Division of Medical Toxicology

History and Background

The Division of Medical Toxicology at Brigham Health was established in January of 2017. The mission of the Division of Medical Toxicology is to provide high quality, expert toxicological consultation services to Partners hospitals and outpatient clinics, develop educational programs for resident, medical students and attending physicians, and conduct innovative research in toxicology and its related comorbidities. The Division is integrated into the Harvard Combined Emergency Medicine Residency as well as the Harvard Medical Toxicology Fellowship. Division members maintain their clinical emergency medicine expertise at BWH and BWFH and see bedside consults at BWH and BWFH. Since its inception, the division of medical toxicology has expanded to include affiliate members at MGH and Boston Children’s hospital.

Activities/Initiatives

Education and Teaching

  • Development of HAEMR Program Toxicology Curriculum consisting of monthly conference presentations on the core topics of toxicology that commonly present to the Emergency Department
  • Establish HAEMR Toxicology Resident Elective
  • BCH Toxicology Fellow Program expanded to include BWH
  • Faculty at Partners Informatics Fellowship
  • Served as instructors for HMS introduction to clinical medicine course
  • Developed a national HMS CME Toxicology conference in partnership with BI, MGH, BCH. This Harvard CME event occurs annually in the Spring

Research and Scholarship

Fulbright US Scholars (E. Boyer)

  • Studies on Kratom in Malaysia. Kratom is a tropical tree native to Southeast Asia, with leaves that can have psychotropic effects. In recent years, people have used kratom as an herbal alternative to medical treatment in attempts to control withdrawal symptoms and cravings caused by addiction to opioids or to other addictive substances such as alcohol.

Federal funding: R01, K23, K24, DARPA, SBIR

  • R01 (E. Boyer) compares a digital pill containing antiretroviral medications to a common electronic adherence technology, a digital pillbox known as Wisepill. The degree of adherence will be confirmed by the gold standard measurement of dried blood spot concentrations of tenofovir and emtricitabine. The study population is HIV+ individuals with poor antiretroviral adherence and suffer from chronic pain.
  • K23 (P Chai): Building and pilot testing a smartphone-based behavioral intervention to respond to patterns of PrEP adherence detected by a digital pill in MSM with stimulant use.
  • Co-investigator on the IGNITE study (R01): MRI imaging to determine mechanisms of pain and spinal inflammation in individuals with acute and subacute back pain. This study randomizes people to minocycline, a potential glial anti-inflammatory agent versus control

NATO Science for Peace and Security grant, Ukraine (T Erickson)

Countermeasures to CBRN agents and Emerging Technologies: Advanced Training Response to Conflict and Security Challenges in East Ukraine.

  • Medical countermeasures against chemical, biological, radiological, nuclear (CBRN) agents;
  • Emerging technologies, including optical satellite technology, unmanned aerial vehicle (UAV drones), and other security-related technological advances.

Industry funding: United Technologies, Philips, Gilead Sciences

  • Philips: Testing operational feasibility of a wearable biosensor to measure biometrics and changes in ED obs patients
  • Gilead: Understanding optimization aspects and feasibility of using digital pills to measure PrEP adherence in MSM with substance use disorder.

Cross departmental research collaborations: Laboratory Medicine, Informatics and Anesthesia

  • DFCI (Hans and Mavis Loapter psychosocial fund): use of cannabidiol to mitigate anxiety surrounding diagnostic imaging in advanced breast cancer
  • Informatics/BWH iHub: deploying an IoT system to measure restroom cleanliness at BWH with expansion for wheelchair restocking for central transport, radiology restroom service and emergent imaging studies in the operating room

Over 30 toxicology-related peer-reviewed publications from the Division in 2017-2019

15 Scientific Toxicological national & international meeting abstract presentations

Clinical Care and Excellence (Interaction with other departments/Partners)

  • 24/7 Toxicology consulting service to BWH/F ED, ICU, Med wards, Outpatient clinics and DFCI
  • Provide attending physician back-up call to BCH Regional Poison Center
  • Invited grand rounds presentations to Critical Care, Laboratory Med & Internal Medicine, Nephrology

Innovation and Technology

  • Music Therapy for Pain Control and anxiolysis: studying the mechanist effects of music as an analgesic therapy, and understanding the psychosocial influencers that are affected by music
  • Digital pills to measure medication adherence
  • IoT buttons to deliver real-time notifications in hospital operations
  • Smart Glasses and Drones for Triage during Mass Casualty Incidents
  • Development and collaboration with global poison center in India
  • Development and collaboration with National Taiwan Poison Center
  • ART adherence and substance abuse interventions using kratom in Malaysia

Goals/Visions/Opportunities

  • Market the Toxicology Division to other BWH Departments
  • Increase band-width with Partners Org and other affiliate institutions (BCH/MGH/BI/DFCI/HHI/MIT)
  • Establish Toxicology Division within HMS system
  • Continue strong presence at national and international Toxicology conferences
  • Hire additional academic toxicology faculty member

Education and Teaching

  • Integrate Toxicology education with HAEMR residency training curriculum.
  • Help create an M-4 HMS Elective in Medical Toxicology
  • Recruit residents from the HAEMR program to apply to national Fellowship Programs
  • Display History of Toxicology exhibit at HMS Library, Center for Medical History
  • Partner with HHI scholarly on human rights and humanitarian response focused on prevention of chemical weapons
  • Present didactic Toxicology lectures to Medical Therapeutics course at Harvard College
  • Continue serving in advisory and thesis committees at HMS
  • Develop clinical consultation and educational opportunities in partnership with New England Aquarium

Research and Scholarship

  • At least two R01s, one K23, and one foundation grant submitted by divisional members
  • At least 5 research peer-review publications from each faculty member per year
  • Service on three Federal grant review panels
  • Help develop proposals for Federal funding from at least three academic BWH divisions
  • Drone research using unmanned aerial vehicles (UAV) to gather physical exams on patients remotely (collaboration with BIDMC Disaster, UMass Disaster and Stratus Center)
  • Ingestible sensors and music therapy (Sync) to decrease opioid use with chronic pain
  • Clinical research trials with new oncologic protocols and antidotes
  • Phase 2 NATO funding in Ukraine
  • Begin T32 proposal

Clinical Care and Excellence

  • Expand BWH, ED, ICU, and clinic system toxicology consulting service
  • Integrating digital health technologies to improve medication adherence monitoring
  • Develop & help raise funding for new Oncology ED at BWH

Innovation and Technology

  • Construct a state-of-the-art interactive web portal highlighting Divisional activities
  • Increase cross-divisional and institutional collaborations (e.g., Critical Care Med telemedicine initiative with federal penitentiary system, Anesthesia collaboration on music interventions, HIV/emergency department initiatives with The Fenway Institute)
  • Develop community outreach affiliations with local zoos, aquariums for public education
  • Develop and market visiting Middle East-sponsored Toxicology fellowship program
  • Continue development and collaboration with middle-low income countries poison centers in India and expand to include Taiwan and Ukraine

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