US Pharm. 2011(36);12:2. 

I am old enough to remember when child safety caps for prescription drugs came on the scene. These haven’t changed much in design and functionality over the years, in that they generally accomplish what they set out to do: make it difficult for young children to get the caps off medication containers. Originally, these caps were optional, and we carried both safety and nonsafety caps in our pharmacy to suit a patient’s preference. This worked out pretty well, except that seniors, especially those with arthritis in their hands, had difficulty removing the safety caps. Over time though, for the sake of expediency and to avoid the cost of keeping both kinds of caps for all container sizes, we decided to dispense only child safety caps on every prescription container. While this caused concern among some seniors, we thought it better that prescription medications be protected from the prying hands of children and grandchildren in every household. So we made a rule that a safety cap would be used by default unless otherwise requested. As a result, some prescriptions left our store with a safety cap that should have had a nonsafety cap, because the patient forgot to ask. I remember some patients coming in to renew their prescriptions with tin foil sealing the container in place of the cap. I thought it odd, until one patient told me she had resorted to the foil because she had had to use a hammer to “smash the cap off.” 

Well, at some point in time child safety caps became the norm for everyone, and most patients adapted to using them. Currently, you would be hard-pressed to find a prescription container dispensed without one. While OTC medications lagged a bit on safety caps, the now-infamous Tylenol tampering ordeal of 1982 sealed the deal, and today nearly all OTC medications are sold in “tamper-resistant” packaging, incorporating some version of the original child safety cap. 

Although I never saw data that proved safety caps worked in preventing medication poisoning by children, it seemed fair to assume that they went a long way toward controlling, if not entirely eliminating, childhood poisonings from prescription medications. That’s why I was disheartened to learn of a recent study conducted by Cincinnati Children’s Hospital Medical Center revealing that the number of young children admitted to a hospital or seen in an ER because they unintentionally took a potentially toxic dose of medication has risen dramatically. 

According to the study data, the researchers followed children aged 5 years and younger over a period of 7 years who were exposed to a potentially toxic dose of a single pharmaceutical agent, either prescription or OTC. A total of 453,559 children were included in the study. The research uncovered that the major cause of increased admissions, injuries, and death was children finding and ingesting medication on their own. Therapeutic errors at home were uncommon and only minimally increased hospital visits and admissions.  

The researchers said that exposure to prescription products accounted for more than half of the emergency visits, admissions, and instances of significant harm. The primary categories of medications ingested were opioids, sedatives-hypnotics, sleep aids, and cardiovascular drugs. 

Unfortunately, there is not much that pharmacists can do to prevent these tragic events other than to make sure every prescription is secured in a container with a child safety cap that leaves their pharmacy. However, every pharmacist should be aware of the location of the closest poison control center or, at the very least, know the toll-free phone number to find a poison control center in their area. This number should be posted prominently in the pharmacy for all to reference. That telephone number is 1-800-222-1222. It could mean the difference between life and death for a young child. 

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