Troubling Rise in Suicides Linked With Common Food Preservative

Summary: Health experts call for stricter regulations for the use of sodium nitrite, a product commonly used for meat curing, following its link to suicides and increased numbers of poisonings.

Source: CMAJ

A recent increase in fatal sodium nitrite poisonings has some health experts calling for stricter regulation of the substance. Sodium nitrite is a white salt commonly used in curing meat. But in recent years, it’s also being used as a poison in suicides.

Ontario has seen at least 28 sodium nitrite poisoning deaths between 1980 and 2020, with most happening in the last two years of that period. Alberta Health Service’s poison center, which also serves the Northwest Territories and Saskatchewan, saw at least two sodium nitrite poisonings causing serious harm last year, and two more this year.

These numbers are likely an undercount because Canada does not collect comprehensive data about sodium nitrite poisoning.

Toxicovigilance Canada, a poison control network led by Health Canada, was unable to share national figures, citing “no national data from medical examiners, coroners or poison centers.” Poison centers also do not have a clear picture of the problem because it’s not mandatory for healthcare workers to pass along information about the poisonings they treat.

In the United States, the National Poison Data System recorded 47 cases of sodium nitrite poisoning between 2015 and 2020. Like in Ontario, most of these poisonings occurred in 2019 and 2020.

Online forums promoting poisonings

Sodium nitrite poisoning was virtually unheard of until very recently, says Eric McGillis, a Calgary-based medical toxicologist at Alberta’s Poison and Drug Information Service. However, “the cases are increasing exponentially over the last several years.”

The trend appears to be driven by online forums detailing how to dose sodium nitrite for suicide.

Amazon became a key marketplace for the substance, leading to lawsuits from bereaved families. (Sodium nitrite no longer shows up in top search results on the site.) Other online marketplaces, including Etsy and eBay, have banned sales of the substance.

Dana Saleh, a fourth-year respiratory medicine resident at the University of Calgary, says it’s concerning to see online communities encouraging people to kill themselves. She is the lead author of a case report about a 20-year-old man who ingested sodium nitrite purchased online as part of a “suicide kit.”

“These are very vulnerable individuals to begin with, and then they have access to these websites essentially teaching them how to suicide,” Saleh says. “It’s coming in assembled and it’s easily accessible.”

Sodium nitrite poisoning can be difficult to identify, and deaths can appear natural without further investigation or evidence suggesting suicide. A lethal dose can vary widely, Saleh notes. “It actually can be a very small dose to a very large dose, so it’s unpredictable about how lethal it is, and we know it can certainly take lives even at a lower dose.”

What physicians should look for

Sodium nitrite ingestion generates methemoglobinemia—a blood disorder in which too little oxygen is delivered to the cells—which can quickly lead to hypoxia and sometimes death. Many patients present with a heart rate over 100 beats per minute and blueish-purple skin. Other symptoms include low oxygen levels and chocolate-brown colored blood. The antidote is the rapid use of methylene blue.

Last May, the Institute for Safe Medication Practices Canada recommended that all emergency departments should have methylene blue on hand to treat patients with sodium nitrite poisoning. Margaret Thompson, medical director of the Ontario, Manitoba and Nunavut Poison Centers, advocated for the bulletin after incidents where confusion over the availability and dosing of methylene blue led to treatment delays. Because the food industry uses sodium nitrite for legitimate purposes, Thompson says it could be a challenge to prevent poisonings by restricting access to the substance.

However, some physicians argue that lawmakers could intervene to block the purchase of sodium nitrite online.

This shows a plate of cured meats
Sodium nitrite is a white salt commonly used in curing meat. Image is in the public domain

“There have to be hoops before anyone accesses sodium nitrite,” says Yub Raj Sedhai, an assistant clinical professor at Virginia Commonwealth University. In April, Sedhai and his colleagues published a case report about their experience treating a 37-year-old man who ingested sodium nitrite bought from Amazon.

“It would be fair to question a person buying sodium nitrite with the intent to help them,” says Sedhai. Because the substance is easily accessible and can be mistaken for table salt, people may also “unknowingly overdose,” Sedhai and colleagues noted in their case report.

Could restricting sodium nitrite sales save lives?

The United Kingdom has listed sodium nitrite as a “reportable substance,” meaning sellers must report suspicious purchases to authorities. However, it’s unclear if such measures reduce intentional poisonings.

After Sri Lanka passed bans on certain pesticides, the country saw a 70% reduction in the total suicide rate.

“Certainly that has worked in Sri Lanka, where there was a lot of suicides using pesticides,” says Thompson. But restrictions on other substances haven’t had the same impact, she says. “In Britain, for example, where you can’t buy more than 30 acetaminophen at a time, that didn’t decrease the number of acetaminophen poisonings.”

One alternative to bans is to sell dangerous substances in small quantities—enough for those who need it for legitimate reasons, but not enough to cause death. That doesn’t necessarily apply in the case of sodium nitrite since small amounts can be lethal. And regardless, Thompson says, “determined people could buy multiple packages.”

Restricting sales to individuals while allowing sales to businesses is another option.

According to a Health Canada spokesperson, “regulatory oversight of sodium nitrite is shared amongst federal, provincial, and territorial regulators, depending on the end use of the product sold.” When asked what Health Canada is doing to address intentional poisonings, the spokesperson told CMAJ in an email that the government is focusing on supporting mental health and wellness.

“Regulatory action is not the appropriate tool to address this issue,” they said, given that sodium nitrite has “many legitimate and necessary uses.”

About this psychology and suicide research news

Author: Press Office
Source: CMAJ
Contact: Press Office – CMAJ
Image: The image is in the public domain

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  1. My brother just commited suicide last night and they said he killed himself with sodium nitrate.

  2. Extremely misleading headline. The writer should be ashamed of themselves. An honest but less clickbait-y way to say it would be “Suicides using a common preservative on the rise”.

  3. Maybe treating the issue of suicide should come first! A simple rope is sometimes used but we don’t limit buying rope. The problem is the way society views suicide maybe we need to rethink this issue.

  4. I’m glad I’m not the only person who found this stupid. I use pink cure #1 aka Prague powder aka sodium nitrate regularly. It is an essential ingredient for preparing processed meats like jerky and sausages as it stops the formation of botulism and allows product to be smoked at low temps. This process also breaks down the Sodium Nitrate. It’s one of the most common food processing ingredients out there and has probably created 100s of billions of lives since it’s discovery by allowing us to preserve meat.

    By the logic in this article, we need to ban the wheel and metal, because people have used them to kill themselves as well.

    1. Right…but “pink cure #1 aka Prague powder” is only 6.75% sodium nitrAte (which is less toxic than nitrIte) but vendors are selling almost 99% pure sodium nitrite. This is the problem because there is no legitimate use for sodium nitrite at that level of purity. Curing salts are not the problem. Nobody is trying to argue that, so let’s try to focus in on the issue and not interpret this more broadly than it should be. Let’s try to save lives.

  5. They been using it this way to cure the meats for thousands of years and now all the sudden it causes people to commit suicide. No data to support the article. Maybe there is something else that causes suicidal thoughts. Maybe it’s all the chemicals they put in food. If someone really wants to kill them selves they will find a way. What happened to my body by choice or does it only apply to pregnant women and not to others and all the chemicals in shots they make us shove up our bodies. Maybe that has to do more with suicide not too much salt

  6. They been using it this way to cure the meats for thousands of years and now all the sudden it causes people to commit suicide. No data to support the article. Maybe there is something else that causes suicidal thoughts. Maybe it’s all the chemicals they put in food. If someone really wants to kill them selves they will find a way. What happened to my body by choice or does it only apply to pregnant women and not to others and all the chemicals in shots they make us shove up our bodies. Maybe that has to do more with suicide not too much salt

  7. 5 people chose salt. Now they’ll choose a plastic bag. Or too much tylonal. Let’s pull that off the shelf.

  8. The last 2 years of death are not caused by sodium nitrite but by inflammatory cytokines and neurodegeneration from spike proteins in the hokey pokey. The fact that this article just glossed right over the unfathomable increase in deaths within the last 2 years of that period, is laughable. Neurotrash.

  9. Seems like another government overstep if someone is serious about death they will do it anyway and with new regulations on other chemicals for “bombings” zero this year when does ones ability to legitimately use certain chemicals and idiots come in let’s just ban everything and when your system fails it’s your fault people will jump into traffic or stop putting billions into markets because you’ll destroy many home business but that’s the real point anyway just like COVID well do it with no thought for everyone just follow the it’s a good idea plan

  10. Take some data, jump to preposterous conclusions. Hahaha nice 😄 I feel dumber after reading this.

  11. Suicide is by definition of a very personal business. It’s my life, I should be allowed to do with it as I please. If people wanna die of hypoxia, while brutal, it is their prerogative. Personally; I’ll stick to a heroin/fentanyl overdose, good old fashioned carbon monoxide poisoning or the primitive auto-arthroscopty. I’m not trying to be sensational or insensitive. I’m just a person with a severe mental illness willing to talk about the ultimate sin in the Catholic world. There is incredible physical pain involved in being suicidal, nobody talks about the overwhelmingly auto-morbid behavior harboring extreme arthritic flare ups and the pressure in the head that feels like our brains are going to eject from our ears and eyes. Sure, it’s selfish. But if I don’t want you to drive my new sports car, that’s acceptable. Why is my life and its sorry condition your business and unacceptable? This isn’t even a discussion in other democratic free states. You wanna die? There’s access to right-to-die clinics in several European countries, and they don’t care where you’re from. I haven’t done it yet, but I’m a sick man and don’t deserve to die cold, alone, confused and covered in my own feces. Maybe death from waisting in dementia is humane to you, now that’s twisted.

    1. Everything you say makes perfect sense to me. I’m ‘holding-on’too. I do have some small hope that you and I, each, will find relief and respite, and community. Death is inevitable. Doing it alone, is not.

  12. Sooo…for about 5.25 or so deaths per year there should be a bunch of laws passed for a preservative that hundreds and hundreds, if not millions, of thousands of survivalists and preppers use to preserve and consume food every year? PUHLEEZE! Why even print this bait?

    1. Dang! Let me know about your crew, so we don’t accidentally engage at a barter circle. Nitrates may be the way of the bunker. But hunter-gatherer still smokes meat. Of course (see what I did there), I won’t use sea salt because of microplastic.

      1. Trying to validate a “stupid-enough-to-be-suspicious” regulatory interference over online sale of a preservative salt. Wtf. Second, if someone wants to end their life, it’s rather nobody’s damned business. They’ll find a way. This news article is drivel and the content is either dumb af or some kind of thinly veiled heads-up?

        1. Soyto the families who lost loved ones. When you have a law that allows assisted suicide, this is bound to happen. It open the door to many more types of suicide. No sanctity of life. Plus living under that dictatorship is no fun either. With cov the last two years I can’t blame them. But it’s still sad to see someone wants to take their life.

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