Addiction Toxicology Resources

This page has been created by the ACMT Addiction Toxicology Committee and contains pertinent resources with this focus. If you are an ACMT Member interested in joining this Committee please fill out this request form.

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Journal of Medical Toxicology Articles

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ACMT & AACT Joint Statement on Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time.
Correction to Above
Authors: Andrew I. Stolbach, Maryann Mazer-Amirshahi, Lewis S. Nelson & Jon B. Cole

ACMT Position Statement: Role of the Medical Toxicologist in the Management of Patients with Substance Use Disorder
ACMT supports the role of medical toxicologists in the initial and long-term care of patients with substance use disorders and affirms that they play an essential role in addressing this public health crisis. 
Authors: Andrew I. Stolbach, Maryann Mazer-Amirshahi, John Cienki, Leslie R. Dye, Lewis S. Nelson, Ryan Marino, Stephanie T. Weiss, Brandon J. Warrick & Paul M. Wax

2023 ACMT Annual Scientific Meeting Abstracts – San Diego, CA

Correction to: The Potential Proconvulsant Effects of Cannabis: a Scoping Review
Authors: Eric E. Kaczor, Kevin Greene, Jennifer Zacharia.

Delta-8-Tetrahydrocannabinol Exposure and Confirmation in Four Pediatric Patients
Delta-8-tetrahydrocannabinol (THC) is a known isomer of delta-9-THC, both found naturally in the Cannabis sativa plant and thought to have similar potency.
Authors: Kerollos Shaker, Andrea Nillas, Ross Ellison.

Characterization of Nonfatal Opioid, Cocaine, Methamphetamine, and Polydrug Exposure and Clinical Presentations Reported to the Toxicology Investigators Consortium Core Registry, January 2010–December 2021
To characterize and compare opioid-only, cocaine-only, methamphetamine-only, opioid-and-cocaine exposure, and opioid-and-methamphetamine exposure and to examine clinical … Authors: Emily Glidden, Kyle Suen, Desiree Mustaquim.


Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder?

Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Authors: Skyler H. Kessler, Evan S. Schwarz, David B. Liss

Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal

Phenobarbital has been successfully used in the emergency department (ED) to manage symptoms of alcohol withdrawal, but few studies have reported outcomes for ED patients who receive phenobarbital and … Authors: Jacob A. Lebin, Anita Mudan, Charles E. Murphy IV

The Potential Proconvulsant Effects of Cannabis: a Scoping Review

A total of 3104 unique articles were screened, of which 68 underwent full-text review, and 13 met inclusion/exclusion criteria. Ten of 11 studies evaluating acute cannabis exposures reported a higher seizure inci… Authors: Eric E. Kaczor, Kevin Greene, Jennifer Zacharia

A Brief Educational Intervention to Increase ED Initiation of Buprenorphine for Opioid Use Disorder (OUD)

Despite the evidence in support of the use of buprenorphine in the treatment of OUD and increasing ability of emergency medicine (EM) clinicians to prescribe it, emergency department (ED)-initiated buprenorphine… Authors: Utsha G. Khatri, Kathleen Lee, Theodore Lin.

Front-Loaded Versus Low-Intermittent Phenobarbital Dosing for Benzodiazepine-Resistant Severe Alcohol Withdrawal Syndrome

Phenobarbital is frequently used to manage severe alcohol withdrawal. The purpose of this study was to compare the incidence of mechanical ventilation in patients with benzodiazepine-resistant alcohol withdraw… Authors: Poorvi Shah, Kati L. Stegner-Smith, Mohamad Rachid.

Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder?

Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Data are needed to inform… Authors: Skyler H. Kessler, Evan S. Schwarz, David B. Liss.

Lebin, J.A., Mudan, A., Murphy, C.E. et al. Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal. J. Med. Toxicol.18, 4–10 (2022).


Impact of a Mandatory Prescription Drug Monitoring Program Check on Emergency Department Opioid Prescribing Rates

Prescription drug monitoring programs (PDMPs) exist in 49 states to guide opioid prescribing. In 40 states, clinicians must check the PDMP prior to prescribing an opioid. Authors: C. James Watson, Michael Ganetsky, Ryan C. Burke.

Opioid Overdose Deaths with Buprenorphine Detected in Postmortem Toxicology: a Retrospective Analysis

Buprenorphine is a unique ÎĽ-opioid receptor partial agonist with avid receptor binding, nominal euphoric reward, and a ceiling effect on sedation and respiratory depression. Authors: Rachel S. Wightman, Jeanmarie Perrone, Rachel Scagos.

“Waste Not, Want Not” â€” Leveraging Sewer Systems and Wastewater-Based Epidemiology for Drug Use Trends and Pharmaceutical Monitoring

During the current global COVID-19 pandemic and opioid epidemic, wastewater-based epidemiology (WBE) has emerged as a powerful tool for monitoring public health trends by analysis of biomarkers including drugs. Authors: Timothy B. Erickson, Noriko Endo, Claire Duvallet.

Opioid Use and Driving Performance

The USA is in an opioid epidemic, with an increased number of individuals taking psychoactive drugs while executing the tasks of everyday life, including operating a motor vehicle. Authors: Keaton T. Cameron-Burr, Albert Conicella, Mark J. Neavyn.

Pediatric Methamphetamine Toxicity: Clinical Manifestations and Therapeutic Use of Antipsychotics—One Institution’s Experience

Methamphetamine toxicity is common in the Southwest region of the United States and presents diagnostic and treatment challenges in the pediatric population. Authors: Hannah R. Malashock, Claudia Yeung, Alexa R. Roberts.

Implementation of a Medication for Addiction Treatment (MAT) and Linkage Program by Leveraging Community Partnerships and Medical Toxicology Expertise

Implementing a hospital medication for addiction treatment (MAT) and a linkage program. Authors: Gillian A. Beauchamp, Lexis T. Laubach.

Descriptive Analysis of Inpatient and Outpatient Cohorts Seeking Treatment After Prescription Opioid Misuse and Medical Toxicology Evaluation

Medical toxicology expertise has expanded into the addiction medicine realm including outpatient medication for opioid use disorder (MOUD) and addiction treatment. Authors: Shawn M. Varney, Timothy J. Wiegand, Paul M. Wax.

California Poison Control System Implementation of a Novel Hotline to Treat Patients with Opioid Use Disorder

In response to the opioid epidemic, California state officials sought to fund a variety of projects aimed at reducing opioid-related deaths. We describe the California Poison Control System’s (CPCS) successful. Authors: Kathy T. LeSaint, Raymond Y. Ho, Stuart E. Heard.


Leadership Roles in Opioid Stewardship and the Treatment of Patients with Opioid Use Disorder Among Medical Toxicologists

One hundred and thirty-one out of 382 eligible individuals from at least 76 institutions responded to the survey. A majority (60%) had a DATA 2000 X-waiver, 21% were board-certified in addiction medicine (AM), an… Authors: Joseph E. Carpenter, Brian Patrick Murray.

Mozeika, A.M., Ruck, B.E., Nelson, L.S. et al. Opioid-Associated Hearing Loss: A 20-Year Review from the New Jersey Poison Center. J. Med. Toxicol. 16, 416–422 (2020).

Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl

Illicitly manufactured fentanyl (IMF) is responsible for a growing number of deaths. Some case series have suggested that IMF overdoses require significantly higher naloxone doses than heroin overdoses. Authors: Joseph Carpenter, Brian Patrick Murray, Sukhshant Atti.

Buprenorphine Initiation in the Emergency Department: a Thematic Content Analysis of a #firesidetox Tweetchat

The height of the opioid epidemic in the USA has led to an increasing call for access to medication assisted treatment for opioid use disorder, including buprenorphine initiation from the emergency department … Authors: Megan Chenworth, Jeanmarie Perrone, Jennifer S. Love.

Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater

Wastewater-based epidemiology with smart sewer selection and robotic wastewater collection is feasible to detect the presence of specific opioids, naloxone, methadone, and buprenorphine within a city. Authors: Norkio Endo, Newsha Ghaeli, Claire Duvallet, Katelyn Foppe.

Understanding Naloxone Uptake from an Emergency Department Distribution Program Using a Low-Energy Bluetooth Real-time Location System

Emergency department (ED)–based naloxone distribution programs are a widespread harm reduction strategy. However, data describing the community penetrance of naloxone distributed from these programs are lacking… Authors: Jeffrey T. Lai, Brittany P. Chapman, Stephanie P. Carreiro.

Assessment of the Utility of the Oral Fluid and Plasma Proteomes for Hydrocodone Exposure

Non-medical use and abuse of prescription opioids is a growing problem in both the civilian and military communities, with minimal technologies for detecting hydrocodone use. This study explored the proteomic … Authors: Brooke L. Deatherage Kaiser, Jon M. Jacobs.

Severe Toxicity to the New Psychoactive Substances 3-Hydroxyphencyclidine and N-Ethylhexedrone: an Analytically Confirmed Case Report

3-Hydroxyphencyclidine (3-HO-PCP) is a new psychoactive substance (NPS) and a hydroxy derivative of phencyclidine (PCP), and N-ethylhexedrone (Hexen) is a synthetic cathinone. Authors: Lisa Christine Dunlop, David Wood, John Archer.

Kratom Adulterated with Phenylethylamine and Associated Intracerebral Hemorrhage: Linking Toxicologists and Public Health Officials to Identify Dangerous Adulterants

Kratom is derived from the plant Mitragyna speciosa…which is indigenous to Southeast Asia. Active compounds, mitragynine and 7-hydroxymitragynine, cause mild stimulant and opioid agonist effects. Authors: Nicholas Nacca, Rachel F. Schult, Lingyun Li.

Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury

Electronic cigarettes (e-cigarettes) are battery-operated devices to insufflate nicotine or other psychoactive e-liquid aerosols. Despite initial claims of e-cigarettes as a nicotine-cessation device, aggressive Authors: Dazhe James Cao, Kim Aldy, Stephanie Hsu, Molly McGetrick.

Search the ACMT Learning Center for the Latest Addiction Toxicology Content

Access all of ACMT’s Addiction Toxicology related digital content including webinars, podcasts, and courses on the ACMT Learning Center. Once there, log in to your account or create a FREE one. Then either manually search the site and select Addition Toxicology as your category or click on “Addiction Toxicology” under Search By Topic.

ACMT Webinars

* Denotes webinars accessible only to ACMT Members

Addiction Toxicology Case Conference

More information

The ACMT/ASAM Addiction Toxicology Case Conference is a monthly webinar series that discusses Addiction/Toxicology cases in an interactive fashion featuring experts from Addiction Medicine, Addiction Psychiatry, and Medical Toxicology. This activity is free and open to the public.

National Journal Club *

Links to webinars by year


January 2024

This month’s topic is Clinical Cannabis Considerations in Children. The articles will be reviewed by the Harvard Medical Toxicology Fellowship Program, led by Dr. Michele Burns.

March 2024

This month’s topic is Dexmedtomidine in alcohol withdrawal. The articles will be reviewed by the Northwell Health Medical Toxicology Fellowship at North Shore University Hospital & Long Island Jewish Medical Center (NS/LIJ).


March 2023

This month’s topic is Body Stuffers and Naltrexone. The articles will be reviewed by the UCSF Medical Toxicology Fellowship Program, led by Dr. Zhanna Livshits.


July 2021

This month’s topic is Pepper Spray and Tear Gas Agents. The articles will be reviewed by the University of Virginia Program in Medical Toxicology, led by Program Director Heather Borek.

March 2022

This month’s topic is Opioid Overdose and Naltrexone. The articles will be reviewed by the Washington University School of Medicine Program in Medical Toxicology, led by Dr. Evan Schwarz.


May 2021

This month’s topic is Withdrawal and Recent Modalities. The articles will be reviewed by the Rutgers Medical Toxicology Program, led by Dr. Jeena Jaco.

National Grand Rounds *

Links to webinars by year


 April 2024   

Psych Evaluation of Transplant Patients

 August 2024   



October 2022        

Cannabis Regulation

February 2022

Gone to Pot? The Complex Relationship between Cannabis, Cannabinoids, and Psychosis


October 2021

NPS Discovery – a five-phase approach to NPS identification, characterization, education, and harm reduction

Practice, Position, and Joint Statements; Public Policy Letters

Practice Statements

Statements by year


Sept. Interpretation of Urine Opiate and Opioid Tests. Read statement.


May. Limiting Harms of Vaping and E-cigarette Use. Read statement.


Nov. Interpretation of Urine for Tetrahydrocannabinol Metabolites. Read statement.

Sept. Buprenorphine Administration in the Emergency Department. Read statement.

Apr. Addressing Pediatric Cannabis Exposure. Read statement.


Feb. Safety Issues Regarding Prescription Fentanyl Products. Read statement.

Position Statements

Statements by year


  • Sept. Expanding Treatment for Youth with Substance Use-related Illnesses. Read Statement.
  • Jun. Role of Medical Toxicologist in the Management of Patients with Substance Use Disorder. Read Statement.


  • Sept. Allow Optimal Treatment for Healthcare Professionals With Opioid Use Disorder. Read statement.


Joint Statements

Statments by year


  • Sept. ACMT & AACT Joint Statement on Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time. Read statement.
  • Feb. ACMT, ACEP, NAEMSP Joint Statement on Naloxone Access and Utilization for Suspected Opioid Overdoses. Read statement.


Nov. ACMT and AACT Position Statement on Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders. Read statement.

Public Policy Letters

Letters by year


Oct 13, 2022. CSOO Requests DEA and SAMHSA Grant Continued Telehealth Flexibilities for Buprenorphine for OUD Declared in Response to the Opioid PHE. Read letter.

May 13, 2022. The Mainstreaming Addiction Treatment Act. Read letter.

Apr 12, 2022. CSOO Members on FY23 Appropriations Letter Aimed at Strengthening the Addiction Service Workforce. Read letter.

Mar 31, 2022. CSOO Members Support Legislation to Screen, Assess, and Treat Maternal Mental Health Conditions and SUDs. Read letter.

Feb 14, 2022. CSOO Members Advocate the Federal Parity Act be Fully Extended to Medicare, Medicaid, and TRICARE. Read letter.


Jul 26, 2021. CSOO Urges Biden Administration to Fly Flags at Half-Staff on Overdose Awareness Day. Read letter.

May 27, 2021. Introduction of the Support, Treatment, and Overdose Prevention of (S.T.O.P) Fentanyl Act of 2021. Read letter.

May 3, 2021. Excellence in Recovery Housing Act. Read letter.

April 6, 2021. CSOO Urges Congress to Include Funding for Programs to Strengthen the Addiction Service Workforce in Fiscal Year 2022. Read letter.


May 5, 2020. CSOO Urges Congress to Include Key Initiatives to Support the Mental Health and SUD Treatment Infrastructure in Next COVID-19 Package. Read letter.

ACMT Visual Pearls