The Q Word Podcast

"Kickin" it at the Poison [Control] Center"

 

Lisa: Welcome back. 

Nyssa: Hi, Lisa. Yeah, it's been a minute.

Lisa:  It has been a minute. Yeah, we had a lot of fun when we saw each other a couple of weeks ago, but we didn't quite lay down as many tracks as we expected.

Nyssa: No, we did have a good time. We ate a lot of good stuff, but ah, yeah, we did some good work. Some logistic stuff. 

Lisa: Administrative. 

Nyssa: We launched our new logo, we put out some stickers. If you haven't gotten yours, you should.

Lisa: Yeah, some of you should have gotten some of our brand new stickers. We hope that others of you will sign up for them so that we can get an email list going. 

Nyssa: We still, yeah, we still have a few left. 

Lisa: So you had an adventure outside of Boston that I didn't get to participate in. But we're going to talk about it a little bit, aren't we?

Nyssa: Yes. I went and visited the headquarters of the Georgia Poison Center in downtown Atlanta. Without you; you were busy working. Sorry about that.

 

Lisa: Well I was busy working in Boston. So there's that.

Nyssa:  Yeah, logistical issue. Yes. And so I had a great visit with Dr. Gaylord Lopez, who is the center director,

Lisa: And he dedicated a lot of his time to you for what, half a day, right?

Nyssa: Yeah, we spent several hours together and I also got to tour the Poison Center, which was a real highlight.

Lisa: Oh, okay. So this is what I like to imagine the poison center looked like: So it's, it's got like this big circular driveway and it's like this monolithic glass structure that sort of like disappears in the sky and you go through doors that woosh woosh open there's glass. There's like all these people in like lab coats behind like a security screen and everything is made of glass, but it's dimly lit, but still lit from behind. And people are like writing in colored markers like you'd like transparent screens and there's lots of bustling around and yeah, that's that. Yeah, very, very busy people. They're all beautiful, of course perfectly dressed. Right? That's what it looks like at the Poison Control? 

Nyssa: So have you been there? You've totally just described it.

Lisa: Oh my gosh! I was right.

Nyssa: So it's on like the eighth or ninth or 11th floor of a high rise in downtown Atlanta, behind the locked glass door as a matter of fact, and they do that intentionally because of their previous site. The previous site address was published and they would have people like patients who had had ingestion or exposures show up on their door. Well, that's not at all what they're designed to do. So now they really are kind of hidden and tucked away in this random skyscraper in downtown Atlanta. So you do have to gain entrance through the glass door. And in it's, it looks a little bit like what a call center would look like a bank of computers and they have a really actually really nice setup. They have several computer workstations that are treadmill workstations.

Lisa: Yeah, we have those all over the place up here in Boston. It just means they are very focused on their health and their cardio which they should be at the poison control. . . poison center.  I keep saying poison control and you even had a conversation with him about that, didn't you?

Nyssa: Yeah. Yes. So I have always known it as poison control, but they refer to themselves as the Georgia Poison Center. And the discussion is that they prefer "center". But that "control" is something that has sort of been in our culture for a really long time. So you'll hear me during the interview, stumble a little bit over trying to use the right term. But they you know, they recognize that they don't take offense to it's not offensive to call them poison control, they're just changing it.

Lisa:  I think I just put it all together with the poison control center so that's. . .

Nyssa:  Yeah, 

Lisa: That's what I say

.

Nyssa: That covers all the bases.

Lisa:  That covers all the bases. Okay, so back to what it looks like so they had treadmill desks. So there's no clinical component to this. If there's no gurneys or hospital beds or. . .

Nyssa: Correct, no, not at all. They're an information center and they do have a 250-gallon saltwater tank in the middle of the call center which is beautiful. They do have a large whiteboard but it's all it's a touchscreen so it's a whiteboard capable has all kinds of information on there: who's on call, what kind of calls they're getting will be scrolling through, the menus of the local restaurants that deliver, the names of the fish in the tank. They also had something that I thought was really kind of curious that they have a sick station. So in one of the back rooms, they have a workstation set up just like all the others, but it's segregated and it's for if an employee comes to work sick and so you imagine there are certain illnesses that you can just medicate and go to work so if you have a common cold you can take some medicine and go to work and we all know people do. And so they just set this up so that you can you know, you can segregate yourself and not spread it with everybody. Very interesting. Never heard of that before. Never seen that before.

Lisa: Is there only one desk? Are there multiple desks? 

Nyssa: Just one. Just one sick station.

Lisa: Huh. Okay. Interesting. What if you're the second guy to call in sick you're like "Oh too bad. Guess I can't come to work."

Nyssa: That's right. And then they have registrars. They have fellows and other types of researchers that are in there doing like epidemiological research and providing information for their databases. Dr. Lopez, because he does teach at multiple schools of pharmacy, he has a, like a robot iPad. It's this iPad that is set on wheels. And so he can finish his Yeah, he can finish his lecture at an off-site campus somewhere at the School of Pharmacy, login to his iPad, wheel it into the boardroom, and actually continue to participate via live streaming. It's awesome. I'll post a picture of it. 

Lisa: Okay, so this is actually a lot cooler than I thought. I mean, I was exaggerating, I thought you were gonna tell me it was some dingy office, they kind of looked, you know, like in some basement someplace. But actually, this does sound pretty, like technologically advanced. 

Nyssa: They are quite cutting edge. Yes.

Lisa: How many people would you say were in the office? Is it 20 people? 100 people? Do you have a sense?

Nyssa: Um, I would say at least a dozen maybe closer to 15 or 20. And they do also have practitioners that are remote. So they're working from home.

Lisa:  24/7 service, right? 

Nyssa: That's correct. 

Lisa: Okay.

Nyssa: Some of the other really interesting things that they've introduced at this poison center may not be national, but what I predict will definitely be heading this way. So you, you know, you have a number that you can call 24 hours a day, seven days a week, they also have a live chat option. And this was something that Dr. Lopez developed that he got a lot of pushback from, from his colleagues saying this will never work. This is a bad idea. They also have a live email option. So you can email but you'll get a response in real-time. So you're not waiting hours for your email response, right. And those live chat email options queue up in a similar order as to when you call in. So let's say you're calling in on the phone and I live chat right behind you, I'm going to be handled second. 

Lisa: I see. 

Nyssa: So they do it in that kind of order. The live chat option was developed for the millennials for the folks who prefer to go to their computer and rather than talk to a live person. A live person is kind of a treat anymore for you or me. And then the next thing in the future he will be moving to text options. That's not quite up yet, but he will be moving to where you can just text Georgia Poison Center. 

Lisa: Wow, that's great. 

Nyssa: It puts them at the forefront. They're quite cutting edge and he did get a lot of it's kind of a pioneer. 

Lisa: Well, the technology is there, it's nice to see that they're using it to, to such a good effect. 

Nyssa: And it's not just that they've made it available, but the public is responding to. me. I mean they're using it.

Lisa: That's really cool. That's really cool. All right, so you had the opportunity after this tour, the chance to sit down and talk to Dr. Lopez in his office, for some time you asked him a lot of great questions, and we are pretty much gonna play that entire interview for you guys, our listeners right now.

Nyssa: Hello Q Word listeners. I am in downtown Atlanta at the headquarters for Georgia Poison Center and I am here with the director who's been the director for over 30 years. He is a Doctor of Pharmacy from the University of California at San Francisco and he's also a Clinical Toxicologist. He's very involved in community outreach and public education. And he's called on often by the media to be a content expert. He has appointments at no less than is it eight schools of pharmacy by my count?

Dr. Lopez: That sounds about right. 

Nyssa: So everyone meet Dr. Gaylord Lopez.

Dr. Lopez: It is great to be here. I'm really excited about today and hopefully, your audience will get a little better understanding of who we are, what we do, and maybe even be surprised at some of the unique services we provide to the state of Georgia.

Nyssa: I think so. And those are some of the things I'd love to highlight that you can let us know about. So just to start off, since you have been here for more than three decades, I was wondering if you could give us sort of like a bird's eye view of what you have seen over the last 30 years, in terms of the calls that come in, and then also kind of what's happening on the street. First, the things that have stayed the same and consistent over 30 years and then maybe you can talk about the things that you've seen that have changed from the 90s, to the 2000s, to the 2000 teens.

Dr. Lopez: There's no question when you look at poison centers, just in general, not just us, but the core to our business is the unintentional poisonings that occur in the young child. And when you look at the way the call statistics break out, children under the age of six, makeup, primarily 50 to 60% of our call volume. So it's that new mom, it's that new Grandma, it's that unsuspecting uncle, who now has to take care of a child, and they don't have eyes on 24/seven to see what's going on with that child. So that's the core of our business. Now, what has happened over the last 30 years, and you're right, I've been blessed to be able to be in the driver's seat for a couple of seconds here, but with that call volume, we started to see it decline over the last 10 to 12 years. Why? Because of Dr. Internet and Dr. Google, you know, people are turning to, unfortunately their computers for that more quicker answer. But here's what I always challenge a mom, a parent with: would you rather go to an algorithm as opposed to a human? That's your choice. And so we want to emphasize that the importance of the human aspect because when someone calls a poison center, they're talking to health care professionals. They're talking to doctors. They're talking to nurses. They're talking to pharmacists, and they're talking to poison specialists. They're not talking to a particular algorithm. And so we've seen a decline in those kind of cases of young children because parents are going to other sources to get the information but I encourage them to call the poison center because we have humans, we have up to date data and we're going to be able to in a timely manner respond to that poison emergency. 

So you asked, you know, what are the common things we've seen what's been what are the common threads that we've seen over the years and, and we typically will put out our reports to talk about the top five things that we see. And year over year, the same things do come up, although lesser nowadays, but when we look at our top five drugs or our top five non-drugs, a lot of that stays consistent. So when we look at top five medicines, or pharmaceutics as we call them, the analgesics, the acetaminophens and the salicylates are probably always going to be in that one or two spot in terms of calls we get. The other things that are very popular include multiple vitamins and surprisingly one that's right up there at the top every year our cough and cold preparations. So when you look at those top three medicines those are the ones we get called about exclusively. Now, when you talk about non-medicines, there's a number one answer that is almost like our number one answer, regardless of its drug or non-drug, and that is the category of cleaning products. Incredibly popular with little kids. Then you've got issues like personal hygiene items, as a very popular group, and then plants and other things that might be, you know, within easy sight and easy view of that child.

Nyssa: Right. And so those are things that are brightly colored and they smell good. 

Dr. Lopez: Those, you know are our standards, but when you talk about what has happened in the poisoning landscape, we can go back probably to 2010 or a little bit before that. Then there came this explosion of synthetic products, synthetic drugs. At the very beginning of this, I recall, partnering with one of our local TV stations talking about the explosion of this fake marijuana. You know.

Nyssa: K2?

Dr. Lopez: Yeah, the K2, the spice products. So the synthetic cannabinoids made a huge splash and if you recall, back in 2010, it went from synthetic cannabinoids to bath salts to mollys. And so, you fast forward to today when you're looking at other synthetic chemicals. This has really been problematic in our area and as healthcare professionals, we find ourselves behind the eight ball because a lot of times these, I call them dorm room chemists stay three or four steps above the law. They stay three or four steps ahead of healthcare professionals. And we're challenged with these weird-looking syndromes, not knowing what they got into, but having a clue that they might have smoked. They might have inhaled. They might have put under the tongue, all these different products. And it's very difficult to get into those. And so we have seen some changes in that poison landscape. But look, what remains our core is that unintentional accidental ingestion that parents, both new and old, you know, are calling about. And that's what we love to let the public know, we're there to help with answering that question.

Nyssa: And I like what you said about getting the human response versus going to Web MD or going to an algorithm because those algorithms are generic and when but when you're getting a human response, it's specific to that child, that age, pre-existing conditions, how much they took, those things may or may not be accounted for in an algorithm.

Dr. Lopez: Yeah, and that's one of the things that I think puts poison centers that much more in tune with, with our community when you know, you can. . . when was the last time you spoke to your doctor for free, you know, that doesn't happen. You're able to talk to health care professionals around the clock for no charge, there's not a poison center in the world, that's going to charge you at least in the United States, that's going to charge you for services. And you've got folks who are up to date on the latest information that's out there. And look, the number of cases we handle. . .we at the Georgia Poison Center are probably the second busiest poison center in the entire nation. So when you talk about the kind of experience that we have, we've probably seen it, we've probably been there, we've probably done that. And so you could rest assured that when you talk to one of our agents, our specialists in poison information, that they will give you, you know, accurate information in a timely manner. And they're going to base it not only in the database that they might have in front of them, but the experience that they have over the years.

Nyssa: So when a parent or a nurse or healthcare provider calls the Poison Control Center, what kind of credentials would the operator potentially have?

Dr. Lopez: Yeah, this is what's unique about our call center. We're not, you know, AT&T operator number 12 or 13. We've got healthcare professionals answering the lines, 24 hours around the clock. So they're primarily nurses, pharmacists and physicians that are answering the call. And many of these folks, at least in our poison center, they have decades of experience. You know, when you've got someone who's been here 40 years, you've got a number of folks that have been here 30 years and 20 years. These are people who know what they're doing. Because, you know, our job is to prevent that unnecessary ER visit and I know you come from an ER background, right? And so if we can minimize. . .

Nyssa: We love preventing unnecessary ER visits.

Dr. Lopez: Exactly! 

Nyssa: We promote that as well. 

Dr. Lopez: Of course.

Nyssa: We have no problem with that.

Dr. Lopez: For us, you know, there are a number of factors there, right. Everything from saving time, saving money in a state where we have a number of folks uninsured. You know, the burden on our healthcare system is less. In fact, a unique stat about our call volume is that 85% of all the calls that we get, require little or no treatment. If anything, it requires reassurance. But here, here's the issue when you've got it, when you've got a parent who has no clue about what's going on with this particular ingestion, right, they have a couple of choices. One, they can do nothing. I don't know that I would encourage parents to sit around and just wait for something to happen. They can rush into their pediatrician's office. That takes time. That costs money. They can rush into the ER. That takes time and costs a lot more money. Or they can call the poison center. It is completely free. 

Nyssa: Right. 

Dr. Lopez: And so, fortunately, the volume that we get we could, almost nine out of every 10 calls, we're going to be able to keep at home. Now. The more difficult calls that we get, the 10-15% of calls that we get that are the most difficult are the ones that come from ERs and ICUs where they've already got patients who have gotten into a bottle full, a bucket full, you know, a large amount, usually intentionally. And those are the ones that we have to bat our eyes at a little bit more frequently because those are the ones that are could be life-threatening. In a world now where there are a number of drugs where one pill can kill, we need to be on our game. And we need to be able to work with these ERs and these ICUs to let them know these are the standards of treatment. This is the indication for therapy. This is when you use an antidote, and we want to make sure that they get the optimum care. We keep them in the hospital for the least amount of time, and then they're properly treated. So between those calls that we keep out of the hospital to those that we manage with you in the ER and the ICU, we want to make sure that we provide optimum care because you can't be experts at everything and even though that's the life of an ER nurse or physician, you know, being the jack of all trades, poisoning is one of those unique specialties where having that little bit more expertise definitely results in better patient care.

Nyssa: I agree. And I will say a few things about that.  One: I think reassurance is very good medicine. A lot of what we do in the ER is reassurance: No, your chest pain is not cardiac related. We have now eliminated that. We might not be sure exactly what it is, but it's not your heart. And so you can go and follow up with your primary care. That's reassurance medicine, that's a lot of what we do. I want to circle back to one pill can kill for sure. And I also think that the emergency nursing specialty is the stabilization of real or imagined emergencies. And so we reach out to specialists all the time because like you said, there's such a breadth of what we do, we need specialists to help us with the depth of what we do oftentimes. And so. So if an emergency nurse were to give a call to the Georgia Poison Center, what type of things would he or she what kind of information would they need to have ready when they make the phone call to ya'll?

Dr. Lopez: Yeah, as in any situation where you're you're trying to get a better handle on the patient and what they got into certainly we're going to ask a number of questions about the patient you have. Age, weight, pre-existing conditions, medicines that may be on, obviously symptoms they're experiencing. And then when we get into the other area of the substance, we're like investigators asking 20 questions about you know, when?, how much?, you know. Was it inhaled? Was it ingested? Things like that. And then from there, we can start doing our investigative work. We, we rely on experience, obviously, we are relying on databases that provide us with information. So we'll ask standard questions about a patient so that we can get, you know, the basics in terms of who they are, how old they are, the symptoms they're having, how long they've been having them, and then dive into the product itself, because we're going to be basing our recommendations on what experience what symptoms they're experiencing right now, and what potential symptoms they could have down the road. If it's one of those things that may be slowly absorbed, or maybe not cause problems initially, but somewhere down the road, and we've got a number of poisons that, you know, do that. And so, yeah, it's been great because many of the nurses are prepared to answer these questions. I think oftentimes, where we might have issues is we do quite a bit of follow-up with you guys in the emergency rooms and on the floors. And so, look, I'm married to a nurse, a critical care nurse. And I know that your day is filled with having to do A, B, C, D and E. And then you got the poison center calling to see what's going on with the patient. Well, we're doing that for a number of reasons. Obviously, one, are folks following our initial recommendations? Is the patient getting the optimum care? We've run into situations many times where we've recommended antidotal therapy and the hospital has stopped it for whatever reason. And it's like no, you still need to continue on. So it's one of those relationships that I know we're probably bugging you, but we want to make sure that the patient is being treated appropriately. And so we may follow up a case, a medical case, you know, four or five times before we say we think there's there's a good medical outcome we can close this case out. But we're there to optimize patient care. But sometimes, the healthcare professionals we may want to talk to just don't have the time. They're too busy doing other things and we understand, but we want to be part of the medical decision-making. And again, we could only make recommendations. Sure if you follow them great. If you don't, we want to make sure that we can minimize any other complications and things like that, that we might see if you don't follow our full recommendations.

Nyssa: Good. So for newer ER nurses who may have not had the experience of calling the Georgia Poison Center yet or their local poison center if they're not in Georgia, they need to have as much information as they can, ready. But your . . .What do you call your operators? 

Dr. Lopez: Yeah, they're called. . . we've got a really sexy name for our folks. 

Nyssa: Ok, ok. Hit me with it. 

Dr. Lopez: So they're called spies. S-P-I-S. 

Nyssa: That is really sexy. I love it.

Dr. Lopez: Yes, it's a very sexy name. But when I got here, and SPIS stands for, for your information, Specialist in Poison Information. Okay. When I first got here, they had another moniker. They were Poison Information Specialists. 

Nyssa: Uh oh.

Dr. Lopez: Exactly.

Nyssa: Not as sexy.  Definitely not as good. 

Dr. Lopez: Not as sexy when you're talking about well . . ."I work with other PISes", ya know?  So we changed that to SPIS.

 

Nyssa: Immediately changed it.

Dr. Lopez: Yeah. And so it's funny when a co-worker of ours would, would be asked, Well, what is it that you do? Well, I work for the Georgia Poison Center, What do you do there? Well, I'm a SPI. Wow.  I want your job. But you know, so it's a SPI. 

Nyssa: That's fantastic. 

Dr. Lopez: Yeah. So that's what they're called. They're Specialists in Poison Information or SPIS. 

Nyssa: Great. So. So my experience is if a nurse calls and has as much information as he or she could gather, your SPIS will then ask some other pertinent questions and they're going to take the lead on the phone call and just walk you walk the healthcare provider right through what needs to be done, including making recommendations about what needs to be the next steps, even labs that can be done whether or not they need to be telemetry are not often whether it's safe to discharge, whether they need to be observed if they need to be observed for how long. And then you guys provide that great follow-up as well. So what would happen if a? So my question is then when you have those situations where the scenario is that somebody wasn't watching the baby, and the baby got into something, nurses are mandated reporters, that could be considered neglect in some cases. So is that something that your SPIS would chat about? Are they also court-mandated reporters or is that going to be a partnership between on the phone call? How will that break down? 

Dr. Lopez: Yeah, it's definitely a partnership because we have an obligation as well. Think about those patients that we're talking those parents we're talking to at home who are not wanting to provide care not wanting to go into the ER. We've run into those situations where, they try to weasel out of a situation when we assess it as:  this is pretty serious. Then all of a sudden, there's a lot of backtracking like, well, what if they didn't get, you know, five? What if they only got, you know, three? 

Nyssa: Right.

Dr. Lopez: You know, and because we had an obligation to report if we feel that a child's life's in danger, we will call necessary authorities to either do. We've had we've called the sheriff's, you know, to come out so well, yeah, to do a wheelchair. These are things that that we definitely take seriously. Now, obviously, as the primary providers in the ER,, you certainly have your obligations as well. And so, when when you give us a scenario that a parent presents to you and it's not adding up with us, we want to make sure that you will know that we find this a little scary, especially those cases where, you know, the child accidentally got into x Mike, how did they accidentally Get into a bottle of pesticide. You know. And we've had some real tragedies here where there have been intentional poisonings with pesticides, where they were put intentionally in, say, a water bottle for an unsuspecting child. You know that's just not something that that happens on a daily basis. And so when that kind of situation come up especially when we're giving you the heads of one of the beauties of what we do is we, if we recognize a case has to be sent in, will call ahead to the hospital to give you the heads up, that someone's coming. And so it's not just you calling us saying the patients here. When we make those 10 or 15% of our cases, as recommendations will say, hey, we've got a child eta is about 20 minutes and they did this, that and the other. Here's our basic assessment. You know, these are the systems these are the symptoms. This is our plan. Let's get this patient and stabilize them. Let's go decontaminate, let's think about you know, supportive care, no antidote in this case. And this is what you need to watch for and for how long. So we'll give you the heads up and I think you've experienced that where you know that you've got a patient coming in so that she could be prepared. And if we find that there may be a fishy story behind that we have sent in a number of fishy stories. It's then we hand off to you to say see what else you know might be behind this because it just doesn't add up. It doesn't sound right.

Nyssa: That's good. So we'll be able to look and see if the child dirty? Are they wearing appropriate clothes, do they have a car seat that's appropriate. . . Very good. So what about the situation that happens a lot where the caregiver brings the, it's usually a child but not always, but caregiver bring someone in and we don't know what they ingested. So grandma dropped a pill but she doesn't know which pill and of course, she takes 15 of them. So we're having to work it backward. So it's kind of- this is a toxidrome. So can you talk me through how a nurse or healthcare provider in the ER and your SPIS would work together on a toxidrome?

Dr. Lopez: Yeah, it's not uncommon for us to have a situation where we just don't know. And the unknown pill scenarios a very common one that we've handled. And you're right. There's a good bit of investigative work that goes into trying to figure out what ends up being the likely scenario or course of symptomatology that we might expect. And you mentioned a keyword toxidrome. And so what we'll do is we'll try to understand the medication history of maybe in this case, a grandparent who might be on everything from diabetic medicines to, you know, heart medicines to blood pressure medicines, and so we'll come up with scenarios for you to in particular, pay attention to because when you're looking at say, a diabetic medication One of those one pill can kill issues where symptoms are not going to happen. Like now, these are some things that may happen 12 and 15, and 16 hours from now. And so when you talk about a drop in blood sugars that can occur in a delayed fashion, we need to have you prepared so we may very well and I don't like using this term, you know, often but the safe than sorry, especially if we're realizing that there are certain medications that are really problematic in this class of compounds. We will ask for longer admission times, more frequent monitoring, and, and help you guys help guide the treatment of that patient in that particular way. And as we look at things that may be more rapid onset, whether it's an antihypertensive or a cardiac medicine, we're going to try to pick out the handful of things that you are definitely going to witness in the first handful of hours. Because most of these cases involve good observation over a four to six-hour period, it's sort of that window where we say, if it's going to happen, most things that we know about are going to happen in this period. There are some rare exceptions like I talked about the diabetic agents, there are some antidepressants that may cause symptoms 12 and 16 hours later, so what we're going to try to do is give you the best case scenarios and the critical signs and symptoms that you need to watch out for. And there are going to be times even when you're talking about drugs that are incredibly dangerous, like antidepressants, where a pill or two can definitely kill. If I don't have a patient, symptomatic, if you're telling me it could be an antidepressant, not sure we have a window of time, in this case, around six hours where we say, if you don't see ABCDE and guess what you can discharge, it didn't happen. So we will take advantage of our knowledge of what the big things we've got to watch out for the kind of things we want you to monitor, and then as we follow up together, we'll be able to determine, well, maybe they didn't get that or they didn't get enough of that to be a problem.

Nyssa: So you mentioned antidepressants, what would you say would be the next two or three classes of medications that would make your SPIS go, we've got something really bad here.

Dr. Lopez: Yeah, I will tell you, when we look at things like sustained release antihypertensive, you're looking at things like the Verapamil and the Diltiazem, and those cardiac agents are incredibly dangerous. I can tell you had a case I had a number of years ago where a three-year-old got into one Verapamil sustained released 240-milligram compound. We lost that kid to make a long story short, the kid died. We were very aggressive and trying to treat this kid but the story was, I don't think the kid got it. And then it happened to be the highest strength it happened to be a sustained-release product. And every life-saving measure was deployed to try to save this kid and we didn't save this kid. And there are a number of situations where if we're recognizing it can be that magical one of something. We're going to let you know upfront, and we're going to say this is one that we've got to keep an eye on. There's another antihypertensive like clonidine, that is problematic. We've got antidepressants like products like Wellbutrin, which your audience may be familiar with, you know, that can cause delayed onset seizures. You know, there are a number of things that we're going to be able to tell you and say, Hey, here's the issue with these compounds and these unknowns that we have and if we know a particularly toxic drug to look out for we're going to give you a front and center what we know sometimes will even provide handouts and, and triage sheets or cheat sheets all which can help that new nurse, you know, help that physician with patient care.

Nyssa: Very good. All right, so let's um let's go to the streets now. Tell me what is the hottest and latest. We talked about bath salts and spice and K2. I'm not seeing those as much anymore. What about you? Would you agree or something new?

Dr. Lopez: Yeah, keep in mind that you know, the volume, the calls that we get, you know, from ERs there, as it relates to some of these synthetics. They're not oftentimes calling us either. You know about these. We might be hearing what's new on the street or what might be you know, troublesome folks, but I will tell you that there has been sort of resurgence in the use of some of these, the synthetic marijuana products in bath salts and the Mollies and the MDMA things are probably not as common, but I will tell you that, you know, we just had an incident just recently last summer of counterfeit Percocet. And so we dealt with that whole thing in your region. 

Nyssa: So my town 

Dr. Lopez: Yeah. So, yes, we're in the midst of a, you know, a devastating opioid crisis and, and while hospitals are not calling us on every heroin overdose, we would be bombarded. We know that that's an issue. But if because many of the physicians it's not magic to treat an opiate exposure. However,

Nyssa: We see it so much that we know what to do. 

Dr. Lopez: Yeah, so you're not calling a poison center for that. But where a physician at your hospital said, I've had something unique happen to me there have been three patients that have similarly presented. And I think I have a problem. What can you help me with to disseminate this information to the general public? Because it's not a matter of, you know, helping me treat these patients. No, it's, I think I have a problem. Is there something you can do to help me notify make it more widely known that there may be some type of outbreak brewing? And you go from three cases at 10 pm to I know about 11. Now, by 1 am in the morning, because I'm calling neighboring hospitals and asking them, look at your record, see if you've noticed any trends. What other similarly presenting patients as we came up with definitions, we realized, holy Mac, we've got a situation. And over a three-week period, you know, we've got the GBI involved. We've got public health involved and not a united front. We're talking to the public about these counterfeit pills that would be difficult to measure how many deaths you prevented or serious injuries you prevented. But it's fair to say that, that there was a lot of prevention that happened. Yeah, I'd like to think that there was a significant impact that both public health and the GBI and the poison center made, I will tell you a funny story. As we're, we're we, we manage this particular incident over about a three-week period. And what was funny is, in the middle of all this, maybe two weeks into it, we get a new case about an individual who has been poisoned in a similar way, you know, bought something, you know, on the street, one pill and he's not breathing but when he's woken up and he's he's revived. The physicians ask them, haven't you been paying attention to the news and the activity that's been going on? And the response was, I just got outta jail yesterday. Wow. And didn't hear about any of this going on. And then I went to go to my dealer to buy this and that, and he tried to offload some bad stuff. Well, apparently, but he was. He was he was incarcerated. And then he goes through a near-death experience. Wow. Yeah.

Nyssa: So Dr. Lopez, what are we going to do about the opioid crisis? What do we do?

Dr. Lopez:  Yeah, you know, it's, it's, it's not just a simple answer. I mean, there's a multi-prong approach that we're taking everything from talking to, you know, caretakers and limiting amounts and, and not looking at incarceration as the answer and having treatment centers. All these take expertise, all the all these solutions cost money, you know, sure, we'd love to have rescue kits, you know, out there and more plentiful supply. Yeah, it's it what's really sad is and we keep on saying this unfortunately for the last couple to three years, it's going to get worse before it gets better. And we've got to get a handle on this. And I think you're starting to see at least things that may impact some of these numbers in two or three years. But, you know, look over the last couple of years despite some of the early moves that we're making, we're still seeing increases in drug overdoses. We're still seeing heroin deaths and of course, the last couple to three years. We've seen the fentanyl analogs. Oh my goodness, when when you talk about now, the whole addition to fentanyl to this to this equation, it really boggles us and really perplexes us because here's the thing with me Now much easier to come by more cheaper to produce. And for drug dealers a greater return on investment when you're looking at including fentanyl and to the unsuspecting buyer who might get a fentanyl-laced product. Now they're dealing with something that could be 50 to 100 times more potent, and they have no clue. And all of a sudden there's they stopped breathing. You know, and I think with the problem that we're seeing with the fentanyl and fentanyl analogs, and I know probably some of your listeners have, have heard the layman's term, the elephant tranquilizer. You know where your tongue Yes, where you're talking right up? Yes. These kinds of products are way more potent than even just garden variety fentanyl if you want to call that you're going to see people unsuspecting folks thinking that they're getting high and the drug dealer is substituting fentanyl-laced products for heroin, and using our brothers and our sisters and our children, as guinea pigs as we get through this, this crisis and, you know, I've spoken to many addicts and you know, their life revolves around getting the next fix, regardless of what manner and when you're when it's strangely enough, you've probably heard this as well is when they hear about someone who may have been killed in an overdose. Guess what, instead of saying let's avoid those batches, the opposite actually happens and that they're more attracted to try to find the same thing that maybe that other person got because, you know, maybe they couldn't handle it but guess what, I can handle this stuff. And so it's this weird attraction where when they're hearing about someone dying actually it is a good thing because they're the They're saying to themselves, I need to get some of that stuff. Because that's the powerful stuff that I need. And I know it's it does, it's counterintuitive to what you might think is like, maybe we should avoid that dealer or that particular brand. But if in fact, I've been told that oftentimes that's what's pretty sexy about this is, are they want to see where that stuff was purchased, who sold that stuff? Because they want some they want so Wow, Isn't that fascinating? It's wild.

Nyssa: So a few comments about the opioid crisis. And you can tell me what you think. Medical medications like methadone, Suboxone arming our first responders, including police officers who have minimal, you know, maybe just basic CPR skills with Narcan. rehab, maybe prevention. What about the link? So I'm just throwing out some things that we're using to, you know, toward the opioid crisis. I don't know for really battling it or just band-aiding it, I'm not sure that's what I'd like to hear your comments on. Also, the idea that for a while pain was a vital sign. And if your patient's pain was not controlled, and most patients would tell you they wanted to zero, then you, ER nurses, boy, I'm treading into some really. ER nurses and ER physicians could get really bad scores on their patient satisfaction, which is linked to reimbursement which is linked to hospital quality scores, and so forth. And so a lot of opioids were being given, give them whatever they want. give them another dose, give them five give them Dilaudid. So can you kind of tie all those things together? Are some of those things band-aids? Are they bridges? Are they answers, are they What do you think?

Dr. Lopez: Yeah. So as I said, you know, the approach to getting a grip This crisis does involve many factors and, and I think when you talk about treatment, whether it's rescuing at the very beginning to treatment with, you know, other meds like Suboxone and, and such, I think we do need to have more rescue kits in the hands of first responders and the general public. You know, people who are dying from these overdoses aren't dying in hospitals, they're dying on the street. And I know it's a controversial thing to say, you know, provide more rescues providing more rescue agents like Naloxone, it encourages, you know, more use, but we're having people dying in front of us and not getting to the hospital in time or not having first responders get to them in time. And so I think when you look at sort of Good Samaritan, you know, laws that have been, you know, included now and, and no persecution of folks who might have been in the presence of these folks, I think we're going to save more lives that way, you know, people are going to continue to, to abuse these drugs. I'm a proponent for getting more Naloxone out there and I know in a world where it's about maximizing your profits, I know these are very costly medications. These drug manufacturers you know, want to make the most money for, for, you know what they're producing, but I think we do have to get this drug in more people's hands. So number one, I am definitely a proponent for that. When you look at the. . . 

Nyssa:  Could you see a time -Sorry to interrupt -Can you see a time where Narcan I don't know intranasal or even like, I guess, could you do like an epi-pen  Narcan could be as ubiquitous as AEDs are now, there was a time where we didn't have AEDs everywhere, but we do now.

Dr. Lopez:  Yeah, a lot of places. that's a great point. And, and I think we need to move to that because too many people are dying. And there are a lot of us who, who should be, you know, could be able to help these people who might get exposed to that unsuspecting dose of, of a fentanyl analog or too much heroin after coming out of treatment and then thinking, you know, the dose I took a year ago is the dose I'll start off with now and even though in a relapse situation, so I'm hoping that one day it is as ubiquitous as even carrying around look, people carry around epi-pens. It should be one of those kinds of situations where we have that more readily available. And, and forever. You know, one of the problems we've had is, is you know, putting a lot of emphasis on rehabilitation because some of the quick answers were incarceration. That's not the way to go with these folks. It's providing them within these, these, these rehab stands are lengthy that involve both drug-related options as well as psychological options. And so these are things that, that we've got to be able to provide for whether it's through insurance companies, there have to be other funding sources, you know, to help these people get off these very powerful and potent drugs.

Nyssa: I do have one other street drug that's related to the opioid that I was reading about: kratom.

Dr. Lopez: So when you look at the kind of things that are out there kratom has gotten a lot of airtime in the last couple of years and I've been, you know, on record, talking about the dangers of kratom to the media and to the general public, both on-air and in print and In, in a world where you're looking at opioid alternatives, the thing is kratom is highly addictive. It can cause many of the same problems that opioids can. And you know people this is not a safe compound your, I've had advocates for trade them just berate me online and and and telling me that I don't know what I'm talking about. And when you see people that are dying from excessive use when you're talking about people who are saying, you know, this is wonderful This is a wonder drug and it is solved my opioid addiction. It is helped my heart condition it is calmed me down. You know, these folks, you know, they're not medical, the, you know, professionals. There, there are people that are harmed more with kratom than people who are helped by kratom and so I've gone on record saying this is something that dangerous. This is something that we need to be aware of what our children what our family members are doing. And it's just not something that should be legalized because I know there's a push to legalize kratom. But many organizations countries have actually banned kratom and said, No, this is a very dangerous compound.

Nyssa:  So is it true? You don't have to answer this but is it true that you have been known to go incognito into some head shops to find out what's happening around your town? Or what's the latest? You don't have to answer?

Dr. Lopez:  No, you know, it's funny you should mention that because at the very beginning of say, some of the outbreaks of use of K two and spice and synthetic cannabinoids, I did venture and the funny part is I I ventured into one of those shops, with driving my vehicle with my wife in the car and so The great thing is I was trying to use the bigger umbrella of "Honey, I'm doing this for research." So we drive up to one of these shops that have neon lights and the x letters all over the place. And it was under the guise of, of legitimate research. And it shouldn't surprise you that my wife stayed in the car. Yeah, but I- it's funny. It was almost as if she were a timer during the Olympics because she was timing me and I did happen to stay in for a little bit.

Nyssa: for research?

Dr. Lopez: . . . researching, and I was looking through books. I was surprised that the variety of stuff that someone could buy and when you're talking about a state that might have outlawed this stuff, you know when you ask the vendor if you could show me books, you know if I want to buy spice, I had a binder that was maybe seven or eight inches thick that I was able to just go through. Now with the availability online, you don't even have to go to the seedy part of town anymore. All you gotta do is go to the internet and boom, you're there. Right? But yeah, I did. I've been known to do a little bit of research. Because we know we do. Troll what may be out there. We've got educators, I've got SPIS.  I've got an education director. Yeah, that sort of, you know, looks for the latest trends and the latest fads because we've we heard about, or news organization was calling me about the tide pod challenge. You know, these crazy things that you see on the internet and we've already had issues with tide pods as unintentional ingestion and little kids. And then you get these people intentionally doing tide pods of putting on pizzas and eating them whole and filming themselves in this world of social media and instant gratification of likes and, and, you know, thumbs up and loves. It's just. . .

Nyssa:  Everyone rate us on iTunes, by the way.

Dr. Lopez:  Exactly. You know, it adds up to two words that are fairly popular with us and that is job security.

Yes. Yes. As an ER nurse, I feel that absolutely.  So tell us about some of the other things I was when I was looking on your website. There are a lot of things that people can call the Georgia Poison Center for that I wasn't aware of. So tell us some of the kind of underutilized resources.

Dr. Lopez:  Yeah, obviously the core of our business is unintentional and intentional poisoning. But people don't realize that for bites and stings, we can get called about In fact, we're very busy this season with snake bites. We're probably the second leading state in the southeast for snake bites, you'd be surprised to learn we handle close to 500 snakebite cases annually. And so there's special expertise to have about to treat or not to treat because just because antivenom exists doesn't mean every patient gets it.

Nyssa: Not every bite in an envenomation. 

Dr. Lopez:  Not every bite is a venomous bite. And so people are always surprised when we tell them we do bee stings, spiders, caterpillars, snakes. And one kind of bite that that that's also very popular with us and it's a service that we provide. We are the animal bite center for the state of Georgia. shorter-term more familiar term is where the rabies Information Center for the state of Georgia and here's the thing about rabies.

Nyssa: And so would these services be across the nation to listeners who are listening outside of Georgia? Would their poison centers also offer the kind of bite?

Dr. Lopez:  Yeah, that's a great question. Here at the Georgia Poison Center. One of our specialties that we do provide to the residents of Georgia, I will tell you that other states don't provide, for example, animal bite services.

Nyssa: And I also saw inhalations and contamination, dermal exposure.

Dr. Lopez: Sure when you look at you know, the ability of poison to cause its problems whether it's ingested, which is the most common route you can, you can inhale poisons, you can get them on your skin. We just had a number of cases where we were dealing with folks in the car cleaning industry, where they were using a special type of wheel cleaner that was able to shine up the mag wheels or the fancy wheels, well, these products and the containing a very potent chemical called hydrofluoric acid, which does great for a cleaner, you know, but it actually is the thing that once gets in once on the skin can get to the bone and cause all kinds of problems. 

Nyssa:  Wow. Well, your passion is clear it comes right through. So it's been a joy to interview. Thank you so much for giving me your time.

Dr. Lopez: Yeah, thanks for having me. I had a lot of fun. And, again, you know, as you, you know, broadcast this out to some of your professionals. Yeah, we want to encourage them, you know, to use our services, call us and work with us so that we can provide that kind of optimum patient care. We want to be part of the team, and we'd love to be able to help you guys out

Nyssa:  Great. And I know you're very, very comfortable in the interview environment, but I understand this is your first podcast right?

Dr. Lopez: This is I'm a virgin and this is great too happy to be part of that. You know, thanks so much for thinking about me.

Nyssa: And I can guarantee it won't be your last.

Dr. Lopez:  Well we look forward to talking to your audience again and hope to share a lot more stories about the who, what, and where of what we do here at the Georgia Poison Center.

Nyssa: That's great and if people wanted to find you on social media, or otherwise, where could we find you?

Dr. Lopez:  Yes, we have a website at georgiapoisoncenter.org. And we have Facebook and Twitter feeds that are at poisoncenter.ga.

Nyssa: Great, we will find you there. And we're going to link all of those in our show notes.

Lisa: Wow, that was great. He sounds like he really knows his stuff and has great faith in his people and sounds like it was a really great guy.

Nyssa:  Yeah, he was a great interview. He really is a content expert. And we were lucky to have some time with him. And they have a great center going there. They offer so many services that you heard about. There are a lot of other services that they offer as well that I'd like I really want to mention so that everyone can use their take full advantage of their resources. So you can call the Georgia Poison Center for any kind of medical medication information. So if you have a question about a side effect, if you have a question about a drug to drug interaction if you want to take an herbal and you're not sure if it's okay to take with your prescription med, but your local pharmacy is closed because it's 2 am or it's midnight, or it's Christmas Day, the Georgia Poison Center is an option for you to call and chat about those things. Another service that they provide that is quite a niche is breastfeeding information. So mothers who are breastfeeding children and want to know if it's safe for them to take XYZ medication, whether or not it will cross into the breast milk can call the Georgia Poison Center and find out they may recommend no this is not something that's safe to pass on to your baby. Or if you need to do it then you can do what's called pump and dump where you know it stays in your breast milk for this many hours. So if you'll just pump that milk and discard it, the milk after that would be safe for your child and something that sort of your OB/GYN might not know your pediatrician might know even your pharmacist might not know. But these guys and gals do well. Other kinds of exposures that would be a little bit less common things like things that are splashed into your eyes, or inhalation exposure or dermal exposure, something that's topical, all of those things are covered. They do snake bites, which we talked about a little in the interview, they do rabies, their rabies information house so you can call and they'll make recommendations about what if any rabies treatment you would need. So there's a lot of things that they provide not just ingestions. 

Lisa:  So let me ask you like in terms of the dermal is this somebody's calling? Because their skin has broken out and they feel that they've touched something? Or do they know they've touched something and they're afraid that it's poisonous? 

Nyssa:  My guess would be that they came into contact with something that that they know about that now is causing a problem but you know, they work the toxidrome, which Is the I'm having a reaction, and let's work backward. They work that with ingestions, I imagine they could do that with the dermal as well and at least give you some things that you need to look for. And then, you know, they would interview you about the types of things that you may have come into contact with and kind of drill down to the exposure.

Lisa:  Interesting. That's a fantastic, fantastic service. I don't know whom to call up here in Boston, I'm certainly going to look.

Nyssa:  The number is 1-800-222-1222. That's all you have to remember and that's nationwide, it will direct you to your correct poison center. Instead of our usual blooper at the end of the episode. I'm going to play you the poison center jingle, which is their phone number. It's quite an earworm. It's very a la Schoolhouse Rock. You guys are going to love it. And you're never going to forget the number for the poison center again, which is the whole point.

Lisa: 2221222 I can already imagine what kind of rhythm it's got. 

Nyssa: Right? 

Lisa: That's fabulous. Well, I'm so glad you get to talk to him. I wish I had had the chance to meet him. I hope that if I do, it's not because I ate something, something or touch something wrong. And we hope that everybody enjoyed the episode. If you did, please rate us on iTunes. Come and see us on Facebook, on Instagram or on Twitter. We are The Q Word podcast.com. Or you can email us at The Q Word podcast at gmail. com. 

Nyssa:  That's it.

Lisa:  You guys have a great week, month, couple of weeks so we will check in with you soon. Bye guys. ,

Nyssa:  Bye

 

Keywords

poison control center, ingestion, kratom, fentanyl, toxidrome, medicines, drug, envenomation