Journal of Medical Toxicology最新文献

The 2024 ACMT Ward and Ryan Donovan Memorial Fund lecture was presented by Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH). This article in an edited version of her keynote address during ACMT's 2024 Annual Scientific Meeting. During the course of her talk, Dr. Volkow discussed the historical factors contributing to the ongoing global opioid epidemic, examined the evidence behind different front-line and policy strategies used to battle the opioid epidemic, and highlighted the importance of recent cultural changes that support more deliberate screening for substance use disorders and pathways for initiating treatment of opioid use disorders in vulnerable populations. An urgent need exists to improve inclusion of social and structural determinants of health in implementation science addressing opioid use disorders, with better attention to special populations, including Native American Indians and Alaskan Natives, African Americans, those over 65 years of age, and teenagers.

Introduction: Tianeptine is an atypical tricyclic antidepressant not approved for medical use in the US but is found in dietary supplements. This study investigates single-substance tianeptine exposures reported to US poison centers.

Methods: We analyzed cases involving tianeptine reported to the National Poison Data System from 2015 to 2023.

Results: There were 892 single-substance tianeptine exposures reported to US poison centers from 2015 to 2023, and the rate of exposures increased 1,400% from 2015 to 2023, including a 525% increase from 2018 to 2023. Most exposures were associated with moderate (51.5%) or major (12.0%) effects, and 40.1% required medical admission, including 22.9% to a critical care unit. Individuals 50 years and older were more likely to experience major effects (RR: 1.70, 95% CI: 1.13-2.56) or require medical admission (RR: 1.43, 95% CI: 1.20-1.72) than younger individuals. Tianeptine abuse accounted for 40.1% of exposures and was more likely to be associated with moderate or major effects (RR: 1.18, 95% CI: 1.06-1.31) than exposures not attributed to abuse. Withdrawal accounted for 22.5% of tianeptine exposures. Tianeptine exposure rates were highest in the US South. Alabama enacted legislation to regulate tianeptine as a controlled substance in 2021. Alabama's tianeptine exposure rate increased by 1,413.7% from 2018 to 2021, followed by a 74.6% decrease from 2021 to 2023, while the rate in other southern states continued to increase.

Conclusions: This study demonstrates the toxicity and rapid increase of tianeptine exposures reported to US poison centers. Uniform regulation of tianeptine across all states may offer an important strategy to help mitigate this public health problem.

Introduction: Poison Centers are vital to prevent and manage exposures to chemicals, toxins, and ionizing radiation. However, many countries still lack sufficient poison information center services. Within the World Health Organization's Eastern Mediterranean Regional Office (EMRO) region, we were not able to identify a formal assessment of its toxicological resources. We sought to assess the clinical toxicological resources in the EMRO region and the attitudes, needs, and perspective of the workforce in that region.  METHODS: This was a two part survey study. First, we developed a poison center questionnaire and scoring system based on the World Health Organization's Guidelines for Establishing a Poison Center; this instrument was administered by phone to poison center directors and faculty in the EMRO region. Questions assessed for the presence or absence of important poison center capabilities listed in the WHO guidelines, and points were assigned based on response. Secondly, we administered an electronic workforce survey to clinical toxicology professionals in the region; participant eligibility for the workforce survey was based on the membership roster of MENATOX.

Results: Out of 22 EMRO countries, 16 countries have an established poison center, and 14 of 16 participated in the poison center survey.  The results reflected a wide variability in capabilities among countries. Areas such as call centers, clinical toxicology units, laboratory services, and data management were relatively lacking while some other areas including toxicovigilance, chemical incidents and emergencies, antidotes/antivenoms, poisoning information sources, and the availability of free services were relatively stronger. Twenty-seven out of 32 workforce respondents were physicians. Results from that survey highlighted a desire for more support from government and better compensation.

Conclusions: Our study identified areas of need for the EMRO region. The poison center survey results reflect large disparities among countries with some areas being stronger than others. The workforce survey highlighted issues such as compensation and government recognition. Overall, a formal assessment of individual poison centers can provide benchmarks to drive improvement of services, but further research is needed to identify and characterize country-specific needs.

Introduction: Novel Psychoactive Substance (NPS) use is increasingly prevalent and is often associated with severe acute recreational drug toxicity (ARDT). 258 UK deaths were attributed to NPS use in 2021. Confirmatory testing which identifies NPS is limited by expense and timeliness. We aimed to identify NPS and other recreational drugs in a sample of 1000 ARDT presentations to a central London hospital in 2019/20 and to compare these drugs to those identified from a previous cohort in 2016/2017.

Methods: We prospectively enrolled 1000 serum samples from ARDT presentations to St Thomas' Hospital between February 2019 and February 2020. Serum samples were deidentified and underwent qualitative analysis via mass spectrometry. Results were returned at the conclusion of testing and statistical analysis performed using 'R' (R Foundation for Statistical Computing).

Results: Twenty-eight unique NPS were detected in 2019/20, compared to 31 in 2016/17. Eight new NPS were detected in 2019/20: four benzodiazepines, two synthetic cannabinoid receptor agonists, one cathinone and one ketamine-analogue. No NPS opioids were detected in either cohort. Cannabis (16%,11% p = 0.02), ketamine (12%,7% p < 0.01) and opioids (57%,24% p < 0.01) were detected significantly more frequently in 2019/20 than in 2016/17, while alcohol (22%,49% p < 0.01), cathinones (1%,15% p < 0.01), GHB (14%,20% p < 0.01) and MDMA (9%,18% p < 0.01) were detected less frequently.

Conclusions: Studies that utilise confirmatory testing to detect NPS in presentations of ARDT provide important information for public health interventions. More NPS benzodiazepines and fewer NPS cathinones were detected in 2019/20, following temporal trends of forensic detection throughout Europe and reinforcing the importance of identifying emerging drugs.