Intoxication and poisoning: Part 2

SNOMED Groups Translation User Group
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From France:

In our point of view the difference between these 2 concepts is not clear (“diminished control of mental, physiological, or physical functioning” indicates that the cause is “harmful to health” so we are a little bit confused.

  • 1149322001 |Intoxication (disorder)|

Interference in normal bodily functions caused by exposure through ingestion, inhalation, absorption, or injection of a substance (e.g. medicinal product, household product, industrial chemical, or plant or animal derivatives) in quantities that cause diminished control of mental, physiological, or physical functioning.

  • 75478009 |Poisoning (disorder)|

Interference in normal bodily functions caused by exposure through ingestion, inhalation, absorption, or injection of a substance (e.g. medicinal product, household product, industrial chemical, or plant or animal derivatives) in quantities that are harmful to health.

  • In the “Medical Dictionary of the Academy of Medicine” the definition is the following:

intoxication (French)

intoxication, poisoning (English)

The action exerted on the body by a toxic substance, a poison. Also refers to all the disorders caused by this substance.

Syn. Empoisonnement => “poisoning »

  • For French, in “MedDRA Introduction Guide Version 28.1” it is written : “Since the words “poisoning” and “toxicity” are used interchangeably in English, no distinction is made between these concepts in MedDRA.”

(Source : https://admin.new.meddra.org/sites/default/files/guidance/file/intguide_28_1_French.pdf - p.40)

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I mentioned in Antwerpen that for alcohol, it does make sense to distinguish between the two as intoxication would be “berusning” (only used of alcohol) with synonym inebriation in English, but alcoholic poisoning would be “alkoholförgiftning”, and the difference is measured in promille (toxication: +4.5 promille for women and +5 promille for men).

The problem is with all other drugs. As of now, we have used “intoxikation” for all in order to be consistent. One alternative in Sweden, however, is to use “rus” for intoxication, which is a more general word with the same meaning as “berusning”. “Rus” is a bit wider in usage compared to “berusning”, but only for amphetamin, cannabis and alcohol. Intoxication is very clinical and not the most natual choice for health care personnel.

Just like with the French example, the linguistic difference between the two is not very clear, but when it come sto treatment and severity level, the difference is more clear. Maybe we could suggest a definition which focuses on severity and treatment?

[I also noted that ICD-11 in Swedish uses “förgiftning” (poisoning) as the translation of intoxication, except for alcohol where “berusning” was used.]

Regarding using another term instead of re-using intoxication in our native languages for some drugs:

“rus” [English: intoxication], a state with influence on judgement, psychomotor activities and reactivity due to the influence of the drug. “Rus” is a common effect from the misuse of psychoactive drugs and a strongly contributing cause for developing a dependence. “Rus” is mainly used in expressions like ”alkoholrus”, “cannabisrus” and “amfetaminrus”. The expression ”berusning” is primarily associated with alcohol. You are not ”berusad” by amphetamin or cannabis, instead concepts like ”affected” or the more colloquial ”high on” are used for these. [source. Swedish Nationalencyklopedin, ne.se, my own translation]

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According to the Norwegian Medical Encyclopedia, “intoksikasjon” has two meanings:

1 in medicine: poisoning (=forgiftning)

2 in mental health: “A condition caused by the intake of a substance that affects the psyche (psychoactive substance), resulting in disturbances in consciousness, thinking, perception, emotions, behavior, or other bodily functions and reactions. The disturbance is directly related to the substance’s effect on the brain and is completely reversible, except when tissue damage or other complications occur. Examples include acute intoxication, trance states under the influence of drugs, and “bad trips.” (translated based on DeepL, but with adjustments)

This definition is quite close the the definition of 1149322001 |Intoxication (disorder)|. But while SNOMED CT stresses “diminshed control” as a consequence, the Norwegian definition states “disturbances”. This doesn’t make it a different concept, though.

According to meaning 2, “intoxication” = “intoksikasjon” in Norwegian. However, it is problematic that “intoxication” also might have the meaning of “poisoning” in Norwegian.

Looking at our ICD-10 translation, “intoksikasjon” is used for F10.0 ,F11.0, F12.0, F13.0, F14.0, etc.

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In Swedish, intoxication is associated with diminished or uncle wakeness status, or even unconsciousness. (Source: Akut förgiftning: handläggning, vård och behandlingsprinciper - Narkosguiden, a Swedish anaesthesia web site).

5

The definitions and the position in the hierarchy were changed in response to a CRS request Jira from the TUG. Based on the CRS request, further clarification with the submitter, and consultation with Chief Terminologist, agreement was reached hence SI reversed the relationship between the two concepts and added the updated definition to “intoxication”.

In a clinical sense, the distinction is relevant when determining whether a patient is merely intoxicated (a non-critical, self-limiting state) or poisoned (a toxic, critical state requiring immediate life support). This differentiation fundamentally shifts the clinical focus from observation to emergency resuscitation.

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Thanks Monica!

Intoxication/intoxicatie and poisoning/vergiftiging are, at least I would say so, synonyms of one another. Medical dictionaries mention one or the other and even the national center for information about poisoning/vergiftiging uses intoxicatie as a synonym at some points.

At the Dutch NRC, we have - for now at least - decided to follow the English FSNs in our own translations, although this distinction is artificial. We also provide a synonym of intoxicatie for poisoning/vergiftiging concepts.

Maybe intoxication could be suitable for a translation such as: ‘under influence of (substance)’. However, the issue remains that being under the influence of something is not equivalent to what you would call in English intoxicated, at least to my understading.
We could also translate poisoning as ‘life-threatening (your term)’ or ‘severe (your term)’, as that is what the difference in the international edition is based on according to what Monica has provided.

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Hi @mharry, at today’s meeting we debated this topic again and analyzed the new definitions.

There’s consensus among the group that the new definitions don’t clarify the difference between both concepts.

Definitions

Both disorders are defined as “Inference in normal bodily functions” caused by the same substances. The only difference between the two is the last part, “diminished (…) functioning” for intoxication vs. “harmful to health”. There is no consensus among the group that any state of intoxication can be considered as not being harmful to health. For example, an alcohol-intoxicated (drunk) patient may be critical if we’re talking about a newborn or an at-risk or otherwise fragile patient. Furthermore, current subtypes of intoxication are clearly harmful to health (Acute intoxication, Acute overdose).

Is there any other way to further distinguish the two concepts?

Modeling

The current modeling makes it that all Intoxication caused by [substance] concepts subsume a number of Poisoning caused by [substance] and Overdose caused by [substance]. Since the concepts are not universally distinguished, the ambiguity persists (and hence the risk of inconsistent use in clinical settings, e.g. that two physicians use the same concept to record different things and viceversa), we’d like SNOMED to consider two options:

  1. Intoxication and Severe intoxication
    If both concepts are considered to be the same except that poisoning is (more) harmful than intoxication, and given that poisoning is a descendant of intoxication, what if poisoning was logically defined as intoxication + a severity indication. That way, we’d have: Intoxication caused by opioid > Severe intoxication caused by opioid (with acceptable syn. Poisoning only in English)

  2. Intoxication (finding) Poisoning (disorder)
    If intoxication if supposed to mean e.g. ‘drunk’ (in the case of alcohol), then it should be treated as a finding. The suggestion would be to model all Intoxication caused by [substance] concepts as a separate branch of children of clinical findings without any descendants, and to model the Poisoning caused by [substance] separately (with Overdose… as potential children).

I’d like to invite @translation-ug the group to vote for their preferred option, or to point out any other possibilities you may see.

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This (like many of the TUG topics) is a problem for everyone, not just translations.
The change @mharry mentions happened in February last year, is an improvement.
But I like @plammertyn suggestion to look at revising the modelling to Findings and Disorders - and have them disjoint branches.

“Intoxication” - I think is synonymous with “under the influence” in English. Though the “severity” of intoxication is a spectrum. Evaluating intoxication is usually based on observations/signs - Confusion, euphoria, speech patterns, movements - and I think this

This seems to align with what @klindve says “rus” is in Sweden.
English has some substance specific intoxications

  • ”alkoholrus” - Drunk, Tipsy
  • “cannabisrus” - Stoned, High

Though they are general informal words, and might be reused for different substances (especially “High”). The Swedish words are unambiguous.

The words associated with alcohol are more established. Other substances have less of a cultural history. In Australia, emergency setting clinicians would just say “intoxicated”; or maybe if they know the substance “they’re on/affected by amphetamine”.

“Legal intoxication” - is based off quantitative values, e.g. blood alcohol content. But is a legal (not clinical) metric - and can vary (based on age, country, state, occupation). Two individuals could have the same BAC but present very differently - one “drunk” the other not.

Most of the definitions discussed seem to be around depressants, the definition of intoxication should also consider the effect of stimulants and hallucinogens etc.

“Poisoning” is a more serious condition. Which some sources describe as “Acute intoxication”.
Like I said, the updated modelling is an improvement because somebody who is poisoned, is also intoxicated.

“Overdose” is another term that I suspect can be synonymous with poisoning - at least for substances for which might be deliberately consumed as part of normal use (normal dose - even if illicit). How does this translate?
For example:

  • 57005003|Poisoning caused by caffeine (disorder)| & 296329002|Caffeine overdose (disorder)| - are probably synonymous.
  • 37131007|Pesticide poisoning (disorder)| - is not an overdose. There’s no reasonable dose.
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Update: Discussion at TUG meeting 2026/02/24: Monica has informed us that this topic is being discussed elsewhere and she will see if the TUG can be represented in a future meeting of this other group.

Beyond the translation issue, there could be modeling improvements to be done.

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@plammertyn I discussed with internal team, response here:

This is intersting; the initial classification viewed intoxication as a subtype of poisoning, a modeling approach recommended by the EAG at the time (2020-2021?) and justified similarly to Pedro’s suggestion. However, this classification was later reversed following the TUG’s query and recommendation and subsequent approval by Jim. This reflects how shifts in perspective can influence our modeling decisions, potentially leading to outcomes that satisfy some members while dissatisfying others.

I think it is a good idea to take this to the MABH and ask for their input. If any change is required, I suggest that the two groups make a proposal to the EAG?

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Thank you, @mharry that is indeed interesting. I wonder what the TUG’s recommendation was at that moment. In any case, it’d be great if you could take this to the MABH, so that we can see what their recommendation is.