Department of Emergency Medicine Toxicology Division

Our Activities

Clinical: 

The Division of Toxicology leads the way in the treatment and management of patients with substance use disorder. As members of the New York City Department of Health and Mental Hygiene’s Opioid Prescribing Guidelines Clinical Advisory Group, we have launched the RELAY-Nonfatal Overdose Response System at The Mount Sinai Hospital, a support system for patients with non-fatal opioid overdoses. We also spearheaded buprenorphine initiation in the Emergency Department, and referral to opioid maintenance treatment programs. To address the medical needs of these patients, we collaborate with the Respectful and Equitable Access to Comprehensive Healthcare Program Clinic at The Mount Sinai Hospital and the Department of Social Work. These programs provide ongoing medical and drug addiction treatment planning. Similarly, at Elmhurst Hospital Center, the division coordinates the Emergency Department Leadership Education and Development program by providing evaluation and outpatient referrals to patients with substance abuse disorder. At both hospitals, we coordinate opioid prevention programs by distributing free naloxone kits to patients, families, and friends.

Medical toxicologists at Mount Sinai Morningside and Mount Sinai West provide bedside evaluation and treatment of the overdosed patient in the emergency department. 

Academic

We provide toxicology medical education at the local, national, and international levels.

  • Within the Icahn School of Medicine at Mount Sinai, we conduct the Introduction to Medical Toxicology elective for fourth-year medical students and teach in the Pathophysiology course for second-year medical students.
  • We participate in the master’s in clinical research and epidemiology course curriculum for culture and health and illness addressing health disparities. 
  • We act as liaison to the Center for Multicultural Community Affairs providing student mentorship.
  • In the Department of Emergency Medicine, we train resident physicians in medical toxicology through lecture series and simulation sessions. We also mentor senior emergency residents on the Medical Toxicology Track and support them through the educational, research, and toxicology fellowship application process.
  • We direct the didactics of the emergency medicine toxicology curriculum at both the Mount Sinai Hospital and Mount Sinai West / Mount Sinai Morningside residency programs.
  • We conduct interdisciplinary Grand Rounds for the Department of Medicine at multiple hospitals within the Mount Sinai Health System and at Elmhurst Hospital Center.
  • Our medical toxicologists collaborate with the New York City Poison Control Center in its annual Toxicology for the Emergency Practitioner course, monthly Consultants’ Conferences, and noon rounds.
  • Medical Toxicologists at Mount Sinai West and Mount Sinai Morningside are active on the American Board of Emergency Medicine Medical Toxicology sub-board.
  • As members of the American College of Medical Toxicology and the American Academy of Clinical Toxicology, our faculty members participate in national and international conferences and committees.
  • As experts in different topics in toxicology, division members participate as speakers in many national and international conferences and as authors in several textbooks.

Research and Grant Funding

The Division of Toxicology is engaged in a range of clinical research, and has examined areas such as drug cardiotoxicity, acetaminophen hepatotoxicity, and the effects of cannabidiol (CBD) on heroin craving in humans. The division at Elmhurst Hospital Center has received K-23 and National Institute on Drug Abuse RO1 research grants.

Research highlights include the following. For further details, see the Research Division <link to??>. 

  • Acetaminophen-induced hepatotoxicity: The predictive value of opiate co-ingestion and utility of aminotransferase biomarkers
  • Thromboelastography in acetaminophen toxicity: pre- and post-transplant.
  • Characterization of the acute and short-term effects of CBD administration on cue-induced craving in drug-abstinent heroin-dependent humans
  • Urgent competitive revision for research on the 2019 novel coronavirus (NIH supplemental grant, PI: Manini). To collect and examine data on the risks and outcomes from the disease caused by the 2019 novel coronavirus (COVID-19) in patients with opioid use disorder using the Toxicology Investigators Consortium (ToxIC).
  • Predicting medical consequences of novel fentanyl analog overdose using the Toxicology Investigators Consortium (NIH R01 grant, PI: Manini). The purpose of this R01 proposal is to deepen our knowledge of the primary cause of drug overdose deaths in the U.S. today: novel psychoactive synthetic opioids, the majority of which are fentanyl analogs.
  • Prevention of the cardiovascular medical consequences of drug overdose (NIH R01 grant, PI: Manini). Assessment of genetic screening, serum biomarkers of tissue/organ injury, and a clinical prediction rule to risk stratify for drug overdose susceptibility, overdose mortality, and in-hospital adverse events.

Administrative:

The division is part of the New York City Department of Health and Mental Hygiene’s Emergency Department Opioid Prescribing Guidelines Clinical Advisory Group. We are active on The Mount Sinai Hospital and Elmhurst Hospital Center Pharmacy and Therapeutics Committee and Medication Utilization Safety Committee.

Select recent publications from Toxicology Division faculty: 

  1. Schimmel J, Manini AF. Opioid use disorder and COVID-19: Biological plausibility for worsened outcomes. Subst Use Misuse. 2020. (Review) [Epub ahead of print]
  2. Shively R, Harding SA, Hoffman RS, Hill AD, Astua AJ, Manini AF. Rebound metabolic acidosis following intentional amygdalin supplement overdose. Clin Toxicol (Phila). 2020;58(4):290-293.
  3. Khan S, Meyers CM, Bentley S, Manini AF. Impact of targeted temperature management on ED patients with drug overdose-related cardiac arrest. J Med Toxicol. 2019;15(1):22-29.
  4. Anderson S, Oprescu AM, Callelo D, Monte A, Dayan PS, Hurd YL, Manini AF; on behalf of the ToxIC Investigators. Neuropsychiatric sequelae in adolescents with acute synthetic cannabinoid toxicity. Pediatrics 2019. 144(2). pii: e20182690.
  5. Taub ES, Hoffman RS, Manini AF. Incidence and risk factors for hyperlactatemia in ED patients with acute metformin overdose. Am J Emerg Med 2019;37(12):2205-2208.
  6. Carreiro S, Miller S, Wang B, Wax P, Campleman S, Manini AF. Clinical predictors of adverse cardiovascular events for acute pediatric drug exposures. Clin Toxicol (Phila) 2020;58(3):183-189.
  7. Shastry S, Manini AF, Richardson LD, Lin M. U.S. ED opioid-related visits increase, while use of medication for opioid use disorder undetectable, 2011-2016. J Gen Intern Med. 2020;35(3):965-966.
  8. Shastry S, Yeo J, Richardson LD, Manini AF. Observation unit management of low-risk emergency department patients with acute drug overdose. Clin Toxicol (Phila) 2020;58(7):773-776.
  9. Campleman SL, Brent J, Pizon AF, Shulman J, Wax P, Manini AF; on behalf of the Toxicology Investigators’ Consortium (ToxIC). Drug-specific risk of severe QT prolongation following acute drug overdose. Clin Toxicol (Phila). 2020;1-9. [Epub ahead of print]
  10. Manini AF, Gibson CL, Miller ML, Richardson LD, Vargas-Torres CC, Vedanthan R, Hurd YL. Biomarkers of endothelial dysfunction in cocaine overdose and overdose-related cardiovascular events. Addict Biol. 2020; e12901. [Epub ahead of print]
  11. Clifford C, Sethi M, Cox D, Manini AF. First-line vasopressor and mortality rates in ED patients with acute drug overdose. J Med Toxicol. 2020. [Epub ahead of print]
  12. Shastry S, Ellis J, Vedanthan R, Richardson LD, Manini AF. Antidotal sodium bicarbonate therapy: Delayed QTc prolongation and cardiovascular events. J Med Toxicol. 2020. [Epub ahead of print]