Today’s episode is an interview with Dr. Wendy Stephan, an educator and epidemiologist for the Florida Poison Information Center in Miami.  As a poison prevention advocate and educator, she shares important messages through storytelling.  **Listener discretion is advised.**  Some of the topics in this episode include children putting weird things in their mouths, poisoning, injury, death, medicine looks like candy, and more.  Again, listener discretion is advised.

Dr. Wendy Stephan is the educator and epidemiologist for the Florida Poison Information Center in Miami.  For the past 12 years, Wendy has promoted the use of poison control and worked to prevent poisonings of all kinds, including from medication, household chemicals, and environmental hazards.  Wendy completed her PhD in Epidemiology and her Master of Public Health degree at the University of Miami and has previously chaired the Public Education Committee of the American Association of Poison Control Centers.  

Website, e-mail, and social media links

• Website(s): www.floridapoisoncontrol.org

• Email: wstephan@med.miami.edu

• LinkedIn: https://www.linkedin.com/in/wendy-stephan-phd-mph-315b70178/

• Twitter: @floridapoison

• Facebook: https://www.facebook.com/FloridasPCC/

Mentioned in the episode

• 1-800-222-1222 is the Poison Help Line (Poison Control)
• poisoncenter@fpicn.org = Florida’s Poison Information Center educators or call 1-800-222-1222.
• Institute for Safe Medication Practices ISMP.org is a non-profit organization dedicated to the promotion of safe medication practices.  
• FDA MedWatch adverse event reporting site:  https://www.accessdata.fda.gov/scripts/medwatch/ 
• https://www.poisonhelp.org/help 
• https://www.webpoisoncontrol.org 

Highlights 

The Florida Poison Information Center in Miami partners with two other centers to serve the state of FL:  Jacksonville and Tampa.  The Miami location serves South Florida.  The Jacksonville location also serves the US Virgin Islands.  

There are 55 poison control centers in the US.  Every state and territory has access to one.  Calls are geographically routed to a call center.  One poison center may serve multiple states.

Contact your local poison center for prevention education.

As a poisoning prevention advocate and educator, Dr. Wendy Stephan shares important messages through storytelling.  People in crisis have stories, which connect with people better than cold facts.  We are programmed as humans to learn through stories.

She teaches pharmacy students.  Students enjoy interacting with the community.

March is Poison Prevention Month.  The 3rd week of March each year is Poison Prevention Week.  

The poison help line number is 1-800-222-1222.  Program it in your phone.

Sometimes, law enforcement needs pills identified.  The poison help line is a great resource for pill identification because calls are recorded and can be used later (by subpoena) if needed.

Teaching kids “asking behavior” is important.  “Mom and Dad, what about poison control?”

Wendy’s work impacts all ages.  According to Wendy, working with caregivers and teachers is more helpful than working with toddlers because it touches more lives and avoids toddlers misinterpreting messages [about poisons].   

Older adults and DD caregivers need Poison Control too.  For example, older individuals with poor vision who may be reading bottles in low light and have multiple medications are at risk for medication errors. 

Organizations like Elder Affairs or an Area Office on Aging is a great place for pharmacists and pharmacy students to volunteer to speak about poison prevention.  Be careful:  don’t lecture, don’t stigmatize.  They know they’re taking a lot of medications.  

Wendy realized she had a passion for poisoning prevention at the age of 6, when she saw a “Mr. Yuck sticker.”  As an adult, she started in poison prevention while working as an educator with Lora Fleming, a Marine Scientist. 

Working at the FL poison center is like the Super Bowl for an epidemiologist.  It’s a once-in-a lifetime experience to be working in the field.  

The COVID pandemic has affected injury epidemiology in FL:

• • Hand sanitizer exposures (eyes, mouth) have increased compared to this time last year.
  • Disinfectant exposures have increased.
  • Bleach exposures have increased.
  • [As a class,] household cleaning product exposures have increased.
  • FL Poison Information Centers have helped the FL Dept of Health with their COVID-19 hotline.  Training and resources were provided quickly.  There have been >50,000 calls to the FL COVID-19 hotline so far.
  • FL Poison Information Centers have seen an increase in calls about supplements and vitamins.  Ex:  vitamin C, vitamins in general, dietary supplements, and homeopathic remedies

Pharmacists need to be aware that people are self-treating with OTC’s.  While patients are at the counter for counseling, ask if they’re taking anything or “mega dosing.”  Supplements can interfere with medications.  

Who are Dr. Wendy Stephan’s coworkers?  Doctors, nurses, and pharmacists who are certified specialists in poison information (abbreviated C-SPI or SPI).  Her staff are 100% physicians in Miami.

Wendy provides support to her coworkers and trains safety educators in the community.  Ex:  healthy start program home visitors who work with parents.  Ex:  foster parents and medical foster parents.  By reaching home visitors (people who work with parents), she reaches more parents.  It’s efficient.

Works with other poison educators and colleagues around the state to design materials:  fliers, social media messages, etc.  Content relevant to the news gets good engagement.  It’s hard to get attention when you’re competing with other content.

Two things that Florida has that Ohio does not have are snakes and aquatic toxins.  People fear snakes, but there are only ~6 bites per month from venomous snakes in FL.  Images of captured snakes in a bucket are something the FL Poison Information Center sees often.  Sometimes the Emergency Dept calls the Poison Information Center for support.

Ciguatera Fish Poisoning happens in Florida.  This marine toxin can even reach Ohio when fish are transported.  Jelly Fish stings from the Portuguese man o’ war and the Box Jelly Fish are common too.  Marine toxins change over time, and some toxins can cause someone go into shock.

Who do I call?  9-1-1 or Poison Control?

Call 9-1-1 if someone is unconscious, having trouble breathing, having chest pain, there lots of bleeding, or there has been an intentional poisoning.  EMT’s will call the poison information center when needed.  

Most 1-800-222-1222 poisoning calls usually present as 

1. Someone swallowed something unusual
2. Someone made a medication mistake.  At first, they seem fine, and there is no drama.  Even when symptoms are not immediate and dramatic, call for help!  Poison Control can walk people through symptoms that may develop.  Then, Poison Control makes follow-up telephone calls.  Ex:  toothpaste + milk = vomit that looks like cottage cheese, and that’s a good thing.

Iron poisonings are serious and deadly because of multi-organ involvement.  Iron tablets can be attractive to children and may look like candy. 

According to Wendy, child-resistant packaging slows a child down ~ 30 seconds.  Child-resistant packages does not guarantee safety.  Lock boxes help prevent medication-related poisonings in all ages.  Make it a habit to hide medications in a lock box.  20% of poisoning deaths are intentional due to depression or a moment of panic.  Lock boxes could slow someone down long enough for the self-harm impulse to pass.

Prevention is for all ages.  Best practices:

• Don’t stockpile medications.  (Ex:  Hurricanes and emergency preparedness)
• Medications that are older and expired may cause confusion about who they’re for, or why they’re on-hand.  If you have forgotten it’s even in the home, it’s time to get rid of it.
• Drug disposal is important.  Use drug disposal programs and do routine “sweeps” and get rid of anything you don’t need.  Don’t accumulate dangerous and unnecessary meds in the home. 
• Some drugs are like time bombs in the home.  Ex:  Hydrocodone and teens or someone depressed due to loss of job.  Get rid of it!  It’s dangerous to keep around. 
• DEA Take Back Days are an option twice/year.
• Some communities pair drug take-back with “shred days” to prevent poisonings and identity theft as a 2-for-1 service.

The National Poison Data System provides nearly real-time poison center data.  This information is reported to the Health Dept and the CDC.  

• • Contaminated products
  • Street drugs
  • Confusing packaging on consumer products. 

Placing a case report helps the poison center identify problems and respond or get the attention of someone who can respond/initiate a public health response.  Ex:  e-cigarettes.

Is it better to call Poison Control or use a poison information website?  Poison information websites are available, but calls are better because diagnostic information can be collected by phone.  Ex:  slurred speech (impairment is present).  Ex:  hearing someone cough after a baby powder exposure.  If someone is hearing impaired, the websites can be very helpful, but in general, they are more of a triage tool.  

A typical week for Wendy involves a mix of office and community work.  Building relationships is important.  She likes the variety and challenge.

Wendy uses a visual aid with high school students, emergency room doctors, and others called the “Cookie Jar of Doom.”  It contains pictures or items to represent the 12 most deadly poisons in Florida.  It leads to great discussions.  Examples include:

• • Carbon Monoxide
  • Prescription drugs:  oxycodone, hydrocodone, methadone
  • Illicit drugs/street drugs:  cocaine and heroin
  • Benzodiazepines 
  • No snakes, no spiders.  Nothing is alive in the jar. 

The source of the items is data from the Injury Prevention Program at the FL Dept of Health on substances leading to deaths.  For more information, see the “poisoning data” tab on the Florida Poison Information Center website.

Stories, games, and interacting with things physically are universally fun for everyone, and variety is good.

What is the scariest poison?  Alcohol.

• • Alcohol changes behavior and judgement, unlike many other poisons.
  • Very serious cause of injury death
  • Alcohol poisoning can result.
  • Alcohol can lead to car crashes.
  • Alcohol can lead to a fatal interaction with a weapon.
  • Alcohol can lead to self harm.
  • It’s the most stealth poison.
  • Alcohol has been partly responsibility for 25% of deaths one year in FL.  It flies under the radar.  Children can’t metabolize alcohol, so they can easily become injured.  

How (in general) can someone prevent a poisoning?

• • Awareness of different poison hazards in the home.
  • Prevent medication mistakes
  • Prevent product exposures
  • Look at the labels
  • Store medications up and away above shoulder height in a cabinet with a closed door.  
  • Drawers and shelves are not good places to store medication and household products.  
  • Know what to do if something happens.  Call Poison Control.  Have the number handy.  Don’t “wait and see” when there has been a medication error.  Call right away.
  • Knowing about “pretty poisons” and look-alike items is helpful.

What does Dr. Wendy Stephan love most about working for the FL poison information center?  Great colleagues in FL and across all poison information centers and being in the community.

What is a challenge she faces?  Getting the word out about their center and getting people’s attention.  People think, “it won’t happen to me.”  

Calls to Poison Control are confidential.  There is HIPPA protection.  Poison Control fields plenty of calls from individuals suffering from mental illness.  Poison control centers don’t judge.  They don’t call child protective services either.  Some communities are fearful of children being removed from the home (suspected abuse).  

Epidemiologists use data to understand the big picture.  Epidemiology drives effective interventions.  Injury data is important.  Talking about medication safety and alcohol will save lives.  Local, state, and national data drives effective interventions and actions public health epidemiologists make.  

How can pharmacists help?  Be that trust professional who can educate people, share expertise, etc. because you have relationships with patients and key members of the community.