2023 ACMT Annual Scientific Meeting Abstracts – San Diego, CA

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TL;DR

This document contains the 2023 ACMT Annual Scientific Meeting abstracts, covering a wide range of medical toxicology topics. Key findings include that postpartum maternal opioid therapy is not associated with adverse neonatal outcomes, and that medical toxicology consultations for poisoned children in PICUs are associated with a 66% lower odds of mortality. The abstracts also highlight emerging threats like xylazine in the illicit drug supply and the increasing severity of toxicological exposures reported to US poison centers.

Full summary

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**Background:** The 2023 ACMT Annual Scientific Meeting abstracts present the latest research in medical toxicology, covering a diverse array of topics from clinical outcomes of specific poisonings to public health surveillance of emerging drugs of abuse. The abstracts are organized by presentation type (Platforms, Moderated Posters, Posters, Lightning Orals) and cover a wide range of xenobiotics, patient populations, and clinical settings.

**Methods:** The document is a compilation of individual research abstracts, each with its own methodology. Study designs include population-based retrospective cohort studies (e.g., Abstract 001 on postpartum opioid therapy), cross-sectional studies (e.g., Abstract 002 on lead exposure and estrogen levels), retrospective chart reviews (e.g., Abstract 006 on pediatric PICU intoxications), and prospective cohort studies (e.g., Abstract 133 on pediatric cannabis intoxications). Data sources include the National Poison Data System (NPDS), the Toxicology Investigators Consortium (ToxIC) registry, the Virtual Pediatric System (VPS), and the Extracorporeal Life Support Organization (ELSO) registry. Analytical methods range from descriptive statistics to multivariable logistic regression and propensity score matching.

**Key Results:** Several abstracts report significant findings. Abstract 001 found that among 85,675 women who filled an opioid prescription postpartum, there was no increased risk of neonatal readmission (HR 0.98; 95% CI 0.93-1.03). Abstract 005 demonstrated that medical toxicology consultation for poisoned PICU patients was associated with a 66% lower odds of mortality (OR: 0.34; 95% CI: 0.15, 0.77) and an 18% shorter PICU length of stay. Abstract 009 showed that following cannabis legalization and edible sales, the proportion of pediatric poisoning hospitalizations due to cannabis more than doubled to 31.8% in exposed provinces. Abstract 075 reported a 203% increase in death from intentional exposures among adults reported to US poison centers from 2007-2021. Abstract 137 found that novel psychoactive substance (NPS) opioids increased over 500% from 2020 to 2021 among suspected opioid overdose patients. Abstract 119 revealed that 88% of patients who reported taking heroin actually had fentanyl or a fentanyl analog in their serum.

**Clinical Implications:** The findings have several clinical implications. The lack of association between postpartum opioid therapy and neonatal harm (Abstract 001) may reassure clinicians and patients. The strong association between medical toxicology consultation and improved outcomes (Abstract 005) supports the integration of toxicology services into PICU care. The dramatic increase in pediatric cannabis poisonings following edible legalization (Abstract 009) underscores the need for public health interventions and regulatory measures. The rising severity of poisonings (Abstract 075) and the high prevalence of fentanyl in presumed heroin overdoses (Abstract 119) highlight the evolving nature of the opioid crisis and the need for clinicians to adapt their management strategies. The emergence of xylazine as a common adulterant (Abstracts 123-125) and the surge in NPS opioids (Abstract 137) require ongoing surveillance and clinical awareness.