Is Halloween Dangerous for Adults?

The Perils and Pitfalls of Halloween Night

Robert Glatter, MD; Laurie Scudder, DNP, NP


October 24, 2012

Editor's Note:
Halloween. The word conjures up wonderful memories for most people, and children often rate it as one of their favorite days of the year. However, it is also 1 of the 3 most likely days of the year to result in a trip to the emergency department for children.[1] The rate of injuries, ranging from trips and falls due to ill-fitting costumes to motor vehicle accidents as a result of crossing unfamiliar streets while trick or treating, is scary.

But does Halloween have the same "scare" potential in adults? Medscape spoke with Robert Glatter, MD, an attending physician in the Department of Emergency Medicine at Lenox Hill Hospital in New York about the unique risk of this very popular holiday.

Medscape: Why is Halloween such a high-risk holiday? A study of college-aged students found that dressing up in costumes led to more use of alcohol and other drugs.[2] Is that your experience? Are there other unique factors that contribute to the injuries and increase in alcohol and substance use typically seen on Halloween?

Dr. Glatter: Halloween is unique because people often feel the compulsion to experiment and explore experiences that have the potential to create self-harm or injury. When people dress up in unusual costumes and step out of their normal lives, they may feel that it is then okay to experiment with drugs and alcohol.

The potential for injuries and falls as a result of loose-fitting costumes and special masks or hats, which may hinder vision and hamper the ability to walk carefully, coupled with mood-altering substances, is a recipe for injury and harm.

Medscape: Are there specific types of injuries that you see at Halloween? Can you describe them, as well as contributing factors?

Dr. Glatter: Generally, I see patients with falls resulting in wrist and ankle fractures, shoulder and finger dislocations, and other extremity lacerations. With alcohol use, altercations are not unusual, which can lead to hand injuries, facial fractures, and lacerations. People can sustain a fifth metacarpal fracture, called a boxer's fracture after punching another person or an object or wall. Also, you may commonly see an open wound called a "fight bite"; this is usually the result of a tooth injury to the knuckle and may cause tenosynovitis of the extensor tendon.

One very common injury to note: Many people will have injuries to their hands and fingers from pumpkin-carving, especially if they are intoxicated or under the influence of mood-altering substances. Puncture type injuries are common, especially to the index finger. (Editor's note: The American Society of Hand Therapists provides Pumpkin Carving Injury Prevention Tips, suitable for distribution to patients.)

Another serious concern with pumpkins is the potential for burns. In addition to being bulky, costumes may be made of flammable materials and pose a risk around a lit jack-o'-lantern. Clearly, alcohol, fire, and costumes may make for a very combustible combination. (Dr. Glatter discussed other costume-related concerns in a recent blog entitled Can Your Halloween Costume Put You At Risk For Physical Danger?)

Although many of these injuries may be relatively minor and easily managed in the emergency department or primary care setting, people should be on the alert for more serious injuries. An exposed tendon, significant bleeding, or a neurologic deficit requires referral to an orthopedic surgeon or a plastic surgeon who does work with hand injuries.

Eye injuries from projectiles or from use of decorative contact lens are common. (Editor's note: Medscape spoke with Michelle Tarver-Carr, MD, an ophthalmologist from the US Food and Drug Administration, about specific concerns about use of decorative contact lenses.)

Finally, high-risk injuries, such as falls from balconies, are a potential risk, especially in an urban environment.

Medscape: One study of college students concluded that Halloween is 1 of the 3 heaviest drinking days of the year.[3] In your experience, is this equally true for older adults?

Dr. Glatter: I would tend to agree. Overall, adults tend to drink heavily on Halloween. In the past few years, I have seen a spike in older patients who tend to drink greater quantities of alcohol than normal, and who may also experiment with such substances as marijuana or other mood-altering drugs. Along with New Year's Eve and Thanksgiving, Halloween represents a day where older adults need to be aware of the amount of alcohol they consume.

Drug use is also common. I see a lot of cocaine use at Halloween. Older adults -- those from their late 30s to 50s -- are more likely to use marijuana. Not uncommonly, marijuana is laced with other substances, ranging from cocaine to synthetic marijuana products, such as K2 and spice. People try to play a joke on others and mix in some other of these products, and then you get this additive effect. Symptoms can range from tremulousness to anxiety. Some patients may experience a seizure. Because marijuana does not cause seizures, that is an indication that some other compound has been mixed in. Another concern is use of prescription products, such as opioids, with alcohol and marijuana.

These adults are the segment of the population who aren't used to partying. If they haven't partied in a while and they are out drinking and using these substances, they are risk for injuries.

Medscape: Are there specific agents used more commonly at this time of year?

Dr. Glatter: I tend to see people consume large quantities of energy drinks with caffeine, along with large quantities of alcohol. I often see patients abusing stimulant drugs prescribed for attention-deficit/hyperactivity disorder. Erectile dysfunction drugs also tend to be abused by older patients, who may experience low blood pressure or syncope as a result of mixing these drugs with alcohol. And illegal drugs -- cocaine, ecstasy, bath salts, GHB (gamma-hydroxybutyrate) and Special K (ketamine) -- are common. GHB is a mood-altering substance that can produce seizures and inhibit the respiratory drive in toxic amounts. It is not common but is more likely to be used by the younger crowd. These are more club drugs that are often see at raves and concerts.

Medscape: Are there challenges in managing these patients that are not typically encountered at other times of the year?

Dr. Glatter: Patients may arrive in the emergency department with bulky or tight-fitting costumes, which may present a challenge to remove, especially after a traumatic accident. Some people even have costumes with fake knives that can have sharp edges, causing them to injure themselves from these sort of play weapons.

You may also see patients experiencing an exacerbation of asthma or chronic obstructive pulmonary disease in a tight-fitting costume -- not an uncommon scenario on a typical Halloween night. Treating those patients is made more difficult by costumes that are hard to remove or cut off.

Medscape: Are there any clinical pearls or words of wisdom you would offer our emergency medicine and primary care readers?

Dr. Glatter: I would advise emergency and primary care clinicians to have extra patience with patients on Halloween, and certainly recommend that they discuss with patients that this holiday is not a pass to experiment with dangerous drugs or alcohol.