200,000+ suicides annually with tens of thousands due to chlorpyrifos. Organophosphates are thought to constitute two-thirds of ingested pesticides in rural Asia. Chlorpyrifos is among the commonly used pesticides used for self-harm. In the US, the number of incidents of chlorpyrifos exposure reported to the US National Pesticide Information Center shrank sharply from over 200 in the year 2000 to less than 50 in 2003, following the residential ban. Treatment Poisoning is treated with atropine and simultaneously with oximes such as pralidoxime. Atropine blocks acetylcholine from binding with muscarinic receptors, which reduces the pesticide's impact. However, atropine does not affect acetylcholine at nicotinic receptors and thus is a partial treatment. Pralidoxime is intended to reactivate acetylcholinesterase, but the benefit of oxime treatment is questioned. A randomized controlled trial (RCT) supported the use of higher doses of pralidoxime rather than lower doses. A subsequent double-blind RCT, that treated patients who self-poisoned, found no benefit of pralidoxime, including specifically in chlorpyrifos patients. Tourist deaths Chlorpyrifos poisoning was described by New Zealand scientists as the likely cause of death of several tourists in Chiang Mai, Thailand who developed myocarditis in 2011. Thai investigators came to no conclusion on the subject, but maintain that chlorpyrifos was not responsible and that the deaths were not linked. Long term Development Epidemiological and experimental animal studies suggest that infants and children are more susceptible than adults to the effects of low-dose exposure. Chlorpyrifos has been suggested to have negative impacts on cognitive functions in the developing brain. The young have a decreased capacity to detoxify chlorpyrifos and its metabolites. It is suggested that adolescents differ from adults in the metabolism of these compounds due to the maturation of organs in adolescents. This results in disruption in nervous system developmental processes, as observed in animal experiments. There are several studies observed in animals that show that chlorpyrifos alters the expression of essential genes that assist in the development of the brain. Human studies: In multiple epidemiological studies, chlorpyrifos exposure during gestation or childhood has been linked with lower birth weight and neurological changes such as slower motor development and attention problems. Children with prenatal exposure to chlorpyrifos have been shown to have lower IQs. They have also been shown to have a higher chance of developing autism, attention deficit problems, and developmental disorders. A cohort of 7-year-old children was studied for neurological damage from prenatal exposure to chlorpyrifos.