Sodium nitrite and nitrate increasingly used in youth suicide attempts

DENVER — Young people are increasingly turning to sodium nitrite and nitrate as a method of suicide after buying the products online, according to research presented during the 2025 American Academy of Pediatrics National Conference & Exhibition at the Colorado Convention Center Sept. 26-30.

Frank Pleban, PhD, associate professor at Tennessee State University and research author, said that the chemicals, which when ingested may cause hypoxia and eventual death, are often readily available for purchase online. He said his findings indicate the need for a robust system with collaboration between public health officials, emergency responders and healthcare workers to address this growing concern.

“There are a variety of prevention opportunities resulting from this work, including increasing awareness about the growing use of sodium nitrite and nitrate in self-harm, providing suicide prevention resources that specifically address this method, and informing the public about the ease of access to these chemical compounds online,” Pleban said.

Both chemical compounds are salt derivatives most commonly used in food preservation, especially in the meat production industry. They can be easily purchased in powder form online as curing ingredients.

Those found to have used the drugs were more likely to have seen a healthcare provider within a month before death, had a mental health emergency department visit in the year prior and had been hospitalized for mental health issues. These interactions are all points at which medical professionals have opportunities to intervene, authors said.

They suggest safeguards that include training first responders and healthcare providers in recognizing symptoms of overdose from these chemicals.

“Public health professionals are uniquely situated to identify emerging risks in their communities. This early identification saves lives,” said co-author Abby Collier, DrPH, Director, National Center for Fatality Review and Prevention, a program of the Michigan Public Health Institute.

The authors received financial support for this research from the Health Resources and Services Administration.

Study author Dr. Frank Pleban is scheduled to present the research, which is below, from 8:35 a.m. to 8:45 a.m. on Saturday, Sept. 27 in the Colorado Convention Center, Meeting Room 108. To request an interview with the authors, contact Dr. Pleban at fpleban@tnstate.edu or Dr. Abby Collier at acollier@mphi.org.

In addition, Dr. Pleban and Dr. Collier will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2025 Call for Abstracts

Submission Type: Section on Child Death Review and Prevention

Abstract Title: Emerging Trend of Sodium Nitrite and Nitrate Self-Poisoning: Fatality Review Challenges and Public Health Implications

Francis Pleban

Clarksville, TN, United States

Sodium nitrite (NaNO2) and sodium nitrate (NaNO3) ingestion is an emerging method of suicide, especially among young individuals. Both substances cause methemoglobinemia (MetHb), leading to severe hypoxia and death. The rising number of deaths linked to sodium nitrite/nitrate self-poisoning, particularly among adolescents, has raised concern [1]. A study using data from the National Violent Death Reporting System (2018–2020) identified 260 suicides across 37 states and one territory due to sodium nitrite/nitrate ingestion. Victims were typically white males with a history of depression and suicidal ideation [1]. However, forensic investigations remain inconsistent, and current surveillance methods may underreport such incidents [2, 3].

Data from the Pediatric National Fatality Review-Case Reporting System (NFR-CRS) was analyzed for pediatric suicides between 2018 and 2023. Two groups were examined: one consisting of 34 children aged 14-21 who died by sodium nitrate (SN) poisoning or another salt-based chemical, and a comparison group of 4,544 children who died by suicide without mention of sodium nitrate.

The mean age was similar for both groups (16.7 years for SN, 16.0 years for non-SN). In the SN group, 38% were aged 14-16, compared to 64% in the non-SN group. White children made up 62% of the SN group and 73% of the non-SN group, with the next highest proportion being Asian (24%) in the SN group and Black (12%) in the non-SN group. Males represented 71% of the SN group and 73% of the non-SN group. Children who died by SN poisoning were more likely to have seen a healthcare provider within a month before death (13% SN vs. 8% non-SN), had a mental health emergency department visit in the year prior (13% SN vs. 9% non-SN), and had been hospitalized for mental health issues (20% SN vs. 9% non-SN). However, children who died by SN suicide were less likely to have received mental health services (21% SN vs. 26% non-SN), had a history of substance use (6% SN vs. 22% non-SN), or experienced maltreatment (6% SN vs. 21% non-SN).

Addressing sodium nitrite/self-poisoning should be part of a broader public health approach to suicide prevention. Collaborations with healthcare providers, emergency responders, and crisis response teams can help spread awareness. Further studies are needed to evaluate the impact of safety interventions on the incidence of sodium nitrite self-poisoning. https://www.abstractscorecard.com/