Toxicology Investigators Consortium (ToxIC)
The Toxicology Investigators Consortium (ToxIC) is ACMT’s multicenter toxico-surveillance network that identifies new and emerging drugs of abuse, adverse effects of new medications in the post-marketing phase, and emerging toxicological threats. ToxIC’s research and programs are currently supported by grants from the National Institutes of Health, along with contracts from the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, and other partners.
In 2024, collaborating ToxIC investigators across the country published 36 abstract and a record-breaking 14 peer-reviewed manuscripts. This research was published across a wide variety of journals including JAMA Network Open, Journal of Addiction Medicine, Academic Emergency Medicine, Alcohol and Alcoholism, Morbidity and Mortality Weekly Report (MMWR), and more.
- Schwarz E, Buchanan J, Aldy K, Shulman J, Krotulski A, Walton S, Logan B, Wax P, Campleman S, Brent J, Culbreth R, Manini A; On behalf of the ToxIC Fentalog Study Group. Notes from the Field: Detection of Medetomidine Among Patients Evaluated in Emergency Departments for Suspected Opioid Overdoses — Missouri, Colorado, and Pennsylvania, September 2020–December 2023. MMWR Morb Mortal Wkly Rep. 2024;73(30):672–674. View Publication
- Weiss ST, Li Xiaobai, Aldy K, Wax PM, Brent J; On behalf of the Toxicology Investigators Consortium (ToxIC). Self-Harm as a Contributor to the Opioid Epidemic: Data From the Toxicology Investigators Consortium Registry. J Addict Med. 2024; Article in Press. View Publication
- Shastry S, Shulman J, Aldy K, Brent J, Wax P, Manini A; On behalf of the ToxIC Fentalog Study Group. Psychostimulant Drug Co-ingestion in Non-Fatal Opioid Overdose. Drug Alcohol Depend Rep. 2024;10:100223. View Publication
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Will Heise
Rob Hendrickson
Reynaldo Hernandez
Jacqui Hiob
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Robert Hoffman
Christopher Holstege
Jason Hoppe
Keahi Horowitz
Zane Horowitz
Christopher Hoyte
Adrienne Hughes
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Matthew Lambrych
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David Liss
Heather Long
Annette Lopez
Michael Lynch
Forrest Mahoney
Greg Makar
Michael Marlin
Brandon Marshall
Stacy Marshall
Kelsey Martin
Danae Massengill
Nik Matsler
Sean McCann
Conner McDonald
Joshua McFalls
Christopher Meaden
Kevan Meadors
Timothy Meehan
Avery Michienzi
Michelle Mieger
Christopher Mitchell
Nadia Mohammad
Andrew Monte
Elizabeth Moore
Pamela Moore
Anita Mudan
Michael Mullins
Karen Muschler
Agnesa Mustafa
Nicholas Nacca
Kristine Nanagas
Lewis Nelson
Hoan Nguyen
Kim-Long Nguyen
Andrea Nillas
Supa Niruntarai
Sandra Nixon
Hannah Norton
Katherine O’Donnell
Nneka Ogbutor
Simon Ostrowski
Rittirak Othong
Jenna Otter
Daniel Overbeek
Serah Oyewole
Mehruba Parris
Todd Phillips
Anthony Pizon
John Rague
Ravikar Ralph
Aaron Ralston
Shelby Randall
Rama Rao
Shahanaz Rashid
Tony Rianprakaisang
Morgan Riga
Marc Rigatti
Bradley Riley
Daniel Rivera
Lynne Rosenberg
Brett Roth
Adam Rowden
Anne-Michlle Ruha
William Rushton
Steven Salhanick
Cynthia Santos
Nishita Saraiya
Zariad Saran
Alkeem Savage
Matthew Scanlon
Scott Schmalzried
Brett Schuchardt
Evan Schwarz
Anthony Scoccimarro
Elizabeth Shanahan
Kapil Sharma
Andrew Sheen
Sophia Sheikh
Tiffany Sheng
Edward Shin
Joshua Shulman
Alex Sidlak
Michael Simpson
Miya Smith
Jerry Snow
Anthony Spadaro
Hannah Spungen
Meghan Spyres
Alaina Steck
Jennifer Stephani
Darien Stratton
Fermin Suarez
Lachie Sund
Ryan Surmaitis
Sammy Taha
Katherine Tang
Neel Tarikeri
Courtney Temple
John Thompson
Trevonne Thompson
Christian Thornton
Christopher Threapleton
Daniel Tirado
Michael Toce
Laura Tormoehlen
Cassie Trammel
William Trautman
Supatpinee Trensawang
Andrew Troger
Alicia Tudor
Merritt Tuttle
David Vearrier
Steven Walsh
Herbert Wan
Yu-Chi Wang
Sam Wang
George Warpinski
Marcus Warriner
Timothy Weigand
Ben Weigel
Marey Wermuth
Brian Wiener
Adrian Williamson
Tyler Willing
Bryan Wilson
Jessica Winkels
Brian Wolk
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ToxIC Program Updates
Core Registry
The ToxIC Core Registry is our largest project with detailed clinical information on patients seen by medical toxicologists across the world. With over 42 sites contributing to the Core Registry, over 110,000 cases have been accrued in the last 15 years. The Core Registry is supported, in part, by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).
Opioid Use Disorder (OUD) Subregistry
The ToxIC Opioid Use Disorder (OUD) Subregistry is designed to capture de-identified data on OUD treatment and harm reduction measures, including the use of medications for opioid use disorder (MOUD) like buprenorphine and opioid antagonists such as naloxone or nalmefene. Data collection spans all stages of care, from prior emergency department visits to discharge and follow-up. Supported by ToxIC’s network, this project will provide critical insights to advance medical toxicology and address the opioid crisis. This project is funded by the Centers for Disease Control and Prevention (CDC).
North American Snakebite Subregistry (NASBR)
Established in 2013, ToxIC’s North American Snakebite Registry (NASBR) is a nationwide surveillance tool with over 2,900 recorded cases. NASBR collects comprehensive data on snake species, clinical effects, diagnostics, treatments, and follow-up care, aiming to reduce snakebite-related morbidity and mortality by enhancing understanding of envenomation responses and optimizing treatment strategies. This project is supported by SERB Pharmaceuticals.
ToxIC Novel Opioid and Stimulant Exposures (NOSE)
The ToxIC Novel Opioid and Stimulant Exposure (NOSE) project is part of ToxIC’s enhanced toxico-surveillance efforts to identify emerging opioid and stimulant exposures. Integrated within the Core Registry, this initiative aims to equip the medical toxicology community with timely data and insights to address rapidly evolving substance use patterns and improve clinical responses. In 2024, the NOSE project was awarded a three-year funding renewal by the Opioid Response Network (ORN) and American Academy of Addiction Psychiatry (AAAP) .
Real-world Examination of Naloxone for Drug Overdose Reversal (RENDOR)
The Real-world Examination of Naloxone for Drug Overdose Reversal (RENDOR) project examines the real-world administration of opioid antagonists by community members, fire and police departments, and emergency medical services (EMS) personnel. The RENDOR project launched in San Francisco, CA; Detroit, MI; Portland, OR; and Pittsburgh, PA. In 2024, 800 cases were recorded. This initiative was made possible through funding awarded to ToxIC by the FDA Broad Agency Announcement (BAA).
The Direct-acting Oral Anticoagulant Treatment (DOACT)
The Direct-acting Oral Anticoagulant Treatment (DOACT) project is a ToxIC initiative aimed at understanding the clinical and logistical factors influencing treatment outcomes for patients with life-threatening hemorrhages caused by factor Xa inhibitors such as rivaroxaban or apixaban. DOACT leverages ToxIC’s multicenter network to collect detailed data on the use of andexanet alfa and prothrombin complex concentrate (PCC) across healthcare sites nationwide. Supported by ToxIC’s infrastructure, site investigators retrospectively enter cases into a dedicated registry, contributing to advancements in the management of acute hemorrhagic events. This project is supported through funding awarded by AstraZeneca.
Fentanyl Analog (Fentalog) Project
The ToxIC Fentanyl Analog (Fentalog) Project was initiated in 2020 and is funded by the National Institute on Drug Abuse (NIDA). Data has been collected on over 8,200 cases of suspected opioid overdose. Under the leadership of Alex Manini, MD, from the Icahn School of Medicine, ToxIC serves as the data coordinating center collecting information from 10 sites across the country. The Center for Forensic Sciences Research and Education (CFSRE) performs analysis on each biological specimen via liquid chromatography quadrupole time of-flight mass spectrometry (LC-QTOF-MS) that test for more than 1,200 drugs including a vast majority of novel psychoactive substances and metabolites. Over the last year, this study has been featured on the Centers for Disease Control and Prevention (CDC) website as one of their two nonfatal overdose dashboards.
The Drug Overdose Toxico-Surveillance (DOTS) Reporting Program
The Drug Overdose Toxico-Surveillance (DOTS) Reporting Program investigated cases of suspected opioid and stimulant overdose, and incorporated a patient interview, chart review, and comprehensive qualitative and quantitative laboratory testing for novel psychoactive drugs. DOTS has over 3400 cases to date from 17 participating sites across the United States.