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

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.