Poison Control Centers Offer Unique Opportunities for Pharmacists

More than $45 million in health care expenditures is prevented, and that money saved, annually by Arizona’s 2 poison control centers. But what do they do?

At the Arizona Poison and Drug Information Center (APDIC), we provide immediate access to care for ingestions and exposures to potentially harmful substances, inappropriate use or overdose of legal or illegal drugs, and bites or stings by venomous creatures. We also answer questions about medications, herbal remedies, chemicals, and exposures to hazardous materials. This is possible because our center is run by clinical pharmacists who hold Certified Specialist in Poisoning Information (CSPI) accreditation, clinical and medical toxicologists, and genetic counselors.

A CSPI and toxicologists are available 24 hours a day, 7 days a week to respond to questions from the public and hospitals regarding medications, toys, desiccants, and other substances. We answer calls from everyone ranging from young children and parents to paramedics and physicians. This includes all health professions, even our state and county health departments, highlighting our remarkably interprofessional environment.

The APDIC serves all of Arizona except Maricopa County, which has its own poison center. The APDIC operates out of the University of Arizona College of Pharmacy. Because of our location in the Southwest, we specialize in bites and stings. In 2018, the center received 30,477 calls, and this included 156 rattlesnake bites and 1598 scorpion stings. Overall, about 47% of our calls are regarding drug substances, and approximately 20% of all calls come from health care facilities for which we provide treatment recommendations on a variety of topics such as occupational exposures, overdoses, suicide attempts, and public health concerns.

We are a locus of many resources, from herpetologists to mycologists. We are the go-to resource for various helplines, including those for rattlesnake and scorpion antivenoms, medication management, and Zika virus. Currently, we also help manage the Opioid Assistance and Referral Line, which began as a response to the Arizona Opioid Epidemic Act to provide information and consultation for patients with pain and opioid use disorders.

One of the most unique aspects of the APDIC is the Clinical Toxicology Fellowship and Medical Toxicology Fellowship programs for pharmacists and physicians. This program is designed to have 1 pharmacist and 1 physician working together throughout a 2-year program. This is a unique pathway for practicing pharmacy that cannot be found elsewhere.

Pharmacy fellows of the Clinical Toxicology Program learn valuable clinical-based skills from their physician fellow, which include conducting physical exams and interpreting diagnostic tests. This combination provides efficient and effective administration of health care to our patients. Rotating students and fellows are provided opportunities to see multiple patients at their bedside per day, and with various conditions. The fellows see patients at 2 hospitals located in Tucson and work with the medical team at each hospital to determine treatment plans for patients. This exemplifies the interprofessional aspects of our program and provides an even more memorable and pharmacy-focused experience.

Additionally, our fellows will tell you that the program is exceptionally independent. There is ample opportunity for fellows to flourish and pursue topics they may be interested in. There are also opportunities to teach lectures to medicine and pharmacy students, residents, and other fellows as well as work closely with faculty, giving them valuable insight into the field of academia.

One of the most useful tools we have at the APDIC is MotherToBaby Arizona. Staff members work directly in the office with the APDIC and are there to provide information regarding medication safety and exposures during pregnancy and breastfeeding. They also work with the general public and various providers on topics that include pesticides, occupational exposures, prescription medications, and diseases/infections. The people who staff MotherToBaby Arizona are board-certified genetic counselors who can comment on any medications, as well as birth defect prevention.

The APDIC hires 2 pharmacy students each year to work as interns in the poison center. The students learn how to do the dayby-day tasks of answering phone calls from the public and are tremendously helpful with rattlesnake bite follow-ups. Patients appreciate interns’ advice and counsel, and interns are exposed to various fields of pharmacy.

Ajla Mujezinovic, a co-author for this article, has served as an intern at the poison center, and found the experience rewarding.

The experience also gave Mujezinovic the chance to learn how to adapt and utilize the knowledge already gained in the most helpful way possible.