Letters
Correspondance

 

Childproof caps open Pandora's box

CMAJ 1997;156:1268
See response by: L.E. Sutherland
Dr. Lynette Sutherland's letter "Childproof caps, revisited" (CMAJ 1996;155:1550) is written from the perspective of "a little old lady with arthritis and high blood pressure" and not from that of a physician. The Canadian Association of Poison Control Centres is concerned that her letter could be cited in reference to child-resistant closures (CRCs) for drug containers.

It is important to emphasize that CRCs save lives. Evaluations of the impact of CRCs have shown a 40% to 55% decrease in the ingestion of various products containing acetylsalicylic acid by children1 and a 42% decrease in the ingestion of many drugs and consumer products.2 Data published a few months ago show a 45% decrease in the mortality rate among children due to poisoning as a result of CRCs.3 At Winnipeg Children's Hospital, we had 32 admissions for poisoning with caustic alkali drain cleaners during the 7 years before mandatory CRCs and only 2 during the 7 years after implementation of that regulation. And, although this was not the intention, CRCs also seem to have decreased the severity of intentional drug overdose in adults.4

CRCs have been described as "a success and a model for accident prevention."5 A particular strength of CRCs is that "the package is the message and serves as a constant reminder of safety education in the market place as well as in the home."6 There also seems to be strong public approval for this type of packaging.6

The association recognizes and acknowledges that CRCs present an obstacle to some senior adults.7,8 Sutherland and her physician can request that her pharmacist dispense her prescriptions in conventional containers. However, this approach must be carefully considered if young children visit her home. Studies show that 13% to 17% of all poisonings involving children less than 6 years old occurred away from their homes, with the most common site being grandparents' homes.8,9 However, a better solution is the development of CRCs that are easier to use for seniors, a step that our association supports.

The CMA agrees with the need for child-resistant packaging for hazardous drugs,10 which has been a remarkably successful injury-prevention intervention.

Milton Tenenbein, MD
President
Canadian Association of Poison Control Centres
Winnipeg, Man.

References

  1. Clark A, Walton WW. Effect of safety packaging on aspirin ingestion by children. Pediatrics 1979;63:687-93.
  2. Walton WW. An evaluation of the poison prevention packaging act. Pediatrics 1982;69:363-70.
  3. Rodgers GB. The safety effects of child-resistant packaging for oral prescription drugs: two decades of experience. JAMA 1996;275:1661-5.
  4. Garrettson LK. The child resistant container: a success and a model for accident prevention. Am J Public Health 1977;67:135-6.
  5. McIntire MS, Angle CR, Sathies K, Lee PST. Safety packaging -- What does the public think? Am J Public Health 1977;67:160-71.
  6. Sherman FT. Tamper-resistant packaging: Is it elder-resistant too? J Am Geriatr Soc 1985;33:136-41.
  7. Cudney SA, Hunter MM. Danger! Grandparents' drugs may be lethal to children. Redesigning medicine packages may prevent tragedy. Geriatr Nurs 1992;13:222-4.
  8. Polakoff JM, Lacourture PG, Lovejoy FH Jr. The environment away from home as a source of potential poisoning. Am J Dis Child 1984;138:1014-7.
  9. Child-resistant packaging [policy summary]. CMAJ 1988;138:960A.

Comments Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre
| CMAJ May 1, 1997 (vol 156, no 9) / JAMC le 1er mai 1997 (vol 156, no 9) |