TOPLINE

A retrospective study found that nearly half of the patients presenting to the emergency department (ED) with intentional self-poisoning had engaged in polypharmacy, defined as the ingestion of multiple medications. Compared with single-substance ingestions, polypharmacy more frequently involved central nervous system (CNS)-acting agents, particularly benzodiazepines, antidepressants, antipsychotics, and opioids.

METHODOLOGY

• Researchers conducted a retrospective cross-sectional study using data from the toxicology registry at a tertiary hospital in Israel.
• They included 322 patients (mean age, 38 years; 68.9% women) presenting to the ED after intentional ingestion of pharmacologic agents during a suicide attempt between 2017 and 2022.
• Researchers assessed and compared substance use patterns, clinical presentation, management, hospital resource utilization, and clinical outcomes between individuals with single-substance ingestion and those with polypharmacy.

TAKEAWAY

• Single-substance ingestion and polypharmacy accounted for 55.6% and 44.4%, respectively, of intentional self-poisoning presentations to the ED. Polypharmacy was associated with a greater use of CNS-acting agents, particularly benzodiazepines (42.0% vs 19.6%; P < .001), antidepressants (31.5% vs 17.9%; P = .004), antipsychotics (26.6% vs 13.4%; P = .004), opioids (14.7% vs 3.4%; P < .001), and toxic alcohols (3.5% vs 0%; P = .006).
• Most patients experienced no or minimal (45.9%) or moderate (29.5%) toxic effects, whereas 21.1% experienced major toxicity and 2.5% died. In-hospital mortality did not differ significantly between polypharmacy and single-substance ingestions (2.1% vs 2.8%).
• Patients with polypharmacy had higher rates of metabolic acidosis (5.6% vs 1.7%), elevated levels of troponin (5.6% vs 1.7%), and elevated levels of lactate (4.2% vs 1.1%) compared with those with single-substance ingestion, but these differences did not reach statistical significance.
• Most patients were discharged directly from the ED (46.6%), whereas 12.0% required intensive care and 41.3% were admitted to hospital wards; these rates did not differ significantly between the two groups.

IN PRACTICE

"This study highlights patterns of substance involvement in suicidal attempts in a Western healthcare setting and underscores the need for timely recognition, toxicological assessment, medical stabilization, psychiatric evaluation, and appropriate follow-up," the authors wrote. 

"Medical toxicology consultation may support diagnosis, risk assessment, and management, while also contributing to education, surveillance, and prevention efforts," they added.

SOURCE

The study was led by Esty Harel, Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel. It was published online on June 22, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS

The study was limited by its retrospective single-center design, incomplete registry entries, missing data, and reliance on medical record documentation.

DISCLOSURES

The study did not receive any funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.