Poison Centers and Public Health Laboratories Partner to Protect

Evolving drug use patterns and the consistent emergence of new substances present complex challenges for clinicians, poison centers and public health. Dr. Travis Olives, medical director of the Minnesota Regional Poison Center (MRPC) and emergency medicine physician at Hennepin County Medical Center (HCMC), has witnessed this evolution firsthand.  

Serving Minnesota, North Dakota and South Dakota, MRCP manages approximately 50,000–60,000 calls annually across a large region with densely populated urban centers and highly rural communities. Often associated with unintentional childhood exposures, poison centers also receive many calls from adult individuals following intentional or unintentional substance exposure. Poison centers provide expert guidance on clinical management of acutely ill patients, including individuals experiencing severe toxic exposures, intentional self-harm or overdose, or substance use-related medical complications. 

Looking for the Obvious…

Poison centers continuously monitor poisoning associated with new and emerging substances, including many that are commercially available. Kratom alkaloids like 7-hydroxymitragynine have increased in both potency and availability in smoke shops. Simultaneously, poison centers observed a dramatic increase in reports of kratom exposure from 258 in 2015 to 3,434 in 2025. Mushroom-infused chocolates, syrups and other products sold in smoke shops or through online retailers present concerns due to their uncertain ingredient composition, variable dosing and resulting toxicity that can be difficult to diagnose. Adult and pediatric consumption of both regulated and unregulated cannabis edibles and drinks are another frequent contributor to poison center calls and consultation requests. Children experience severe effects of THC intoxication at much lower doses than adults, presenting elevated concern to poison centers.

Opioids like fentanyl continue to rightfully receive substantial attention due to their enduring role in overdose morbidity and mortality. However, Olives also identified methamphetamine as a substance of primary concern due to its major contribution to morbidity and healthcare utilization. Methamphetamine is one of many substances associated with the national shift from a focus on opioids towards polysubstance use, which challenges traditional diagnosis and treatment guidelines due to the complex clinical presentations produced by varying substance combinations. Polysubstance use is further influenced by drug adulterants, like xylazine and medetomidine within the illicit opioid supply, which can produce clinical effects that substantially differ from those of more familiar drugs and often require different treatment approaches. 

…Through a New Lens

Partnerships between poison centers, clinicians and public health laboratories have a particularly significant impact in responding to overdoses. The Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA) provides actionable toxicological information about non-fatal overdoses, identifying that three or more substances were detected in nearly 40% of all biosurveillance specimens collected from submitting hospitals in Minnesota in Q2 of 2024, confirming the growing shift towards polysubstance use.

Data from MNDOSA has also assisted with informing treatment decisions and improving patient care. After MNDOSA identified the presence of medetomidine within patient populations across Minnesota, including HCMC, HCMC was able to tailor treatment for patients suffering from severe withdrawal associated with medetomidine use by utilizing dexmedetomidine. This partnership also provides the public health laboratory with a rich resource. Because clinicians and poison center personnel have direct patient contact, their knowledge of the patient population can provide perspective on underlying contexts of substance use and overdose, like socioeconomic status, personal support systems, resource availability, housing stability and other individual factors. 

Collaboration between poison centers and public health laboratories also plays a critical role in responding to rare but potentially high-consequence exposures. A longstanding partnership with Minnesota’s Laboratory Response Network for Chemical Threats program facilitates rapid sample collection, testing and consultation when unusual chemical exposures like thallium or ricin poisoning are suspected, significantly improving clinical decision-making and patient outcomes.

As the toxicological landscape continues to change, the integration of poison center expertise, clinical practice and public health laboratory surveillance is increasingly important. For Olives, these partnerships are successful because they simply make sense: “All of that’s come together organically because we have been working over many years across silos, just because it’s the right thing to do.”