P3.032: Toxic Trends: The Hallucinatory Appeal of the TikTok Benadryl Challenge

Background: The "Benadryl Challenge" is a dangerous social media trend promoted by adolescents and young adults that emerged on TikTok in 2020, encouraging individuals to ingest over 300mg of diphenhydramine to induce hallucinations or get “high.” Diphenhydramine, a first-generation antihistamine with anticholinergic properties, is widely available over the counter and, when misused, can cause severe toxicity, including arrhythmias, seizures, coma, and death. Although gaining attention in 2020, the challenge resurfaced in 2023, with case reports continuing despite efforts to eliminate the trend, highlighting its ongoing impact. We hypothesized that this social media trend would increase the number of diphenhydramine-related adverse event reports to the FDA’s Adverse Event Reporting System (FAERS).

Methods: A retrospective study was conducted using diphenhydramine-related adverse event reports in individuals 10-25 years of age from January 2013 to December 2024 from FAERS. Reports were pulled from FAERS using all single ingredient Benadryl and diphenhydramine product names. Reports were removed if they were duplicates, occurred outside the US, listed additional suspected ingredients, or had reasons for use inconsistent with the study objective. May 2020 marked the challenge’s emergence with the first reported challenge-related hospitalization. We utilized data from January 2013 to April 2020 to forecast trends in reports via Auto Regressive Integrative Moving Average (ARIMA) modeling for May 2020 through December 2024 to determine if the “Benadryl Challenge” had a significant impact on adverse event reports to the FDA. Model performance was assessed via RMSE, MASE, and ACF1.

Results: A total of 413 reports met study inclusion criteria. The number of reports across years varied with 2013 and 2016 having the lowest number of reports (n=7) and 2023 having the highest (n=73) followed by 2020 (n=62; Figure 1). From January 2013 to April 2020, monthly reports ranged from 0 to 16. The forecasted monthly report counts from May 2020 to December 2024 ranged from 2.13 to 6.63 (Figure 2, RMSE=2.85, MASE=.88, ACF1=.045). Reports exceeded forecasted amounts several times after April 2020 including July 2020, December 2020, July 2021, February 2023, May 2023, January 2024, and June 2024.

Conclusion: While the increase in diphenhydramine-related adverse event reports may not be directly attributed to the "Benadryl Challenge," the continued rise in cases among adolescents and young adults underscores a concerning national trend warranting healthcare provider attention. Peaks in reporting coincided with the challenge’s emergence, while declines may have resulted from public health advisories or other factors, requiring further analysis. These findings highlight the need for continued vigilance among healthcare providers, public health officials, and policymakers to address the risks of over-the-counter medication misuse, particularly in the context of evolving social media trends. Strengthening preventive strategies, including education and monitoring, may help mitigate future harm.