In the dark, early days of the coronavirus pandemic, Michael Toce saw something shocking. As a pediatric emergency physician at Boston Children’s Hospital, he sees many children who have overdosed. The problem wasn’t that they were overdosing on opioids or painkillers or marijuana. Instead, they ingest more melatonin, a supplement used as a sleep aid. The side effects of this mistake seemed to be mild at worst—sleepiness, nausea, vomiting—but the number of children affected went up, up, up.
Other doctors across the country were seeing similar things. In 2022, a group in Michigan asked Toce to join them in investigating the incident. Theirs earnings, published last June, was impressive. Over the past 10 years, the number of annual calls to control the toxicity of melatonin in children has increased by 530 percent. By 2020, poison control was receiving more calls about children’s overdoses of melatonin than any other substance. Last month, in a study hard based on emergency room data during the same period, researchers at the CDC reported a 420 percent increase in melatonin intake in children. Meanwhile, the number of prescription drugs for other products fell sharply in the 2010s: Tylenol, down 53 percent; opioids, down 54 percent; most cough medicine is cold, down by 72 percent. The question is: What makes melatonin different?
The most obvious answer is its recent rise in popularity. From 2009 to 2018, American melatonin use increased five times, and from 2016 to 2020, US sales of the supplement increased from $285 million to $821 million. Time of plague running in bedridden patients may have only increased this popularity. A year before the use of melatonin began, the CDC established it nothing reducing drug use for all children. It advocated the introduction of travel restrictions and child placement, and campaigned to educate parents about the safety and storage of medicines. It is possible that melatonin overdoses are rarer now than they would have been without the CDC’s protection, but they are still on the rise due to the success of the market.
The changes needed “are the reason” for more surgery, said Pieter Cohen, a physician and supplement specialist at the Cambridge Health Alliance, in Somerville, Massachusetts. Whether they count everything of quantity or many about it or just others about that is still a mystery. Several other factors appear to be involved, Cohen told me. For starters, melatonin supplements come in a fun gummy form. So are all kinds of vitamins and minerals for children—vitamin A, vitamin C, calcium, zinc—but melatonin is not a vitamin or a mineral. It’s an active hormone, and the body hasn’t developed good ways to deal with overeating, Cohen said.
Almost all of the patients Toce saw ate gummies, and the majority of those identified in the CDC clinical study were between the ages of 3 and 5. Maribeth Lovegrove, the researcher who led the CDC study, told me that for most drugs, the prevalence is among children under the age of one. two. This disparity shows, he said. Children do not know what they are eating and often put random things in their mouths; Slightly older children, such as those who have been taking a lot of melatonin, may mistake candy for candy.
Supplements are regulated by the FDA as foods rather than drugs. This means that, according to the CDC’s safety guidelines, topical melatonin should not be used in children. The fact that it’s marketed as a “natural” supplement may also lead parents to think it’s safe, Lovegrove said. And the exact amount of melatonin in each gummy — and how it compares to the level advertised on the packaging — is also not regulated, Cohen told me. Last month, he published a learning and researchers from the University of Mississippi show that many types of melatonin-gummy contain more of this hormone than they claim. One had three and a half times more than advertised; the other had no melatonin at all. The Canadians learning from 2017 that looked at melatonin supplements in general, not just on gummies, came to a similar conclusion. In one case, this disagreement has resulted in a a case.
Even the higher percentages the Michigan team realized were mild, as Toce observed, less so he wasn’t. About 300 children required intensive care, five were placed on ventilators, and two died. Toce also found this surprising. He told me: “When you drink too much of anything, you have stomach problems, nausea, vomiting.” But there’s no known way melatonin can cause more problems, and Toce said it’s hard to know if the supplement actually helped. Maybe some ingredient in the gummies caused the bad luck, or maybe it was something else – just an accident of timing.
Michael Beuhler, a physician who co-authored a paper in the investigation of the deaths of seven children in North Carolina that may be related to melatonin, they think that they may have caused a melatonin overdose, combined with perhaps an unusual risk among the victims. “You don’t want to say that melatonin is absolutely, 100 percent responsible for these deaths,” Beuhler told me, but “this is the kind of thing that should make people think twice, especially when using it in young children.” Meanwhile, Cohen said, the exact source of the deadly effect remains “a big mystery.”
A mystery made more difficult to solve by the instability of the support industry. The industry has many well-known problems: the lack of scientific evidence of the benefits of certain products, the tendency of misleading advertisingtoo dependent magical thinking. But the recent overuse of melatonin in children represents an even bigger problem: the drug’s poor stability. If no one knows what’s in the supplement, doctors can’t understand whether it’s harmful or not.