Doctors are among those calling for stricter regulation of sodium nitrite as more Canadians die after intentionally ingesting dangerous amounts of the common food preservative in its pure form.
Sodium nitrite, not to be confused with naturally occurring sodium nitrate, is a synthetic medicinal salt. It is commonly used to preserve meat, but can be fatal if ingested in certain doses. Forensic pathologists say people intent on self-harm have been buying it online, following advice found on suicide forums for several years.
Ontario recorded at least 23 deaths from sodium nitrite poisoning in 2019 and 2020, according to a study published in 2021 by scientists from the Ontario Office of Forensic Pathology (OFPS).
Dr. Tyler Hickey, lead author of the study, told CTVNews.ca that “almost all” of those deaths were determined to be intentional.
Hickey experienced his first death from sodium nitrite poisoning in 2019 while working as a forensic pathology fellow in Toronto.
“Prior to this time, I’m not sure I was aware of these substances being used in this way,” he told CTVNews.ca.
As a forensic pathologist, part of Hickey’s job is to observe the ways people die and then share that information with public health systems.
“Noticing that there seems to be a newer and more innovative way in which people are ending their lives, I read a bit more about the subject and those first two cases,” he said, “and through that reading I learned more about these support groups .”
The earliest example Hickey found of an intentional death from sodium nitrite poisoning was recorded in New Zealand in 2010. In the United States, the National Poisons Data System recorded 47 cases of sodium nitrite poisoning between 2015 and 2020 ., most of which in 2019 and 2020. National data for Canada are not available because that country does not collect national data from medical examiners, medical examiners or poison centers on sodium nitrite poisoning.
From what he’s seen, however, Hickey believes the trend is growing.
For several years, sodium nitrite has been promoted in pro-suicide online communities like the ones Hickey discovered because of its availability through online vendors and consumer marketplaces like Amazon.
Sodium nitrite is permitted as a food additive in Canada and is subject to food and drug regulations to ensure that it is in amounts that are safe for consumption. However, Hickey believes lawmakers must weigh its value as a readily available food preservative against its danger.
“I think one of the questions that needs to be asked is … is the value of [sodium nitrite] to be freely available for certain uses, outweighed by the potential dangers it could start to have in society if people use it for ways to hurt themselves?” he said. “And maybe there should be a restriction on its availability both within Canada and maybe being ordered outside of Canada.”
There are no regulations in Canada to prevent individual consumers from purchasing sodium nitrite, either for intended use or for self-harm.
Dr. Alok Raj Atreya wants to see that change.
Atreya is an associate professor of forensic medicine and toxicology in Nepal and co-author of a case report published in April 2021 about a 37-year-old man who ingested sodium nitrite purchased from Amazon. He believes that governments around the world should put regulatory barriers between the average consumer and sodium nitrite, and that manufacturers should be held accountable for the safe distribution of the food preservative.
“It’s sad that sodium nitrite can easily be purchased over the counter,” Atreya told CTVNews.ca in an email, adding that the compound should be treated with the same regulatory care as over-the-counter antibiotics and opioid analgesics.
He said other approaches to limiting access could include only allowing it to be sold to businesses and industries that use it for food processing; requiring distributors to maintain a database of information on each individual purchaser and volume purchased; and requiring purchasers to fill out a questionnaire “that would both warn of its harmful potential and screen for suicidal tendencies in anyone who buys it.”
Some countries have already introduced barriers to access and exposure to sodium nitrite. For example, the UK lists sodium nitrite as a “reportable substance”, meaning sellers must report questionable purchases to the authorities, and France is phasing out nitrites in food.
When asked what Health Canada is doing to address intentional sodium nitrite poisonings, the agency said in an emailed statement that it is focusing on promoting mental health and wellness. It also provided guidance to hospitals on how to treat sodium nitrite poisoning, for example by administering a fast-acting antidote known as methylene blue.
For NDP MP Gord Johns, that’s not enough. Johns agrees with Atreya that the federal government should explore a regulatory response to the problem.
“We need to make it harder for people to access methods [of suicide] that make it very easy to cross a point of no return, like firearms or sodium nitrite,” said Johns, who is the party’s critic of mental health and harm reduction.
“And the number of sodium nitrite poisonings is probably an undercount because Canada does not collect comprehensive data on sodium nitrite poisoning. [Regulation] it’s definitely something we should explore and [which] may be referred to the health commission.
What Johns wants most is swift action from the federal government on the promises it has made to support mental health and tackle the root causes of depression and self-harm.
He pointed out that the Liberal government has yet to follow through on a 2018 motion by NDP MP Charlie Angus to create a national suicide prevention action plan. This motion received support from the Liberals and was passed unanimously. In its progress report on the 2020 Federal Suicide Prevention Framework, the federal government said it “supports the development of the action plan while highlighting ongoing federal suicide prevention initiatives” and that it will provide updates on the plan’s progress every two years.
REGULATION AGAINST LITIGATION
In the United States, bereaved families are using litigation to demand more accountability from companies that manufacture or distribute sodium nitrite.
Texas resident Ruth Scott filed a lawsuit against Amazon earlier this year after her son Michael died of an intentional sodium nitrite overdose in late December 2020.
The lawsuit, filed by the CA Goldberg Victim Rights Law Firm, alleges that Mikael purchased the chemical from Amazon after learning about it on a suicide forum. On December 27, 2020, his mother found him when she came home from work as a nurse.
Scott said she tried several times after her son’s death to inform Amazon. Eventually, in the case, she got an answer from an employee named Marvin.
“I’m sorry for the trouble you had with the sodium nitrite…I’m sorry for your loss,” the email read. “But at least your son is now in the hand of our God.”
Scott’s lawsuit alleges that Amazon knew or should have known that it was selling sodium nitrite to customers who intended to use it to die by suicide, and that it failed to provide sufficient warnings about the chemical.
“Nowhere on the bottle or on the Amazon website does it inform consumers that ingestion of the product can cause prolonged, agonizing death,” it said.
The lawsuit also provides images that show the website offers other drugs and equipment used in the dying process of sodium nitrite poisoning in its “Frequently Bought Together” feature.
In an email to CTVNews.ca, a spokesperson for Amazon Inc. explained that the company complies with applicable laws and regulations when listing items for sale, and that it has policies for product reviewers and selling partners that prohibit any messages that promote self-harm or harm to others. In addition, searches for the word “suicide” present customers with a banner at the top of their search results with the phone number for Talk Suicide Canada.
“We extend our deepest condolences to the families and loved ones personally affected by the suicide,” Amazon spokeswoman Samantha Boyd said in an email to CTVNews.ca.
“As for sodium nitrite, it is commonly used to preserve foods such as meat and fish and can also be used in laboratories as a reagent. This is a widely available product offered by retailers and unfortunately, like many other products, it can be abused.”
As of publication, high-concentration sodium nitrite no longer appears in the site’s top search results, although salt mixes with up to 6.25 percent sodium nitrite intended for curing meat still appear. Other online marketplaces, including Etsy and Ebay, have banned the chemical, according to the Canadian Medical Association Journal.
If you or someone you know is struggling with suicidal thoughts or mental health issues, please call the National Suicide Prevention Lifeline at 800-273-8255 (or 988 as of July 16, 2022) or at Canada’s Talk Suicide 1-833-456-4566. The following resources are also available to support people in crisis:
- Hope for Wellness Hotline (English, French, Cree, Ojibway, and Inuktitut): 1-855-242-3310
- Embrace Life Council Hotline: 1-800-265-3333
- Trans Lifeline: 1-877-330-6366
- Children’s Helpline: 1-800-668-6868
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