Pediatric Emergency Medicine physician and Medical Toxicologist. I love my wife, my kids, and punk rock. Midwestern by birth, Boston by choice. @Bostonchildrens
Boston, MA
Joined April 2016
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Overall pre-hospital encounters for youth opioid ODs have stabilized post-pandemic. However, ODs continue to increase in the 12-17yr age group. Exceptional work by lead author @DrJamieLim and @jen_hoffmann1 @LuriePEM
jamanetwork.com/journals/jam…
Michael S. Toce retweeted
📊 Among adolescents and young adults with #Depression, misuse of prescription psychotherapeutic drugs and prescription drug use disorder were more common than among peers without depression. ja.ma/4zzGgr7
Michael S. Toce retweeted
Adverse health encounters related to recreational nitrous oxide misuse increased sharply in MI 2019–2023. Awareness of the severe and potentially permanent health effects from chronic nitrous oxide use by people who use drugs is important. More: bit.ly/3G1wp6Z
ALT A nitrous oxide bottle on top of a green balloon.
Michael S. Toce retweeted
Between 2020 and 2023, buprenorphine dispensing increased among adolescents but decreased among young adults, despite ongoing high rates of opioid use disorder.
ja.ma/4gE8sjg
The child opportunity index (COI) is a measure of social determinants of health. Using the PHIS database, we found that more advantaged patients (higher COI) have a higher risk of Rx and OTC med poisonings, and a lower risk of illicit substance poisonings. 1/
The COI has emerged as a valuable research tool in evaluating environmental risk factors for a number of childhood conditions, and these findings support its use also in furthering our understanding of pediatric poisonings and the development of poison prevention strategies. 2/
Article can be accessed for free here: authors.elsevier.com/a/1kExI…
@ftbourgeois @SocPedResearch @Harvard_Tox
Michael S. Toce retweeted
Mitigation 2: Parents & caregivers can ensure regular conversations w/ their kids about the risks of today's drug landscape, their mental health, how to seek and get help and protect themselves and their friends. Free resources from @SongforCharlie at thenewdrugtalk.org/
Michael S. Toce retweeted
Mitigation 3: Have Naloxone! But mere availability is no silver bullet. Research from @therealMikeToce @DrScottHadland @ ja.ma/4eGIxa8 shows there is work to do.
Kids need to explicitly understand the risks and know how to respond if needed. See mitigation 1 &2.
Our latest work in @JAMAPediatrics
Youth with fatal drug overdose are more likely to have never had a prior non-fatal overdose, use alone, and have no prior history of opioid misuse.
Naloxone IS part of the solution...but other steps are needed.
@ftbourgeois @DrScottHadland
In this retrospective analysis of opioid-related overdose deaths among youths, naloxone access law implementation was not associated with decrease in mortality. ja.ma/4eGIxa8
Additionally, I would advocate for high-quality PEDIATRIC-based studies examining the effectiveness of opioids versus non-opioids in the treatment acute pain in the ED/inpatient/outpatient setting and the development of CPGs to reduce potential bias in prescribing.
🚨 @AmerAcadPeds just released our new guidelines for opioid prescribing in children at #AAP2024 🚨
Take-homes:
1️⃣ **Opioids are still necessary**
While non-opioid treatments are central to treating most acute pain, opioids can be essential for managing severe pain. The goal? Lowest effective dose, shortest duration.
2️⃣ **Addressing disparities**
Youth of color, those with disabilities, and youth with substance use disorders have often been denied proper pain treatment. Our guidelines push for equitable access to pain management for all children.
3️⃣ **Naloxone with every opioid prescription**
We’re recommending that Naloxone (Narcan), a lifesaving medication that reverses opioid overdoses, be prescribed with every opioid. It's an essential safety measure for families managing an opioid prescription.
Effective pain management and safety can coexist. Let’s make sure children don't suffer from untreated pain while also minimizing risk.
**Repost** to help spread these important updates!
Full guidelines here: publications.aap.org/pediatr…
Michael S. Toce retweeted
📊 #DYK: About 17% of people 12 years old and older had a substance use disorder in 2023. #NSDUH #RecoveryMonth
Check out more important data in the 🆕 2023 National Survey on Drug Use and Health (NSDUH) report ➡️ samhsa.gov/data/release/2023…
ALT Infographic titled "Substance Use Disorder NSDUH asked respondents aged 12 or older about the effects of their drug or alcohol use on their lives in the 12 months before the interview." It shows statistics for 2023, with 48.5 million people having a past SUD, representing 17.1% of the population. A breakdown of drug use includes 27.2 million for Drug Use (9.6%) and 28.9 million for Alcohol Use (10.2%). Icons illustrate a clipboard with graphs, medications, a beer mug, and a wine glass. A bar chart comparison between 2023 and 2022 indicates a 2% increase for Alcohol Use Disorder, while Drug Use Disorder remains unchanged. A footer includes the logo of SAMHSA and the text "National Study on Drug Use and Health | NSDUH 2023".
Pre-hospital databases (like @NEMSISTAC) can provide valuable information on the state of the overdose crisis and capture patients that might be missed with traditional ED surveillance systems.
Prehospital encounters for youth opioid overdoses were increasing prior to the pandemic, increased with the onset, and then stabilized, remaining higher than prepandemic levels.
ja.ma/4epWJni
It is encouraging to see naloxone dispensing increasing. However, the majority of youths who die of an overdose had no known prior history of opioid use, had not previously experienced a known overdose, and use drugs by themselves, rendering the presence of naloxone ineffective.
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Cost remains a significant barrier to naloxone access. Benefits to OTC status will be muted unless price comes down.
Association Between Cost Sharing and Naloxone Prescription Dispensing jamanetwork.com/journals/jam…
Michael S. Toce retweeted
TY @WCVB for providing space to talk about the importance fathers have on emotional health @BostonChildrens, highlight @healthyboston father-centric programs, and letting me s/o my kiddos 💙🩷 Please enjoy Father's Day wknd 🙏🏽 Watch segment here: youtu.be/7XqItjS8aNo?si=d8_t… – at Boston, MA
I have had many wonderful airport beers. I have yet to have mediocre (let alone good) airport chicken wings.
Excited to be headed to #ACMT2024 in D.C. where I’ll be presenting on the public health impact of OTC naloxone. Talk is Friday at 1:40pm in the Addiction Medicine track. Stop by and offer a comment thinly veiled as a question. @acmtmedtox