The state of poison center services in the US

Despite a seven-decade-long history of proven cost-effective and life-saving services, inadequate US poison center funding continues to destabilize the centers. This document provides background information on the history of poison centers and the deliver of poison exposure triage and treatment guidance in the US, core services provided, operations and cost-effectiveness. 

As of January 2026, there are 54 entities providing triage and treatment guidance for poison exposures in the US. All 50 states, DC and the territories are served. Fifty-three of the poison centers provide call centers to serve designated regions (partial states, single states, or multiple states). One additional center, the National Capital Poison Center, provides fully-automated, all digital triage and treatment services to the entire US through webPOISONCONTROL, intended especially to reach those who cannot or prefer not to call.

The first U.S. poison center was established in 1953 in Chicago. There were 17 by 1957, 347 by 1960, 590 by 1970, 641 by 1976, to a peak of 661 in 1978¹. These early centers were often based in emergency rooms or hospital pharmacies, staffed by ER nurses, residents, hospital pharmacists, or even EMTs - all with no special training in toxicology and limited informational resources and backup. But by the late 1970s, fueled by the Emergency Medical Services Systems Act of 1973, an effort to improve the quality of US poison centers was launched. This effort, dubbed "regionalization" included the development of national standards and accreditation processes for centers. 

Those minimal accreditation standards were expensive to implement, leading to a rapid decline in the number of US poison centers - to 384 in 1983, 100 in 1992, and 54 in 2024. The remaining centers served larger and larger regions, and in most cases the decline in numbers that occurred in the 1980s and 1990s led to improved services by increasing the portion of the population served by accredited poison centers. These accredited centers had dedicated health professional staff with certification as poison specialists or board certification in clinical or medical toxicology, 24/7 service, extensive on-site resources, medical toxicologist backup, comprehensive regional poison prevention programs, educational programs for health professionals and poison hazard surveillance efforts. All in all, the accredited regional centers were light years ahead of the small ER-based poison center of the 1970s. They had become concentrated centers of expertise. 

While the decline in the number of US poison centers led to better service when it resulted from the elimination of non-accredited centers, over the last three decades the accredited poison centers are increasingly threatened by funding shortfalls. This persistent and protracted chipping away at the poison center infrastructure threatens poison centers in the US today. Most US poison centers are inadequately funded through a patchwork of state, local and federal government funding, host institutions, service contracts and philanthropy, and face relentless funding cuts, often jeopardizing service.

Cost and cost benefit

In 2012, a report issued by the Lewin Group showed that the total cost of providing poison center services in the United States was $136M, with 13% provided by the Federal government (through HRSA), 62% provided by state and local funds, and 25% provided by private funds (host institutions such as hospitals and pharmacy schools, donations, and research grants).² The report is based on 2011 funding of poison centers and is the most recent compiled national data available. Based on a 3% annual healthcare inflation rate, the cost of providing poison center services in the United States in 2015 is approximately $153M.

The report also shows the major cost of operating a poison center is personnel: 76% of all costs. This expense is due to the 24/7 personnel-intense activity of handling public and health professional calls and the requirement for highly-trained expert staff.

Poison centers lead to huge savings in the overall cost of our healthcare system. For every dollar spent on poison centers, a series of studies conducted over the last three decades have shown cost savings of $6 to $36.^3-14  One analysis pegs the return on investment at $13.39 per dollar spent (including medical care savings and reduced productivity loss), or $1.8 billion/year.² These savings are attributed to 1) avoided medical utilization such as unnecessary ER visits ($752.9 million), reduced hospital length of stay due to poison center guidance ($441.1 million), prevention of poisonings ($23.9 million), and reduced work-loss days ($603 million).

Always in crisis

A 1994 Congressional hearing¹ shed light on the financial struggles of US poison centers at the Federal level for the first time and led to the first coordinated Federal funding for US poison center operations, although that funding covered only 12% to 15% of poison center costs. Across the US both large and small poison centers were closing their doors and many of the surviving centers were struggling. But even then, three decades ago, the fact that poison centers were cost-effective and life-saving public health services was not disputed.

Unfortunately, three decades later, the financial exigencies have not abated. Federal funding for poison centers was reauthorized in 2014 through the Poison Center Network Act (P.L. 113-77), authorizing the Federal funding of poison centers through FY 2019 at $30.1 million annually (the immediately prior authorizing legislation was P.L. 110-337, the Poison Center Support, Enhancement and Awareness Act of 2008). Most ($28.6M) of the authorized funding is designated for a grant program that funds operations of the then 55 poison centers, awarded proportional to the population each center serves. A major contributor to the poison center funding problem stems from the fact that the Act is not funded at the authorized level. The Federal poison center program was funded at $29.3M in FY 2010, but in FY 2012 to FY 2015 appropriations were only at $18.8M of the authorized $30.1M. Thus poison centers nationally experienced a 36% cut in Federal funding. Most centers have also experienced state and host institution funding cuts.

The magnitude of the poisoning problem

By 2008, poisoning had become the leading cause of injury death in the US, surpassing motor vehicle traffic deaths. A dramatic increase in drug poisoning deaths, especially opioid deaths, caused the rise. These fatalities result from both substance abuse and from therapeutic use of opioids.

The table below incorporates poison center data from the National Poison Data System (AAPCC’s NPDS) and other data sources (CDC, AHRQ, NCHS) to provide a composite view of the extent of the poisoning problem in the US. By drawing from several data sources, it highlights the data from multiple perspectives, including cases reported to poison centers as well as deaths, hospital admissions and ED visits reported through other national databases.

Characterizing US poison exposure reports

In 2025, about 2.34 million human poison exposure cases were reported in the US, including cases handled by the phone-based poison centers and cases handled online, nationally, by webPOISONCONTROL^®.

In 2024, 55 US phone-based poison centers handled 2,092,689 human exposures (5,718/day), 34,919 animal exposures (95/day), 285,736 information calls (781/day, ranging from pill IDs to drug and poison questions), 5,054 human confirmed non-exposures (e.g. thought child took the pills, but later found them), and 28 animal confirmed non-exposures.¹⁵ Poison centers also place follow-up calls to provide additional information as the clinical course progresses, monitor outcomes, and provide poison prevention education. These follow-ups may increase the safety of guiding patients by phone. In 2024, 2,442,000 follow-up calls were placed, including at least one follow-up in 41.5% of human poison exposure cases and multiple follow-up calls in 22.6% of cases.

Of the human poison exposures reported to US poison centers in 2024, 39% involved children younger than 6 years, 7% involved youth 6-12 years of age, 8% involved teens, and 45% involved adults (>19 years). Peak poisoning frequency was seen in 1 and 2-year-old children, but no age group was immune.¹⁵

Most reported poison exposures were unintentional (78%, including therapeutic errors, bites and stings, occupational exposures, food poisoning, and “grazing” toddlers). Suicidal cases comprised 12% of reports, and were often more serious, involving larger quantities and/or more toxic substances. Poison centers also handle substance abuse, adverse reactions, tampering, and withdrawal cases.

The majority of cases reported to poison centers (67%) were managed on-site (usually at home) without health care intervention. About 31% of cases were managed in a healthcare facility (2024 NPDS data) with the guidance of a poison center. In most of these healthcare facility cases, the patient was already in an ER or hospital when the poison center was called by the physician or other health professional for help managing the case. Poison center cases have become more serious over time.

Staffing US poison centers

Physicians and other health professionals also rely on poison centers for their specialized toxicology expertise and generate about a quarter of the calls to poison centers. That expertise is developed through training and certification programs for the nurses and pharmacist who provide the phone consultations (Certified Specialists in Poison Information) and for the clinical and medical toxicologists who provide backup, guidelines, training, surveillance, preparedness and research.

US poison centers (call centers) are staffed by Certified Specialists in Poison Information (CSPIs). These are specially trained registered nurses or pharmacists who sit for a national certifying exam after extensive on-the-job training in a poison center. Each trained and certified full-time Specialist handles about 3000 to 4000 human poison exposure cases annually.

Within each poison center there is also a mixture of board-certified medical toxicologists (physicians) and board-certified clinical toxicologists (American Board of Applied Toxicology [ABAT], mostly pursued by PharmDs although a small number of RNs and PhDs have achieved this board certification). Medical toxicologists (physicians) are most often trained initially in emergency medicine, then additionally trained in medical toxicology, although pediatricians, internists and occupational medicine physicians may also become medical toxicologists. There are nearly 600 board-certified medical toxicologists in the U.S. (not all practicing medical toxicology) and fewer than 150 clinical toxicologists in the U.S. who are board-certified by the American Board of Applied Toxicology (ABAT).

Surveillance

The real time collection of data by US poison centers and its upload to the National Poison Data System (NPDS) every 5 minutes enables powerful monitoring of data to detect chemical/bioterrorism events, public health issues, product hazards, and emerging substance abuse problems. This surveillance is conducted at both the poison center level and the national level. It includes automated analyses around the clock for 1) hourly volume outliers, 2) outliers in any of the specific clinical effects, and 3) combinations of clinical effects suggestive of chemical/bioterrorism (anthrax, cyanide, botulism, nerve agents, blister agents, smallpox, etc). Email alerts go to toxicologists when outliers are detected, then further case analysis is performed to identify public health issues.

Poison centers have also established a strong track record of identifying product hazards and alerting regulators to these hazards. Examples include sounding the alarm for the 20 mm lithium coin cell causing esophageal perforations and deaths in toddlers. Poison centers have also urged reformulation, banning, label changes or repackaging for dibucaine-containing topicals, acetonitrile-containing nail glue removers, iron supplements, laundry detergent pods, lamp oil, and amoxapine (the antidepressant) – to name a few hazards we’ve detected and worked to eliminate. The synthetic marijuana “epidemic” and bath salts issues all received federal and media attention because of alerts from poison center data.

webPOISONCONTROL

US poison centers have traditionally relied on the telephone to provide consultations - urging the public to call instead of guessing what to do in a poison emergency. However, over the past several decades, more and more people have begun to turn to the internet for health information. At the end of 2014, the National Capital Poison Center launched an online triage app for poison emergencies - webPOISONCONTROL. The app was developed to provide accurate triage guidance and a trusted resource for poison emergencies, to replace the misinformation found elsewhere on the web. The pilot phase demonstrated that webPOISONCONTROL is a safe and reliable source of information for those who prefer the internet over the telephone. This triage app has the potential to:

• Expand access to immediate expert guidance for poison exposures,

• Decrease the cost of managing low risk poison emergency consults by replacing personnel-intensive telephone consultations with computer-guided recommendations, and

• Harmonize triage guidelines throughout the US.

webPOISONCONTROL has provided triage and treatment guidance for 1.2 million poison exposures since its inception, currently handling more than 155,000 cases/year. webPOISONCONTROL triage guidelines are also used in more than 20 poison centers to assist with triage of poison exposure calls. webPOISONCONTROL exclusions are self-harm, age extremes (younger than 6 months or older than 79 years), pregnancy, and multiple substance exposures. The app handles ingestions, skin, eye and inhalation exposures, injections and bites/stings, whether or not symptomatic.

Learn more about webPOISONCONTROL here.

References

1. American Association of Poison Control Centers statement in “Hearing before the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations”. House of Representatives. 103^rd Congress, 2^nd Session. Mar 15, 1994. P72-113.

2. The Lewin Group. Value of the Poison Center System. Final Report. Sept 26, 2012.

3. Zaloshnja E, Miller T, Jones P, Litovitz T, Coben J, Steiner C, Sheppard M.  The impact of poison control centers on poisoning-related visits to EDs--United States, 2003.  Am J Emerg Med 2008; 26(3):310-315.

4. Zaloshnja E, Miller T, Jones P, Litovitz T, Coben J, Steiner C,  Sheppard M. The potential impact of poison control centers on rural hospitalization rates for poisoning. Pediatrics 2006; 118(5): 2094-2100.

5. Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis. Ann Emerg Med 1997; 29:239-245.

6. Vassilev ZP, Marcus SM.  The impact of a poison control center on the length of hospital stay for patients with poisoning. J Toxicol Environ Health: Part A 2007; 70(2):107-110.

7. Bunn TL, Slavova S, Spiller HA, Colvin J, Bathke A, Nicholson VJ.  The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions. J Toxicol Environ Health A 2008; 71:283-288

8. King WD, Palmisano PA. Poison control centers: can their value be measured? South Med J 1991 Jun; 84(6):722-726.

9. LoVecchio F, Curry S, Waszolek K, Klemens J, Hovseth K, Glogan D.  Poison control centers decrease emergency healthcare utilization costs. J Med Toxicol 2008; 4(4):221-224.

10. Phillips KA, Homan RK, Hiatt PH, Luft HS, Kearney TE, Heard SE, Olson K. The costs and outcomes of restricting public access to poison control centers: results from a natural experiment. Med Care 1998; 36(3):271-80.

11. Harrison DL, Draugalis JR, Slack MK, Langley PC. Cost-effectiveness of regional poison control centers. Arch Intern Med 1996; 156(22):2601-2608.

12. Blizzard JC, Michels JE, Richardson WH, Reeder CE, Schulz RM, Holstege CP. Cost-benefit analysis of a regional poison center. Clin Toxicol (Phila) 2008; 46(5):450-456.

13. Hilton J, Wahl M. Poison centers and medical cost avoidance: Revisiting the concept $7 saved for every $ spent. Clin Toxicol (abstract) 2008; 46(7):591.

14. Galvão TF, Silva MT, Silva CD, Barotto AM, Gavioli IL, Bucaretchi F, Atallah AN.  Impact of a poison control center on the length of hospital stay of poisoned patients: retrospective cohort. Sao Paulo Med J 2011; 129(1):23-9.

15. Beuhler M, Feldman R, Gummin D, et al. 2024 Annual report of the National Poison Data System® (NPDS) from America’s Poison Centers®: 42nd annual report. Clin Toxicol (Phila). 2025;63:1029–1280. doi:10.1080/15563650.2025.2571299.

16. CDC QuickStats: Number of deaths from poisoning, drug poisoning and drug poisoning involving opioid analgesics - United States, 1999-2010. MMRW 2013; 62(12):234.

17. Reid NE, Johnson-Arbor K, Smolinske S, Litovitz T. 2020 webPOISONCONTROL data summary. Am J Emerg Med. 2022 Apr;54:184-195. doi: 10.1016/j.ajem.2022.02.014. Epub 2022 Feb 7. PMID: 35158261.

18. Litovitz T, Benson BE, Smolinske S. webPOISONCONTROL: can poison control be automated? Am J Emerg Med. 2016 Aug;34(8):1614-9. doi: 10.1016/j.ajem.2016.06.018. Epub 2016 Jun 7. PMID: 27321939.

Updated Jan 2026.