Death by unintentional poisoning is prevalent in the USA. A rare occurrence in the very young, unintentional poisoning is behind only road traffic injury and firearm violence as a cause of injury death among those 15–24 years old. It moves into second position for 25–34 year olds and is the leading cause of injury death from 35 to 54 years of age.1 Drug overdose death rates have risen steadily in the USA since 1970, nearly doubling in the last 10 years alone (figure 1).

The US Centers for Disease Control attribute most of this increase to inappropriate use of prescription opioid medications.2 As clinicians have moved, rightly, towards more aggressive treatment of acute and chronic pain, prescription of narcotic painkillers has skyrocketed.3 While opioids are clearly useful for the treatment of acute pain, they are …