New research finds elementary and middle school students are increasingly affected, while teens face more severe outcomes
Reported intentional substance exposures at school rose 77.5% between 2000 and 2024, according to a new study.
Elementary school students saw the biggest increase in reported exposure rates, followed by middle school students.
High school students continued to experience more serious medical outcomes, highlighting the need for earlier prevention and stronger support.
Substance-related incidents at school aren't just a concern for teenagers. New research suggests elementary and middle school students are increasingly involved in intentional substance exposures, raising questions about how schools and families can help prevent these incidents.
Researchers at Nationwide Children's Hospital and the Central Ohio Poison Center examined reports made to U.S. poison centers over a 25-year period. Their findings, published in the American Journal of Emergency Medicine, showed that reported intentional substance exposures at school increased overall, with the sharpest increases occurring among younger children.
One of the most striking findings was how the age pattern changed over time, researcher Hannah Hays, MD, said in a news release. By about 2015, the reported exposure rate among middle-school-aged children had surpassed that among high-school-aged youth. At the same time, high-school-aged adolescents continued to experience the most serious medical outcomes. These findings tell us that prevention needs to begin earlier, while older adolescents also need ready access to clinical and mental health support.
How researchers examined school-related exposures
For the study, researchers conducted a retrospective analysis of data from the National Poison Data System, a database maintained by America's Poison Centers. They reviewed reports involving children ages 6 through 18 from 2000 to 2024.
The team used U.S. Census Bureau population estimates to calculate exposure rates per 100,000 children, allowing researchers to compare trends across different age groups and over time. They also examined the substances involved, the circumstances surrounding exposures and the resulting medical outcomes.
After excluding certain records that did not meet the study's criteria, researchers identified 122,700 reports of intentional substance exposures occurring at school during the study period. Because the analysis relied on poison center reports, the findings reflect reported cases rather than necessarily capturing every incident that occurred in schools.
What the findings mean for families and schools
The overall rate of reported intentional substance exposures at school increased 77.5%, from 7.5 per 100,000 children in 2000 to 13.3 in 2024. Among elementary school students ages 6 to 10, the rate climbed 287.4%. For middle school students ages 11 to 13, it increased 111.9%. Meanwhile, the rate among high school students ages 14 to 18 declined 4.2%.
The substances involved also varied by age. Elementary school exposures commonly involved cosmetics and personal care products, arts and crafts supplies, and plants. Among middle schoolers, cosmetics and personal care products were also common. High school reports more frequently involved pain relievers, stimulants and street drugs, and certain prescription medications.
Although many cases did not require treatment at a healthcare facility, 10% were associated with serious medical outcomes, including two deaths. Pharmaceutical exposures were particularly concerning: They were about 10 times more likely to result in a serious medical outcome than exposures involving non-pharmaceutical substances.
For families and schools, the findings underscore the importance of age-appropriate substance education, safe storage practices, and early identification of students who may need help.
The increasing rate of reported intentional substance exposures at school among elementary school- and middle school-aged children, combined with the greater severity observed among high school-aged children, underscores the need for targeted and coordinated prevention and early identification strategies that integrate substance use education and mental health screening and intervention, researcher Gary Smith, M.D., DrPH, said in the release.
Collaboration among school officials and educators, clinicians, poison centers, and public health professionals is important for reducing intentional substance exposures in schools, especially those associated with suspected self-harm and suicidal intent and substance abuse.
For immediate concerns about a possible poisoning, the national Poison Help Line at 1-800-222-1222 offers free, confidential guidance around the clock.
Posted: 2026-10-09 16:03:36









