the poison control system is "one of the most successful and cost-effective public health programs in the nation...It's vital that policymakers and the public understand the importance of funding this essential public health service." Dart told me that due to funding cuts, the Rocky Mountain poison center has lost staff and has had to cut back on educational outreach — "we can't spare staff to do education because we need them on the phones."
"It's one of those nasty cycles — decreases in education lead to more poisonings which leads to more calls," Dart told me. "We're really holding our breath week to week and month to month because we know that many centers are very close to closing."
A sentinel system
If a poison center closes, not only will residents and health care providers lose a vital source of expertise and life-saving help, but also the rich data that help shape effective interventions and often serve as an early warning of new dangers. For example a few years ago, young people in Colorado Springs were trying to get high off a new product called Green Hornet, which contained high levels of over-the-counter drugs diphenhydramine and dextromethorphan. It was causing seizures and the Denver poison center picked up on it, Dart said. Soon after, the U.S. Food and Drug Administration took action to alert consumers to its dangers and urge people to avoid it completely.
Similarly, back in New England, Simone noted that in the aftermath of a severe ice storm that knocked out power throughout the region and led residents to hook up their generators, the poison center detected an uptick in carbon monoxide poisoning. The real-time data helped local health officials craft appropriate prevention messages and target those messages where they were needed most. Simone also noted that poison centers began noticing an increase in opioid poisoning long before the problem hit the front pages. (Prescription painkiller misuse was involved in more than 475,000 emergency room visits in 2009, a statistic that doubled in just five years.)
"This data is crucial to have — the earlier we can detect a problem, the faster we can correct it," said Dart, who described poison control as a sentinel surveillance system. "If we start to lose centers, we'll start losing that early detection."
Dart said demand for the poison center's help hasn't declined — "people still need our help as much as they ever did." Interestingly, though, he noted that even though opioid-related calls have gone up, overall call volume into the Denver center remains about the same. He said it might indicate that more people are turning to the Internet for poison information. In response, creating a larger presence on the web and looking for ways to interact with people via the Internet and text messaging has become a top priority, he noted. In New England, the poison center recently debuted a new chat feature on its website that residents are just beginning to use, Simone said.
Both Simone and Dart emphasized that there's no replacement for a poison center — the emergency rooms and hospitals that would likely fill the gap also depend on poison centers and their trained staff for accurate, immediate information. As is the case with much of the public health system, decreasing poison center funds today only increases medical spending in the long run. It's a message — regardless of the mountains of evidence in its favor — that doesn't always fall on receptive ears. (In fact, Dart told me that one congressional representative told him that even though poison centers are among the best data-justified programs out there, he just didn't believe the government should be paying for such a service.)
"The response from (some) politicians is that this is an individual problem," Dart said. "Is that really an appropriate way for our society to address this? I don't think so."
For a copy of "Final Report on the Value of the Poison Center System," visit www.aapcc.org. If you have a poisoning emergency, call 1-800-222-1222.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.
The question is why should the states not fund it? Does the state legislature not see any value. It seems that this is the sort of thing to be funded at a state level, perhaps with a 1% tax on all poisons such as cleaning solutions insecticides and the like.
Why do elected leaders act as pond scum and look down their noses at people as if no one in their family would ever need such services? Tell that congress critter to take a flying leap and do his or her part to fix it. Cripes, what else do those sods do on a daily basis?