Increased rates of diphenhydramine overdose, abuse, and misuse in the United States, 2005-2016

Clin Toxicol (Phila). 2021 Nov;59(11):1002-1008. doi: 10.1080/15563650.2021.1892716. Epub 2021 Mar 10.

Abstract

Objectives: To describe trends in abuse, misuse, and suicide attempts involving diphenhydramine (DPH).

Methods: We analyzed intentional DPH exposures of individuals ≥10 years old reported to U.S. Poison Control Centers using data from the National Poison Data System, 2005-2016.

Results: There were 158,774 intentional DPH exposures in our dataset. The rate of intentional exposures increased 63% over the 12-year study period for all ages combined. Suicide attempts involving DPH showed a bimodal distribution-increasing 263% among children 10-14 years of age, and 126 and 143% among those 55-64 and ≥65 years of age, respectively. Older adults in both the 55-64 and ≥65-year-old age groups had about a 230% increase in rates of misuse. Major adverse clinical effects increased by 91%. There were 745 total reported deaths with a 3.6% increase across all age groups.

Conclusions: Intentional DPH exposures among individuals ≥10 years old have been increasing since 2005. Increasing rates of suicide attempts among children ages 10-14 and increasing misuse among individuals ≥65, coupled with a trend toward greater severity of overdoses, highlight the significant public health impact of this commonly available over-the-counter drug.

Keywords: Benadryl; Diphenhydramine; abuse; misuse; suicide.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Diphenhydramine / poisoning*
  • Drug Misuse / trends*
  • Drug Overdose / diagnosis
  • Drug Overdose / epidemiology*
  • Female
  • Humans
  • Illicit Drugs / poisoning*
  • Male
  • Middle Aged
  • Nonprescription Drugs / poisoning*
  • Retrospective Studies
  • Risk Assessment
  • Suicide, Attempted / trends*
  • Time Factors
  • United States / epidemiology
  • Young Adult

Substances

  • Illicit Drugs
  • Nonprescription Drugs
  • Diphenhydramine