Nicotine Poison Prevention

By: Scott Schaeffer* and Chantel Hartman** * Managing Director, Oklahoma Center for Poison and Drug Information ** Cessations Systems Coordinator at the Oklahoma State Department of Health

Oklahoma acknowledges the traditional and sacred use of tobacco among American Indian people living in Oklahoma. Unless otherwise stated, any reference to tobacco in this article refers to the use of commercial tobacco.

While it may not seem likely, children are natural explorers and will readily eat things that adults would not think of ingesting, including cigarette butts and chewing tobacco. As little as one cigarette or three cigarette butts can cause toxic symptoms in a child, and vaping liquid can be quite toxic even in small amounts. Symptoms of nicotine poisoning typically occur rapidly and include sweating, dizziness and vomiting. In more severe intoxications, seizures, dysrhythmias and respiratory muscle paralysis can occur.

The Child Nicotine Poisoning Prevention Act of 2015 requires the Consumer Product Safety Commission to hold liquid nicotine packaging to the same standard as other child-resistant packaging requirements for poisons and medications. During interactions with patients you should emphasize safe storage as a key strategy towards preventing inadvertent nicotine exposure. Tobacco products, including vaping liquid and nicotine replacement pharmaceuticals, should be stored out of the reach of children. You can also encourage patients to become familiar with the Oklahoma Center for Poison and Drug Information.

The Oklahoma Center for Poison and Drug Information, which is staffed with specially trained pharmacists and nurses, provides residents and healthcare professionals. The Poison Center aims to save lives as well as provide a cost-effective service to patients and residents by promoting the appropriate use of health care resources. During interactions with patients it may be beneficial to highlight that there does not need to be a medical emergency for them to contact the Poison Center and to learn more about the prevention and management of potentially toxic exposures.

If you are looking for ways to promote nicotine poisoning prevention in your practice, the Poison Center is equipped to provide dental providers with Poison Center magnets, stickers and brochures for patients. 44 journal | Nov/Dec 2020 The Center also continues to partner with the Oklahoma State Department of Health to develop additional resources, such as the Child Nicotine Poisoning Prevention and Nicotine Poisoning Symptoms & Prevention factsheet, and to explore new opportunities to address nicotine-related poisonings in Oklahoma.

Informing patients about the dangers of nicotine poisoning presents another opening for dental professionals to encourage patients to quit for their health and families. To show additional support for patients who would like to quit and to bring awareness to the importance of planning for a tobacco cessation journey, dental professionals in Oklahoma are encouraged to celebrate the American Cancer Society’s Great American Smokeout® on the third Thursday in November. The Smokeout is an opportunity for dental professionals as healthcare providers who maintain lifelong relationships with patients from all backgrounds to highlight that the likelihood of a successful tobacco cessation journey is increased with a good plan and support. You can also inform patients that incorporating counseling and medications in their tobacco cessation journey can double or even triple their chances of quitting successfully. For more information about the Great American Smokeout® and to download free promotional materials, please visit the American Cancer Society’s website or contact poisoning management advice to Oklahoma

the Oklahoma State Department of Health’s Center for Chronic Disease Prevention and Health Promotion at Cessation@health.ok.gov.

Additional examples of how you can educate patients and staff on the dangers of nicotine poisoning and the importance of remaining tobacco and vape-free include the following:

• Ensure that the entire dental team is confident in communicating the dangers of tobacco use, including the use of e-cigarettes and vapor products, and that no tobacco does not mean no nicotine.

• Remind patients with small children in the home to never refer to tobacco or medicine as “candy” or another appealing name. children in the home to only buy liquid nicotine refills that are in child-resistant packaging, and keep tobacco products/ accessories out of children’s reach.

• Remind patients to save or post the

Poison Control number (1-800-2221222) on or near every home telephone and cell phone for access 24 hours a day and 7 days a week in the event of possible nicotine poisoning

• Update patient intake forms to ask about tobacco and vaping use in plain language.

• Utilize the 5 A’s and motivational interviewing techniques for all patients, including teens.

• Refer patients directly to the Oklahoma

Tobacco Helpline for free counseling and nicotine replacement therapy by fax, electronic medical record, or through the web. Patients interested in quitting can explore options by calling 1-800-QUIT

NOW (1-800-784-8669) or visiting

OKhelpline.com.

• Post Oklahoma Tobacco Helpline promotional materials in your waiting room. You can order or download free promotional materials, including pens and posters, by visiting OKhelpline.com.

• Refer younger patients (13-17 years old) to the My Life, My Quit youth cessation program for free live text support, web chat, and phone coaching. To sign up, teens can text “Start My Quit” to 855891-9989 or visit MyLifeMyQuit.com.

If you would like to learn more about patient resources or how to schedule trainings with a board-certified clinical toxicologist, please call 405-271-5454 or visit oklahomapoison. org. The Oklahoma State Department of Health’s Center for Chronic Disease Prevention and Health Promotion is also available to assist healthcare systems and providers create tobacco-free healthcare environments and implement a Helpline referral system. For assistance, contact the OSDH Center for Chronic Disease Prevention and Health Promotion at (405) 271-3619 or Cessation@health.ok.gov.

ABOUT THE AUTHORS:

Chantel Hartman currently serves as Cessations Systems Coordinator at the Oklahoma State Department of Health. Her duties include the management and oversight of collaborative, population-based cessation assessments and assistance programs for adults and youth in Oklahoma. Hartman received her Master of Public Administration degree with a concentration in Public Health Administration from Troy University and a Bachelor of Science in Biology from Auburn University Montgomery. In addition to completing the Centers for Disease Control and Prevention's Office on Smoking and Health Leadership and Sustainability School, Hartman is a Senior Fellow of the Millennial Policy Initiative Commission on Healthcare , and an abstract reviewer for the Alcohol, Tobacco and Other Drugs section of the American Public Health Association.

Scott Schaeffer graduated from the University of Oklahoma College of Pharmacy in 1992 and has been working in the field of clinical toxicology for over 25 years. In addition to his position as Managing Director of the Oklahoma Center for Poison and Drug Information, he serves on several state and national committees related to drug abuse and toxicology. Scott has particular interest in the areas of drugs of abuse and health literacy.

Number of Oklahomans Helped by the Oklahoma Tobacco Helpline:

Put Your Patients on the Right Path

You know the risks of tobacco, but what about your

patients? Talk to them about tobacco use and introduce the FREE services from the Oklahoma Tobacco Helpline, including: - At least a two-week supply of patches, gum or lozenges - Access to Quit Coaching - 24/7 phone, web or text support

These evidence-based methods are proven to increase the odds of quitting. For more information and free promotional materials, visit OKhelpline.com. Now, 13-to-17-year-olds can receive free help to quit through live text, phone or web chat. Visit MyLifeMyQuit.com or text “Start My Quit” to 855-891-9989.