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Conference Report:
Erowid Presents
at the North American Congress of Clinical Toxicology
by S. Thyssen and Earth Erowid
Nov 2006
Citation:   Thyssen S, Erowid E. "Erowid Presents at the North American Congress of Clinical Toxicology". Erowid Extracts. Nov 2006;11:22-23.
Paracelsus (1493–1541) is considered the father or founder of modern toxicology. He is credited with the widely-repeated quotation "All things are poison and nothing is without poison; only the dose makes something not a poison." (Often summarized as "The dose makes the poison.")
Erowid was invited to present at this year's North American Congress of Clinical Toxicology (NACCT) meeting, held October 4–9 in San Francisco. Organized by the American Academy of Clinical Toxicology [website] and co-sponsored by the American Association of Poison Control Centers [website], the event brought together physicians, nurses, pharmacists, and scientists from around the world to share knowledge on a variety of issues relevant to clinical toxicology.

What Is Clinical Toxicology?
Toxicology is concerned with the poisonous effects of chemicals and metals on organisms. In 2000, we attended a conference of the California Association of Toxicologists--a gathering heavily oriented towards law enforcement efforts such as drug testing and the investigation of drug-related deaths. Presenters included a DEA field agent and a California narcotics officer; a strident anti-drug message pervaded the entire conference. It wasn't until the recent NACCT conference that we realized there are important practical differences between forensic toxicologists -- whose primary work includes drug testing for employment, law enforcement, and investigatory purposes -- and clinical or medical toxicologists--the doctors, nurses, and pharmacists who work with health-related toxicology issues.

When dealing with psychoactive drugs, the relationship between forensic toxicologists and human subjects is often adversarial, while the relationship between clinical toxicologists and their subjects is one of caregiver to patient. Clinical toxicologists work to solve medical problems, regardless of whether the toxicological incident involves criminal activity, and their first priority is the health of their patients.

Who Attended the Conference?
Most conference attendees were physicians or pharmacists who had specialized in toxicology and were trained in the diagnosis and treatment of toxicological health issues, including those related to psychoactive drugs. Medical schools cover clinical toxicology briefly, but doctors interested in the field typically do a two-year toxicology fellowship following residency (see "Medical Toxicologists" sidebar). The number of toxicology fellows in the United States is very small, with one physician at the conference half-joking that nearly all of the "tox fellows" in the country were standing within a hundred yards.

How Was Erowid Involved?
Fire, Earth, and Sylvia presented at a pre-meeting symposium titled "Substance Abuse and Addiction: Getting High, Getting Hooked and Getting Help". A crowd of 325 toxicologists gathered for lectures on topics ranging from opiate addiction treatment and prevention, to the roles played and methods used by toxicology labs related to drugs of abuse, immunotherapies for addiction treatment, and high-dose cannabis use in the Netherlands. Erowid presented a talk titled "The Evolution of Erowid: Straddling a Very Tall Fence".

What "Tall Fence"?
Conference organizers asked us to present a brief history of Erowid and give an overview of our work. We chose to focus on the theme of the perceived split between "sides" of drug politics and how we envision our work as an attempt to build bridges between different communities. We had been warned that we might face criticism at this conference for "promoting illegal drug use", so part of our goal was to address and debunk that misconception.

During our presentation, we covered some of the criticisms that have been leveled against us in medical journals, the lack of evidence that our work increases illicit drug use, and the small amount of evidence that suggests it may increase the care with which people use psychoactives.

"Although a few years ago, I might have definitively stated that Erowid leads solely to increased drug abuse, I do not now believe that to be the case. If it did, we should have seen a sinicuichi outbreak, or something similar. I think that most of the entheogens are not appealing to many, and those who wish to explore consciousness are a small proportion of the population. Ultimately, the public health threat simply isn't there, but the educational function is."
-- Edward Boyer, MD, PhD
No Fence at the NACCT 2006
At one point during our presentation we wondered aloud how much time we needed to spend introducing the content of Erowid and asked for a show of hands from those who use the site. We were surprised when more than 90% of the people in the room raised their hands, everyone looked around, and a small laugh rippled through the audience. We were pleased to learn how valuable Erowid is to clinical toxicologists.

During the question and answer period following our talk, a series of people stepped up to the microphones, gave their names and credentials, and complimented us on our work. The expected confrontation did not occur and, in fact, we were blown away by the positive response we received. Both Dr. Edward Boyer and Dr. Paul Wax, who had authored papers critical of Erowid in peer reviewed journals, stepped up to publicly state that they had changed their opinions about Erowid.

Noteworthy Conversations
The day was full of interesting conversations and stories. One woman approached to say she had previously felt uncomfortable about supporting Erowid, but after seeing how many others used the website, and hearing all the positive comments from her peers, she wanted to become a member. Another physician told us that the hospital she worked at had recently begun filtering web access on their network and Erowid was on the list of sites blocked by the software. When she asked to have it unblocked, she was told Erowid is "a drug site" and that she would have to get written permission from the hospital's Institutional Review Board to bypass the filter. We were saddened, but not surprised, that the hospital had a policy of blocking sites like Erowid regardless of the fact that their own toxicology specialists use these sites in their professional work.

Several people who work at poison control centers around the United States commented on how helpful Erowid has been for them. One of the roles a clinical toxicologist may have at a poison control center is to field calls, emails, and instant messages from other physicians who have questions about toxicology issues, such as drug interactions or overdoses. These toxicologists use all of the tools they have available to them, including proprietary digital databases and the internet. While it is natural that information about psychoactive substances on Erowid could be useful for toxicologists, this is the first we've specifically heard of experts on call using Erowid to answer questions for emergency rooms and poison control centers. Thanks to all of the volunteers and members who help make Erowid possible. Your efforts and support have helped provide doctors with information they use to improve people's health and lives.