Journal of Medical Toxicology Provides International Perspective on Poisonings

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The Journal of Medical Toxicology, the official journal of the American College of Medical Toxicology, reports in its September issue on a variety of poisonings that represent public health concerns on an international level.

American College of Medical Toxicology

Poisoning is a public health issue throughout the world, though the specific poisons that hold the greatest impact vary by country or region. In certain international communities natural toxins abound, in others man-made toxins are prevalent in the environment, while in some drugs available for recreational abuse may be the leading problem. The Journal of Medical Toxicology (JMT), the official journal of the American College of Medical Toxicology (ACMT), provides an international perspective on poisoning in the September issue, with articles that describe poisonings in countries including the United States, Iran, and those of the Asia Pacific region, including Thailand.

A U.S. study looking at the influence of drug use on heat stroke found 28% of patients with life-threatening hyperthermia in whom a urine drug screen was performed to have cocaine or methamphetamine detected in the urine. Another study described poisonings in infants and toddlers reported to the Toxicology Investigators Consortium (ToxIC) registry, a database of patients cared for by medical toxicologists in the U.S. While cardiac and psychiatric medications used by adults accounted for the majority of exposures resulting in hospitalization in this group, recreational and controlled opioid medications accounted for nearly 10% of exposures.

The journal issue devotes three articles to the topic of substance abuse in the Asia Pacific region. Though opioids and cannibis remain commonly abused substances in this region, the use of amphetamine-type stimulants and ketamine are increasing in some parts of Asia. Ketamine, a drug similar to but tamer than phencyclidine, or PCP, as well as the nonprescription cough suppressant dextromethorphan, are commonly abused among Thai youth in particular. A separate U.S. case report of psychosis that developed in an adult man after the use of “bath salts” highlights the potential dangers of this newer class of amphetamine-like stimulant drugs. The drugs found in bath salts, such as MDPV or mephedrone, have been easily available in the US and Europe, although regulations to remove them from sale in head shops and retail outlets are rapidly expanding.

Intentional ingestion of poisons for the purpose of self-harm is a world-wide public health problem, and the agents that are most commonly used are highly reflective of the specific country. A study from Iran investigates potential mechanisms of toxicity of aluminum phosphide, a pesticide that is readily available there despite controls and widely associated suicide attempts. The fatality rate following such exposure remains high even with excellent care. Pesticide poisoning remains the major public health concern of most developing and agricultural nations. Organophosphorus pesticides lead the list of concerning agents worldwide and many countries are looking at ways to limit their availability or concentration to reduce the human harm associated with these important chemicals.

The Journal of Medical Toxicology is an international journal that publishes peer-reviewed scientific literature online first, with print issues published quarterly. It is the official journal of the ACMT, a professional, nonprofit association of physicians with recognized expertise in medical toxicology. The College is dedicated to advancing the science and practice of medical toxicology through a variety of activities.

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