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About the Toxicology Investigators Consortium (ToxIC)

Background and Purpose

The Toxicology Investigators Consortium (ToxIC) is a multicenter toxico-surveillance and research network comprised of physicians specifically qualified in the field of medical toxicology. Conceived of in 2009 by Drs. Jeffrey Brent and Paul Wax, ToxIC was initiated on Jan 1, 2010 with six participating sites. Since that time ToxIC has grown to approximately 50 participating sites comprised of nearly 100 hospitals and clinics. Currently, the great majority of medical toxicology practices and training programs in the U.S. are active ToxIC participants. 

ToxIC functions under the auspices of the American College of Medical Toxicology (ACMT), the professional society of physicians specializing in that discipline. ToxIC has four pillars: Infrastructure, Research, Industry, Toxicovigilance.  As currently constructed, ToxIC consists of a multi-center research group and multiple case registries. The research group is designed to provide an infrastructure for research and other data gathering projects and ToxIC sites participate in these multi-center activities on an as needed basis depending upon the design of particular projects.

The ToxIC Core Registry was designed to address the lack of accurate and reliable data on adverse effects deriving from exposures to medications, drugs of abuse, natural substances, metals, pesticides, or other chemical substances (“chemicals”). Because all cases entered into the ToxIC Registry have been formally evaluated by medical toxicologists the toxicological data is expected to be, by design, of extremely high quality. 

For over a decade, ToxIC has been successfully managing and adapting its registry to serve as a database for public health surveillance and emerging exposures within the field of toxicology. An example of this was highlighted during a national outbreak of young and otherwise healthy patients presenting to various emergency departments with severe lung injury after THC and/or nicotine e-cigarette use. ToxIC was able to create and implement an additional data collection system to gather more specific information about product use patterns, clinical symptoms, radiological and laboratory findings, and outcomes from this exposure. This information served as a tool to discuss these cases with public health partners. 

Data Collection Practices

As a condition of participation ToxIC sites must agree to enter all cases formally consulted on by their medical toxicologists. The design of ToxIC, therefore, is such that the data collected is representative of significant toxicologic disease at the participating sites. Because cases of exposure to chemicals that do not require a medical toxicology consultation are not currently reflected in the ToxIC Registry, the data contained therein represents those cases of exposure that are associated with significant medical consequences.

Currently cases are added to the ToxIC Registry at a rate of approximately 150 per week. Since its inception ToxIC has accumulated data on over 50,000 cases. All data collected is completely depersonalized and protected information under the Health Insurance Portability and Accountability Act is not collected. The data is entered on a secure password protected electronic interface maintained by ACMT.

Research Applications

As a toxico-surveillance network ToxIC can detect new and emerging drugs of abuse, adverse effects of new medications in the post-marketing phase, and emerging toxicological syndromes. As an example of its  toxico-surveillance capabilities,  ToxIC recently  detected a surge of cases brought to medical attention related to use of new synthetic cannabinoid receptor agonists. This was brought to the attention of the U.S. Centers for Disease Control and Prevention and was published in its Monthly Morbidity and Mortality Monthly Reports (MMWR) {insert link}. That report exceeded the 99th percentile in press and internet mentions deriving from MMWR reports.

Since its inception over 200 abstracts based on ToxIC data have been published and presented at national and international meetings. Approximately 60 full ToxIC manuscripts have been published or are in submission and several are actively in preparation.

ToxIC has a number of focused research projects currently underway. Several of these are prospective data collections in specific project-dedicated sub-Registries. For example, the North American Snakebite Sub-Registry is overwhelmingly the most detailed systematic prospective collection of clinical data on these snakebites that has ever been collected. Currently that sub-Registry contains detailed data on the presentation, treatment and outcomes of over 1500 snakebites. 


Current funding for ToxIC comes from grants from the National Institute of Health, a data-sharing contract with the U.S. Food and Drug administration, and a grant generously provided by BTG International.

About the American College of Medical Toxicology (ACMT)

The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of more than 600 physicians with recognized expertise in medical toxicology. In 1993 the American Board of Medical Specialties (ABMS) formally recognized Medical Toxicology as a medical specialty. In that same year ACMT was founded as the primary organization to serve physicians who are board certified as Medical Toxicologists. Medical Toxicology is a medical subspecialty focusing on the diagnosis, management and prevention of poisoning and other adverse health effects due to medications, drug overdose, acute drug abuse problems, chemical exposures, occupational and environmental toxins, biological agents and envenomations.
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