As we batten down the hatches for the upcoming winter, gather provisions, check and check again our safety plans for cold weather, we also turn our thoughts to lighter fare. We consider the holidays, our families and friends, what last year brought and what next year will bring.
Regardless of your political leanings, change brings change. There is rarely a day were I don’t encounter something that will likely affect us (doctors with a tox interest) at some point in the future—changes that have toxic recourse. Marijuana is being ‘legalized’ across the country both for medicinal and recreational use—pediatric exposures to THC have increased; ‘vaping’ is reported to be a safer alternative to cigarette smoking—unfortunately nicotine liquids are not mandated to be in child-safe containers (see below); MDMA is in the news being researched as a PTSD medicine; psilocybin is being used to treat anxiety in cancer patients (among other things). The opioid death rate continues to increase with progressively potent adulterants added to the heroin supply (fentanyl, alfentanil, carfentanil, insulin (?), and more).
Home safety begins there. Holiday get-togethers are a great place to spread not only cheer but also advice on drug/medicinal safety. Take the risk of being a downer for a minute during these gatherings and remind people to check the batteries in their smoke detectors, make sure they also have CO detectors, let people know that they should look through their medicine cabinets and get rid of any medications they no longer need or use. Many pharmacies (and some police stations) will dispose safely of returned medications. A great resource you can let them know about is the DEA.gov webpage about ‘Take Back’. Ask them to look around in their homes and dispose of any non-edible chemicals being stored in food containers—always a source of inadvertent exposures.
This issue is filled with excellent material from new voices both near and far. Dr. Steven J Walsh, from the Philadelphia Poison Center has written an informative piece on advice for the newly minted toxicology fellowship graduates or really for anyone just starting a new career. Drs Su and Wu from the NYC Poison Center have written an excellent “Must Know Now Knowledge!”—an illustrated case report of a benign appearing, but devastating if missed, injury. Dr Stephanie Ruest presents a review on Vaping fluids and associated pediatric risks and Dr Tess Wiskel presents a review on medication induced hyperthermia—both from Brown University Department of Emergency Medicine.
Happy Holidays and New Years to everyone!
Jason Hack, MD