Empirical data from poisons information centres facilitate the characterisation of medication errors occurring in the community and across the healthcare spectrum. Poison centre data facilitate the detection of subtle trends in medication errors and can contribute to pharmacovigilance. Collaboration between pharmaceutical manufacturers, consumers, medical, and regulatory communities is needed to advance patient safety and reduce medication errors.

Purpose The aims of this study were to examine a national database to assess codeine poisonings before and after the new guidance for pharmacists while also evaluating rates of codeine prescriptions following the introduction of restrictions on supply. Methods Anonymised enquiry data of reported poisoning cases were reviewed for a period from 2005 to 2016 inclusive. The rate of pharmacy claims for codeine containing products was also examined using the national pharmacy claims database. Segmented regression analysis was used to detect changes in poisonings and claims before and after the new guidance. Results There were 1851 codeine‐related poisonings reported over the study period. An annual decline was evident with a significant 33% reduction from 2010 to 2011 (β2 coefficient for level change, 42.1; 95% CI, −68.1 to −16.0; P = 0.006). Following 2011, the declining rate of codeine poisonings plateaued. Analysis of the national pharmacy claims data revealed no change in the reimbursement rate for co‐codamol products restricted by the guidance in 2010 (Incidence rate ratio 1.04, 95% CI, 0.997‐1.08; P = 0.07). There was no corresponding increase in the reimbursement of alternative opioid medications. Conclusions New guidance on codeine supply coincided with an initial reduction in reported codeine poisoning cases. This reduction was in keeping with the previous trend. However, this was without an increase in the prevailing rate of prescription claims for these products or potential substitutes. Policymakers may consider further restriction of codeine products to improve public health outcomes.

Poison information centres should maintain a registry of expert mycologists who are available for consultation following potentially serious mushroom intoxications. Health care workers should not attempt to identify toxic mushroom species using the Internet as erroneous identification can occur. Digital photography may help with mushroom identification when there is likely to be a delay organising a physical examination of mushroom tissue.

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White Spirit, a hydrocarbon solvent-based paint remover, has a de-fatting action. Dermal exposure can cause irritation, blistering, necrosis and burns. 1 We present a case series of peri-anal injury following White Spirit ingestion.(1) A male adult attended an Emergency Department (ED), following ingestion of 350 mL of White Spirit and 500 mL of plant fertiliser. At 1 hour post ingestion, he had vomiting, abdominal pain and diarrhoea. Initial blood results showed hyperkalaemia (K ϩ ϭ 5.3 mmol/L), which resolved with Insulin/Dextrose (K ϩ ϭ 4.8 mmol/L). He had no further diarrhoea although " a hydrocarbon odour " was reported. At 48 hours post ingestion, he had blistering, redness, broken skin and excoriation around his anus. He received prophylactic intravenous Pantoprazole, intravenous Penicillin and oral Paracetamol for 3 days followed by oral antibiotics. The fertiliser probably caused hyperkalaemia but is unlikely to have contributed to the peri-anal injuries.(2) A male adult attended an ED and required intubation via tracheostomy following trauma. At 24 hours post ingestion, he was alert and admitted ingesting 2L of White Spirits. At 48 hours post ingestion, a computed tomography contrast scan and an oesophago-gastroduodenoscopy showed corrosion on the tongue and hypopharynx, mild oesophagitis and gastritis. He had peri-anal burns and reported having several episodes of diarrhoea at home. Prophylactic Amoxycillin, Clarithromycin and Pantoprazole were prescribed.(3) A female adult attended an ED 7 hours post ingestion of 1L of White Spirit. She had diarrhoea at home. She was commenced on intravenous Omeprazole for dyspepsia. At 16 hours post ingestion, she was passing watery rectal fl uid, and had infl ammation and severe excoriation to the inner thighs and peri-anal region. Analgesia (paracetamol 500 mg/ codeine sulphate 30 mg), prophylactic oral antibiotics (Penicillin, Metronidazole) and topical silver sulphadiazine (1% w/w) were administered.Peri-anal injury following White Spirit ingestion is rare with only two previous cases in the medical literature. Chemical burns occurred following ingestion of 750 mL of White Spirit in a patient who presented with diarrhoea and respiratory distress. At 48 hours post ingestion she had an erythematous rash to her buttocks and thighs which progressed to epidermal sloughing and necrosis. Diarrhoea persisted for 2-weeks. 2 Another patient (reported in a French Journal) ingested 500 mL of White Spirit, had diarrhoea at 3 hours post ingestion and developed isolated peri-anal burns. The authors proposed that White Spirit rapidly transited the gastrointestinal tract due to its high polysaccharide and low lipid content resulting in early-onset diarrhoea. 3 The stratum corneum (outermost skin layer) is a lipid-rich intercellular protective barrier. White Spirit leaches lipids from the stratum corneum and repeated applications cause epidermal necrosis. 4 The peri-anal stratum corneum is especially thin and prone to dematoses due to high concentrations of bacteria, humid cond...