Journal of Medical Toxicology and Clinical Forensic Medicine

Description

The American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC) Core Registry in 2010. With the agreement that all bedside and telehealth medical toxicology consultations will be entered, the Core Registry collects data from participating sites. The registry's 2021 data and activity, including the additional 8552 cases, are compiled in this twelfth annual report. A query of the ToxIC database for any case entered between January 1 and December 31, 2021, identified cases for inclusion in this report. These cases' demographics, the reason for the medical toxicology evaluation, the agent and agent class, the clinical signs and symptoms, the treatments and antidotes administered, mortality, and whether life support was removed were all gathered into comprehensive data for the purpose of providing information. 50.4% of cases were experienced by females, 48.2% by males, and 1.4% by transgender or gender non-conforming individuals. The most frequently reported agent class was non-opioid analgesics (14.9 percent), followed by opioids (13.1 percent). Acetaminophen was the most frequently mentioned drug. Fentanyl was the opioid that was reported the most frequently and caused the most fatalities. 120 people died, which was 1.4% of all cases. Major demographic and exposure characteristics trends were consistent with previous years' reports. New demographic characteristics, such as marital status, housing status, and military service, the ongoing COVID-19 pandemic and related toxicologic exposures, as well as novel substances of exposure, were described through sub-analyses. In 2021, the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) Core Registry received 8552 individual cases from 55 distinct health care facilities spread across 34 locations. The Core Registry contained 87,790 cases as of December 31, 2021.

COVID-19 Pharmacovigilance

The ToxIC initiatives for 2021 included expanding the number of registry sites that participated, initiating brand-new research projects, and maintaining support for and expanding existing research initiatives. Five new sites were welcomed by the registry, and a new research partnership program called "Novel Opioid and Stimulant Exposures (NOSE)" was launched. Additionally, ToxIC aided in the expansion of two ongoing research partnerships that were established in 2020: the FDA ACMT COVID-19 Pharmacovigilance Project and the ToxIC Fentalog Project (FACT). In cooperation with the Opioid Response Network (ORN), the ToxIC Novel Opioid and Stimulant Exposures (ToxIC NOSE) project began in 2021 with funding from the American Association of Addiction Psychiatry. ToxIC improved the sentinel event detection instrument as a result of this collaboration to better identify and characterize novel opioid and psychostimulant exposures. Quarterly reports highlighting novel exposures and intriguing trends in novel opioid and stimulant exposures reported to the registry are based on these data. In addition, the project provides ACMT and ORN members with educational outreach in the form of webinars and tweetchats on topics related to ToxIC NOSE reports. Since its inception in January 2021, the NOSE project has published quarterly online reports that highlight intriguing cases and trends. Alex Manini, MD, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai and a longtime collaborator of ToxIC, is leading a prospective clinical study of opioid overdoses in the emergency department that will last for five years and is supported by the National Institutes of Health National Institute on Drug Abuse (NIH NIDA, Award Number R01DA048009). The prevalence of fentalogs, novel psychoactive drugs, adulterants, and other substances in the clinical presentation and treatment of opioid overdose patients is being investigated by ToxIC. In addition to this grant, ToxIC is collaborating with Mount Sinai Health System on the collection of specific COVID-19 infection-related data from opioid-addicted patients.

The ToxIC Fentalog Project, which connected clinical data with information about substances and illicit drug analytes, saw the entry of 406 cases all the way through 2021. The project has resulted in the publication of thirteen abstracts and one manuscript in the Morbidity and Mortality Weekly Report that discuss the co-exposure of opioid-susceptible patients to illegal benzodiazepines. This year, the Fentalog Project will be submitting additional peer-reviewed publications. ToxIC and the US Food and Drug Administration (US FDA) collaborated to implement a real-time national toxicosurveillance project during the COVID-19 pandemic to look for adverse drug events related to COVID-19 treatment or prevention: the FACT Pharmacovigilance Project of the FDA ACMT COVID-19 ToxIC. The project recorded 851 adverse events related to the treatment or prevention of COVID-19 by the end of 2021. Ivermectin-related adverse events for COVID-19 treatment have been described in six abstracts and one published manuscript by the project. This year, project collaborators intend to submit more publications that have been reviewed by peers. In 2021, nine complete ToxIC publications were published in four different journals. Thirty ToxIC abstracts from national and international conferences were published. This is the most abstracts using the ToxIC Registry that have been published to date. In 2021, 24 brand-new ToxIC projects were launched. Nine researchers started projects for the North American Snakebite Registry, while fifteen researchers started projects for the Core Registry.

Toxicologic Exposures

ToxIC received funding in 2021 from the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and BTG International, Inc. These collaborations have been enriching for ToxIC, but they have also provided investigators with unique networking opportunities. This year, in addition to providing a summary of the data from the Core Registry, we are also looking into the distribution of brand-new demographic variables, the ongoing effects of the COVID-19 pandemic on toxicologic exposures, and emerging opioid and stimulant trends. The Core Registry and additional surveillance projects are just two examples of the ToxIC project's ongoing expansion and development. Because it represents prospective data gathered from cases evaluated by medical toxicologist specialists, the Core Registry remains unique among databases. Even though this feature prevents extrapolation to the entire population, it makes it more likely that high-quality data will be collected and that there will be a stronger correlation between exposure cases and clinical findings. The prospective nature of the registry also makes it possible for research efforts to examine how trends in toxicology shift during concurrent public health crises. The Core Registry and ToxIC continue to place a strong emphasis on efforts to improve quality and conduct surveillance.