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ACMT 2018 Annual Scientific Meeting Abstracts—Washington, DC

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Journal of Medical Toxicology (2018) 14:3–67 https://doi.org/10.1007/s13181-018-0655-7 ANNUAL MEETING ABSTRACTS ACMT 2018 Annual Scientific Meeting Abstracts—Washington, DC Abstract: These are the abstracts of the 2018 American College of Research Question: How does that availability of naloxone in retail Medical Toxicology (ACMT) Annual Scientific Meeting. Included here pharmacies compare to the prevalence of opioid-related hospital visits are 174 abstracts that will be presented in April 2018, including research (ORHV), socioeconomic status, and population? studies from around the globe and the ToxIC collaboration, clinically Methods: All retail pharmacies in 10 New Jersey cities were surveyed by significant case reports describing new toxicologic phenomena, and en- phone. The standardized survey instrument asked identical questions to core research presentations from other scientific meetings. each pharmacist concerning the stocking of naloxone for dispensing. A single investigator conducted all the surveys. Population data and socio- Keywords: Abstracts - Annual Scientific Meeting - Toxicology economic data for each city were obtained from census.gov.ORHVwas Investigators Consortium - Medical Toxicology Foundation - Pediatric obtained through the NJ SHAD database. Using these data, the Environmental Health Specialty Units prevalence of ORHV was calculated. Naloxone availability was plotted against the prevalence of ORHV, socioeconomic status, and population. Correspondence: American College of Medical Toxicology (ACMT) Pearson’s coefficients were calculated to assess correlation. 10645N. Tatum Blvd Phoenix, AZ; [email protected] Results: Ninety pharmacies in total were surveyed. Naloxone availability ranged from 15.4 to 67.7% by city. Naloxone availability was lowest in Introduction: The American College of Medical Toxicology the cities where the prevalence of ORHV was the highest (R: − 0.46) and (ACMT) received 225 eligible research abstracts for consideration those with the largest population (R: − 0.51). Availability was highest in for presentation at the 2018 Annual Scientific Meeting (ASM), in- cities with the highest median household income (R: 0.69). cluding 119 research studies and 106 case reports. Each abstract was Discussion: This study suggests a complex yet concerning pattern: patients reviewed in a blinded fashion by at least four Research Committee living in the most populous poorer areas, where opioid overdoses are the members. Each abstract was independently scored based on the clin- most common, are also living in areas where fewer pharmacies have nalox- ical question, data source, analytic method, results/conclusion, and one available. Our findings may reflect a need for targeted improvement in clarity of presentation. The overall acceptance rate was 78%, 91% for naloxone availability, especially the poorest areas where opioid-related hos- research studies and 63% for case reports. This work would not be pital visits are the most prevalent. Further study should seek to develop and possible without the hard work and diligence of our abstract re- evaluate strategies to enhance the consistency of naloxone stocking. viewers: Annie Arens, Vik Bebarta, Katie Boyle, Diane Calello, Conclusion: Naloxone availability in retail pharmacies is inversely relat- Stephanie Carreiro, Jon Cole, Kirk Cumpston, Kristin Engebretsen, ed to the prevalence of opioid-related hospital visits and population, and Yaron Finkelstein, David Jang, Louise Kao, Ken Katz, Kate Katzung, directly related to median household income. Russ Kerns, JoAn Laes, Eric Lavonas, Michael Levine, Gerry Maloney, Andrew Monte, Mark Mycyk, Travis Olives, Anne Riederer, Sam Stellpflug, Shawn Varney, Richard Wang, Brandon 002. Comparison of Buprenorphine and Methadone Exposures Wills, and Luke Yip. Even more important is the contribution of Reported to the U.S. Poison Centers 2013–2016. the ACMT staff: Lizzy Nguyen led the process with significant as- sistance from Paul Wax. Congratulations to all the contributors Saumitra Rege1, Anh Ngo2, Justin Rizer1, Sana Sharma3, Nassima Ait- whose work will be presented in Washington, D.C. Daoud Tiouririne1,2, Christopher Holstege1,2. We look forward to seeing you there. 1Department of Emergency Medicine, Division of Medical Toxicology, Sam Stellpflug, MD, FACMT, Abstract Review Chair; Shawn Varney, School of Medicine, University of Virginia, Charlottesville, VA, USA. MD, FACMT, Abstract Review Co-Chair; Russ Kerns, MD, FACMT, 2Department of Student Health, Division of Student Affairs, University Chair, ACMT Research Committee of Virginia, Charlottesville, VA, USA. 3Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA. Day 1: Platforms, Abstracts 001-004 Background: Buprenorphine and methadone are widely used in the US 001. Narcan’t: Sociodemographic Factors in Retail Pharmacy society. We investigated and compared the trends and characteristics of Naloxone Availability buprenorphine and methadone exposures reported to the US Poison Centers (PCs). Kevin Lozo1, Diane Calello1,2, Lewis Nelson1,2 Methods: We retrospectively identified all closed, human exposures to 1Rutgers New Jersey Medical School, Newark, NJ, USA. 2Department of buprenorphine and methadone as reported to the National Poison Data Emergency Medicine, Newark, NJ, USA. System (NPDS) from 2013 to 2016, as specified by the generic codes 0200625 and 0037703, respectively. Trends in buprenorphine and meth- Background: Retail pharmacies in NJ are permitted to dispense naloxone adone exposures were evaluated by using Poisson regression. We descrip- without a prescription. However, not all pharmacies have participated in tively assessed key demographic and clinical characteristics of the expo- this effort, and it is not clear what factors may impact its availability. sures using chi-squared tests. 4 J. Med. Toxicol. (2018) 14:3–67 Results: Buprenorphine exposure calls increased by 12.3% (p = 0.01) from inside. Contamination from crushing, mixing, and melting drugs was 2013 (3321) to 2016 (3731). In contrast, methadone exposure calls de- mostly localized. Surface contamination of fentanyl on users’ tables creased by 23.1% (p < 0.001) from 2013 (3777) to 2016 (2906). Adults was low but varied widely and exceeded the threshold one occasion. In between 20 and 39 years (40.2 and 40.1%), and males (53.2 and 52.4%, this case, the levels were still below those considered biologically active. p = 0.16) constituted the highest percentage of buprenorphine and metha- Long-term accumulation of fentanyl or other hazardous materials on sur- done cases. The proportion of suspected suicides (15.7 vs 29.7%, p < 0.001) faces cannot be ruled-out so cleaning after every consumption event and and drug abuse (20.6 vs 22.1%, p < 0.001) was higher in methadone expo- the use of disposable impermeable gloves should be mandatory. sures. Compared to buprenorphine exposures, major clinical effects (4.7 vs 13.7%, p < 0.001) and deaths (0.3 vs 1.27%, p < 0.001) were more frequent with methadone. Methadone exhibited a significantly higher number of 004. Novel Illicit Opioids Masquerading as Counterfeit deaths due to intentional exposures (85 vs 53.5%, p < 0.001). Single- Pharmaceuticals on the Drug Market substance exposures were more commonly reported for buprenorphine ex- posures (60.4 vs 41.1%, p < 0.001). Buprenorphine exposure cases were Donna Papsun1, Keith Temporal1,BarryLogan1,2. less frequently admitted to the critical care unit as compared to methadone 1NMS Labs, Willow Grove, PA, USA. 2Center for Forensic Science & exposures (26.1 vs 34.1%, p < 0.001). Multiple substance exposures Research, Willow Grove, PA, USA. accounted for a higher proportion of major medical outcomes in buprenorphine exposures (73.1 vs 32.9%). The most common product re- Background: Medical toxicologists are tasked with treating drug over- ported for buprenorphine exposures was the Suboxone film (37.8%). doses in emergency room settings. Diagnosis and management of drug Conclusions: Buprenorphine exposures were more frequently reported com- overdoses are problematic without the challenge of counterfeit pharma- pared to methadone exposures during the study period. Buprenorphine dem- ceuticals. Medical toxicologists need to be aware that novel illicit opioids onstrated fewer mortalities and major outcomes compared to methadone. are masquerading as counterfeit pharmaceuticals, which complicates Buprenorphine exposure cases were less frequently admitted to the critical treatment of suspected overdoses. care unit as compared to methadone exposures. These outcomes might be Methods: This is a retrospective study of drug chemical testing and attributed to the Bceiling effect^ property of buprenorphine. toxicological data from a large reference laboratory. Data from 2016 to 2017 were reviewed for the confirmation of novel illicit opioids such as furanylfentanyl or U-47700 in submitted counterfeit pharmaceuticals and 003. Quantification of Fentanyl Exposure to Health Care Workers: biological specimens obtained during the course of death investigation, Environmental Sampling in Overdose Prevention and Supervised impaired human performance, and suspected overdoses. Consumption Service Sites Results: In 2016, there was one case of counterfeit oxycodone tablets con- firmed as furanylfentanyl, four cases of counterfeit alprazolam tablets con- Marcus Lem1, Tina Chiang2, Victor Leung3, Stephanie Dubland4,Robin firmed as U-47700, and one case of counterfeit oxycodone tablets confirmed
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