Clinical Toxicology
ISSN: 0009-9309 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ictx18
Institute of Clinical Toxicology To cite this article: (1975) Institute of Clinical Toxicology, Clinical Toxicology, 8:1, 111-122, DOI: 10.3109/15563657508988052 To link to this article: http://dx.doi.org/10.3109/15563657508988052
Published online: 25 Sep 2008.
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Date: 06 November 2015, At: 07:17
CLINICAL TOXICOLOGY 8(1), pp. 111-122 (1975)
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NEWS ITEM
Institute of Clinical Toxicology
Academic Year 1974-75
INTRODUCTION The Institute of Clinical Toxicology, located in Houston, Texas,
is a nonprofit organization established for the purpose of research, teaching and delivery of services in the a r e a of clinical toxicology. Clinical toxicology is a medical subspecialty dealing with diseases caused by drugs and other toxic substances, and with illnesses commonly associated with the abuse and misuse of such agents. The professional staff of the Institute consists of physicians and scientists with special expertise in areas concerned with diseases of toxic etiology. In addition, an extensive consulting faculty of prominent experts from throughout the world serves the Institute by providing professional guidance concerning its current and ongoing research and education activities. PUBLICATIONS The Clinical Toxicology Bulletin is published quarterly by the Institute. Current information in the field of clinical toxicology and related research is made available to subscribers who include physicians, pharmacists, nurses, and those in other health care disciplines. Volume 4 of the Clinical Toxicology Bulletin will be issued in 1974. Another vehicle for the Institute's program of informing and educating the professional community about toxicologic problems is
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a monthly newsletter which details the current progress of the Institute. The Emergency Drug Formulary for Acute Poisonings is a wall chart designed to guide pharmacists and hospital emergency room staffs to the minimum essential substances for the treatment of acute intoxication. This formulary is recommended for use in all pharmacies and emergency rooms likely to encounter acute poisonings. The staff and the Consulting Faculty of the Institute collaborate in the annual updating of the Formulary. T R A I N I N G AND E D U C A T I O N Since 1972, the Institute has provided training opportunities for medical students through formal course work and six-week clerkships in clinical toxicology. Elective courses and seminars are provided for students in local colleges on drug abuse, treatment of poisoning, occupational toxicology, pharmacology of addiction, analytical toxicology, and seminars on current literature. CONTINUING EDUCATION PROGRAMS
1. One month full time training in selected aspects of diagnosis treatment o r clinical research. Tuition is required. 2. Three-month clinical and/or laboratory service programs permit full time application to selected activities such as treatment of drug abuse, emergency information and consultation services, occupational and environmental toxicology, laboratory diagnostic methods, o r selected intensive laboratory o r clinical research projects. No tuition required. 3. One year Clinical Toxicology fellowships which provide intensive training and clinical experience with all aspects of diseases caused by toxic substances and drugs and management of associated disorders. Upon completion of the one-year program, the physician is expected to be able to organize a clinical toxicology program in his community. Limited number of stipends are available. 4. Seminars and workshops organized periodically to provide 2-3 day intensive training in well-defined areas of special clinical inter est. Programs are supported by registration and are open to all interested persons. Recent programs have been: Emergency Treatment of Poisoning and Drug Overdose and Drug Abuse, May 1-2, Chicago, 1972.
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Institutional Consortium on Endemic Lead Poisoning, May 3-4, Chicago, 1972. Advances in Analytical Toxicology, December 3, 4, 5, Houston,
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1973.
Clinical Perspectives on Non-Narcotic Drug Abuse, May 20-22, Houston, 1974. Workshops on Psychodrama in Drug.Abuse Treatment, May 22, 23, Houston, 1974. I C T SERVICE PROGRAMS I C T POLYDRUG ABUSE T R E A T M E N T PROGRAM Physical Facilities The ICT Polydrug Abuse Treatment Program is operated by the Institute of Clinical Toxicology and is located on the ninth floor of Center Pavilion Hospital, immediately adjacent to the Texas Medical Center in Houston, Texas. The unit is a controlled access facility with six single rooms and four double rooms for a total of fourteen beds. Ten of these beds are funded through a grant from the National Institute on Drug Abuse (NIDA) for the study and treatment of nonnarcotic drug abuse. In addition to administrative and secretarial offices, there are two conference rooms, an examination room and EEG and observation room, a dining and recreational area and a psychodrama stage. The total floor space is 7500 square feet. Professional Staff The treatment program is staffed 24 hours a day, seven days a week Each shift employs a minimum of one nurse and two orderlies, and the day shift is supplemented with two psychiatric nurses. Other members of the professional staff include the following: Eric G. Comstock, M.D., Principal Investigator and Clinical Toxicologist Betsy S. Comstock, M.D., Co-Principal Investigator and Psychiatrist Travis Peterson, ACSW, Program Manager Gary Byrd, M.D., Psychiatrist Harlan Nevin, M.D., Internist Thomas Faulkner, Ph.D., Toxicology Laboratory Director
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James W. Hayden, Ph.D.,
Toxicologist
Freeda Biggs, RN, MSN, Nursing Supervisor
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Margaret McDermott, ACSW, Social Worker Dona Dooyema, RN, MSN, Group Therapist and Psychodrama Leader Treatment Protocol The ICT Polydrug Abuse Treatment Program serves as a detoxification facility for individuals dependent on nonnarcotic drugs. Included in this nonnarcotic category are sedatives, hypnotics, stimulants, and tranquilizers. Individuals dependent on alcohol or narcotics (e.g., heroin) are treated only if there is a simultaneous dependency on a nonnarcotic drug. The Detoxification schedule proceeds through the following steps: 1. Admission and initial maintenance. During this period the patient is admitted to the Unit, and urine and blood specimens are collected and sent to the toxicology laboratory for screening. The patient is maintained for approximately one day on the implicated drug of abuse while he is given an extensive examination which includes an EKG, chest x-ray, and appropriate clinical laboratory work. Also during this period, the patient is interviewed by one of the two psychiatrists at the Unit. 2. Titration to toxicity. When the clinical and toxicologic data have been evaluated, the patient is "titrated" to a state of mild intoxication in order to determine his tolerance to his drug of abuse. In this procedure, the patient is given one to two times the normal therapeutic dose of the drug per hour until clinical signs of intoxication become apparent (e.g., nystagmus for sedative drugs). Blood samples are collected during the titration, at toxicity, and after toxicity until the next dose of drug is administered. 3. Withdrawal. The results of the titration procedure are used to determine a maintenance dosage of the abused drug, then this dosage is decreased approximately 10% per day until-the patient is drug free. Blood samples are collected as necessary during this period for half-life estimation o r as a guide to the EEG sleep studies. After a minimum of usually two days of drug-free maintenance the patient is discharged to an appropriate community agency. 4. Follow-up. Patients are asked to return to the Unit at a specified time after discharge. During this visit a urine specimen is collected for analysis by the Toxicology Laboratory. Throughout the entire detoxification procedures the patient is exposed to intensive psychotherapy in the form of group therapy and
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psychodrama. Clinical conferences are held regularly to achieve maximum integration among the various disciplines involved in the evaluation and treatment of the patient. Analytical Toxicology Laboratory Texas Southern U n i v e r s i t y S c h o o l of P h a r m a c y The School of Pharmacy of Texas Southern University maintains a Toxicology Laboratory for the identification and quantitative determination of dangerous drugs and heavy metals. The laboratory occupies approximately 700 sq. ft. and is equipped with a variety of analytical instruments including gas chromatographs, ultraviolet, visible and infrared spectrophotometers, a spectrophotofluorometer, a liquid scintillation counter, and an atomic absorption spectrophotometer. Capability is also provided for the identification of toxic substances by thin layer chromatography. The laboratory performs a dual function in providing toxicology services for patients hospitalized at the ICT Treatment Unit and the H a r r i s County Psychiatric Hospital and in serving as a research faculty for the investigation of diseases of toxic origin in man. Emergency Drug Abuse and Poisoning Consultation Program The staff of the Institute is available to provide consultation for physicians, drug treatment programs, and the lay public concerning significance of drug issues and treatment guidance for medical emergencies. The Institute maintains elaborate files on toxicology. Outreach consultation allows fellows to attend drug abuse emergencies in local emergency rooms and to assist in the continuing c a r e in intensive treatment facilities under the guidance of the Director. Alcohol and Heroin Detoxification P r o g r a m A short-term detoxification program for heroin and alcohol addiction is carried out in 14 inpatient beds at the H a r r i s County Psychiatric Hospital under the direction of Eric Comstock, M.D. Ten to 14 days are used for pharmacologic detoxification while group therapy and individual counseling is utilized to give insight into the addictive phenomenon and to develop plans for continuing c a r e in other community agencies.
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L i t e r a t u r e Surveillance on T r e a t m e n t The combined efforts of the staff of the institute are used to identify publications occurring in the current medical literature which make significant contributions to the state of the art of treatment of diseases related to drugs and other toxic substances. Commentary of these publications appears in the section of the Clinical Toxicology Bulletin titled "Current Commentary." Occupational Toxicology Services Inpatient and outpatient facilities are available for diagnosis and treatment of diseases related to occupational exposure to potentially hazardous substances. The toxicology and clinical laboratory provide analyses of toxic substances and other biologic parameters useful in the monitoring of occupational hazards. Medico- Legal and F o r e n s i c Toxicology The staff of the Institute provides consultation and research relevant to toxic substances in the medical-legal and forensic context. Drug Investigation Facilities and staff are available for evaluation of safety and efficacy of sedative, hypnotic and psychotropic drugs in humans. Bioavailability, pharmacokinetic and sleep EEG studies regularly are performed.
COURSES
-
ACADEMIC YEAR 1 9 7 4 - 7 5
101 Introduction to Clinical Toxicology
- 20 hr
Lecture course covers diseases caused by toxic substances and associated medical and psychopathology, information sources, clinical and laboratory diagnostic techniques and principles of treatment, Course is designed for medical students and pharmacy students. 102 Drug Abuse and Addiction - 20 hr Lecture course covers the phenomenon of habituation and addiction,
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substances commonly abused and their effects, review of treatment including inpatient residential and outpatient modalities. Subjects include solvents, alcohol, opiates and nonopiate drugs. Course is designed for students of medicine, pharmacy, social work, and public health.
-
103 Occupational Toxicology and Economic Poisons 20 hr Lecture course covers prevention, diagnosis and treatment of common occupational hazards including solvents and other organics, metals, pesticides, and herbicides, Clinical and laboratory methods for surveillance of populations at risk are discussed. Course is designed for undergraduate and graduate biomedical disciplines.
104 Pharmacology of Tolerance and Addiction - 20 h r Lecture course on assessment of addictive potential of drugs in animals and man, clinical, pharmacologic and neuropsychiatric collates of addiction, and pharmacology and pharmacokinetics of drugs in human tolerance. Course is designed for students of medicine, pharmacy, and pharmacology.
105 Analytical Toxicology - 20 hr Lecture course on principles of chemical and instrumental analysis of drugs and other toxic substances, their metabolites and biologic effects of diagnostic significance and their interpretation. Course is designed for experienced medical technologists and students of medicine, pharmacy and biomedical sciences. 106 Seminar on Current Literature - 4 h r per month 50 to 100 selected reprints of current publications on diagnosis and treatment of poisoning and drug abuse are received by the Institute each month. A two-hour evening seminar is held biweekly for review and discussion of the most significant current contributions. Attendance is open to any interested person. 201 Practice of Clinical Toxicology
Six week full time clerkship for medical students provides experience with inpatient and outpatient programs for treatment of drug abuse, emergency toxicology, and attendance of the occupational toxicology clinic. 202 Epidemiology of Drug Abuse
Six week full time clerkship devoted to studies on incidence of drug abuse in various populations including schools, colleges, emergency rooms, crisis clinics, and other community social service agencies.
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Data collection consists of record reviews and client social and drug history interviews. Accumulated data contribute to the current awareness program of surveillance of drug abuse trends in the Houston area. The program is open to students of public health, social service, pharmacy, and nursing. 203 Special Research Six week full time research clerkship allows the student to pursue intensively a highly restricted research project in any area associated closely with the ongoing research programs of the Institute and to compile a report on his project. The subject area may be either clinical laboratory or basic science. Eligibility is determined individually. 301 Clinical or Laboratory Training Programs, 4 wk, tuition - $350 Specialized programs providing intensive training in highly restricted aspects of clinical or laboratory activities are provided on an individually designed basis for professionals currently engaged in service delivery. The purpose is to supplement o r to generate specific skills. Typical areas are chemotherapy of addiction, psychotherapeutic techniques for inpatient drug abuse treatment, trace element analysis, radioimmunoassay, thin layer and gas chromatographic analysis of drugs and their metabolites, and gas chromatographicmass spectrometric analysis of drugs. Registration limited to one person per subject area per month. Tuition is required to cover supplies and staff time displacement. Training is on a one-to-one basis with an ICT staff member. 12 wk full time, tuition - free Twelve-week training programs are designed in accordance with individual needs to provide supplementary training for professionals currently active in service delivery. The full spectrum of training resources of the Institute are available. A tuition-free 12-week program is possible by the expectation that clinical services delivered by the trainee will offset staff time required. 303 Clinical Toxicology Fellowship - One-year full time, stipend $12.000 The one-year clinical toxicology fellowship is designed to build upon previous postgraduate medical training for physicians wishing to pursue a career in service and research in clinical toxicology. The fellow will rotate through the full spectrum of activities of the Institute, will assume primary patient c a r e responsibilities under '
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the supervision of the Director and the clinical staff and will assist in preparation and delivery of teaching programs. It is anticipated that this program will prepare the physician for certification in clinical toxicology when a certifying mechanism is developed by the American Academy of Clinical Toxicology. The program will f i r s t be available for the academic year 1974-75.
304 Research in Toxicology One-year full time postdoctoral program for .nonphysician graduates in pharmacy and biomedical sciences. Stipend to be determined. A one- to two-year program designed to assist in the development of a career in research in basic sciences and/or clinical investigation in areas related to human toxicology, analytical toxicology, drug research, pharmacology, and neurophysiology of tolerance and addiction. Training and research activities are individually designed in consultation by applicant with appropriate staff members. CONSULTING FACULTY The following is a list of the Consulting Faculty of the Institute of Clinical Toxicology: Julian D. Acland Walsall WS 2 9 PS England
Fred W. Clayton, D.V.M. Bethesda, Maryland
Herbert C. Anderson, Jr. Raynesford, Montana
Betsy S. Comstock, M.D. Houston, Texas
Emilio Astolfi, M.D. Bueonos Aires, Argentina
Joseph H. Davis, M.D. Miami, Florida
John Autian, Ph.D. Memphis, Tennessee
Walter J. Decker, Ph.D. Fort Sam Houston, Texas
Newton C. Birkhead, M.D., Ph.D. Tuckahoe, New York
David G. Doherty Oak Ridge, Tennessee
Jules Bohnn, M.D. Houston, Texas
William Campbell Douglass, M.D. Sarasota, Florida
John Kennedy Brown, Ph.D. Stockton, California
John Doull, M.D., Ph.D. Kansas City, Kansas
Robert Bucklin, M.D., J.D. L a Jolla, California
S. Albert Edwards, Pharm. D. Houston, Texas
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Matthew J. Ellenhorn, M.D. Beverly Hills, California
William J. Kinnard, Ph.D. Baltimore, Maryland
Henry W. Elliott, M.D., Ph.D. Orange, California
J a n e t P. Kramer, M.D. Wilmington, Delaware
Thomas Faulkner, Ph.D. Houston, Texas
Yves Lacasse, M.D. St-Zotique, Montreal
David C. Fenimore, Ph,D. Houston, Texas
Robert F. Lash, M.D. Knoxville, Tennessee
Nancy Elizabeth Gary, M.D. New York, New York
Lawrence J. Lesko, Ph.D. Boston, Massachusetts
George R Gay, M.D. San Francisco, California
H a r r y Shepherd Lipscomb, M.D. Houston, Texas
Vernon A. Green, Ph.D.
Kansas City, Missouri
J a m e s Lumeng, M.D. Honolulu, Hawaii
J a m e s Guilford, Ph. D. Houston, Texas
George D. Lundberg, M.D. Los Angeles, California
William T. Haeck, M.D. Jacksonville, Florida
Charles B. Maclean, Ph.D. E. Lansing, Michigan
William B. Harrell, Ph.D, Houston, Texas
Matilda S. McIntire, M.D. Omaha, Nebraska
J a m e s W. Hayden, Ph.D. Houston, Texas
Ewen Garth McQueen, Ph. D., M.R., B.S., F.R.C.P. Dunedin, New Zealand
Robert C. Hoppe, M.D. Philadelphia, Pennsylvania Page Hudson, M.D. Chapel Hill, North Carolina
Peter I. Jatlow, M.D. New Haven, Connecticut
Joel B. Mann, M.D. Miami, Florida Anthony P. Markello, M.D. Buffalo, New York
Roy Elton Joyner, M.D. Houston, Texas
Joseph F. Martin&, M.D. Augusta, Maine
Sidney Kaye, Ph.D. San Juan, Puerto Rico
Henry Matthew, M. B., Ch. B. Edinburg, Scotland
Milton 0. Kepler, M.D. Houston, Texas
George Edward Mawer Manchester, England
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NEWS ITEM Howard C. Mofenson, M.D. Mineola, New York
G. Alan Robison, Ph.D. Houston, Texas
F e r r i n Moreland, Ph.D. Houston, Texas
Joseph C. Schoolar, Ph.D., M.D. Houston, Texas
Albert S. Moraczewski, O.P., Ph. D. Houston, Texas
Edward C. Senay, M.D. Chicago, Illinois
E. Napke, M.D. Ottawa, Ontario Harlan Nevin, M.D. Houston, Texas
Harrison E., Ph.D. Rochester, New York Milan Slavik, M.D., Ph.D. Bethesda, Maryland
R Thomas Solis, M.D. Houston, Texas
Frederick A. Oehme, D. V. M. Manhattan, Kansas
David E. Smith, M.D. San Francisco, California
JohnE. Ott, M.D. Denver, Colorado
Joseph T. Sobota, M.D. Kalamazoo, Michigan
John E. Overall, M.D. Galveston, Texas
Jane H. Speaker, Director Philadelphia, Pennsylvania
John J. Pepper, M.D. Nutley, New J e r s e y
Herbert Eli Spiegel, Ph.D. Nutley, New J e r s e y
Albert L. Picchioni, P b D . Tucson, Arizona
John J. Spikes, Ph.D. Houston, Texas
Richard T. Rappolt, Sr., M.D. San Francisco, California
William Q. Sturner, M.D. Dallas, Texas
Gerald Ratinov, M.D. Houston, Texas
Daniel T. Teitelbaum, M.D. Denver, Colorado
David S. Rausten, M.D. National City, California
F o r e s t S. Tennant, Jr., M.D. M.P.H. Los Angeles, California
Osvaldo Norbert0 Re, M.D. Northridge, California
Clinton H. Thienes, M.D., Ph.D. Sherman Oaks, California
Helmut M. Redetzki, M.D. Shreveport, Louisiana
Mark Thomas, M.D. Des Moines, Iowa
Thomas A. Rejent Buffalo, New York
M. J. Valaske, Capt., MC, USN Bethesda, Maryland
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Carlos Vallbona, M.D. Houston, Texas
James E. Weaver, Ph.D. Cincinnati, Ohio
Kenneth L. Vaux, Dr. Theo. Houston, Texas
Patrick R. Wells, Ph.D. Houston, Texas
William C. Waggoner, Ph.D. New Brunswick, New Jersey
Donald R. Wesson, M.D. San Francisco, California
Jack E. Wallace, Ph.D.
Charles L. Winek Pittsburgh, Pennsylvania
San Antonio, Texas
ISSN: 0009-9309 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ictx18
Institute of Clinical Toxicology To cite this article: (1975) Institute of Clinical Toxicology, Clinical Toxicology, 8:1, 111-122, DOI: 10.3109/15563657508988052 To link to this article: http://dx.doi.org/10.3109/15563657508988052
Published online: 25 Sep 2008.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ictx18 Download by: [University of California, San Diego]
Date: 06 November 2015, At: 07:17
CLINICAL TOXICOLOGY 8(1), pp. 111-122 (1975)
Downloaded by [University of California, San Diego] at 07:17 06 November 2015
NEWS ITEM
Institute of Clinical Toxicology
Academic Year 1974-75
INTRODUCTION The Institute of Clinical Toxicology, located in Houston, Texas,
is a nonprofit organization established for the purpose of research, teaching and delivery of services in the a r e a of clinical toxicology. Clinical toxicology is a medical subspecialty dealing with diseases caused by drugs and other toxic substances, and with illnesses commonly associated with the abuse and misuse of such agents. The professional staff of the Institute consists of physicians and scientists with special expertise in areas concerned with diseases of toxic etiology. In addition, an extensive consulting faculty of prominent experts from throughout the world serves the Institute by providing professional guidance concerning its current and ongoing research and education activities. PUBLICATIONS The Clinical Toxicology Bulletin is published quarterly by the Institute. Current information in the field of clinical toxicology and related research is made available to subscribers who include physicians, pharmacists, nurses, and those in other health care disciplines. Volume 4 of the Clinical Toxicology Bulletin will be issued in 1974. Another vehicle for the Institute's program of informing and educating the professional community about toxicologic problems is
111
NEWS ITEM
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112
a monthly newsletter which details the current progress of the Institute. The Emergency Drug Formulary for Acute Poisonings is a wall chart designed to guide pharmacists and hospital emergency room staffs to the minimum essential substances for the treatment of acute intoxication. This formulary is recommended for use in all pharmacies and emergency rooms likely to encounter acute poisonings. The staff and the Consulting Faculty of the Institute collaborate in the annual updating of the Formulary. T R A I N I N G AND E D U C A T I O N Since 1972, the Institute has provided training opportunities for medical students through formal course work and six-week clerkships in clinical toxicology. Elective courses and seminars are provided for students in local colleges on drug abuse, treatment of poisoning, occupational toxicology, pharmacology of addiction, analytical toxicology, and seminars on current literature. CONTINUING EDUCATION PROGRAMS
1. One month full time training in selected aspects of diagnosis treatment o r clinical research. Tuition is required. 2. Three-month clinical and/or laboratory service programs permit full time application to selected activities such as treatment of drug abuse, emergency information and consultation services, occupational and environmental toxicology, laboratory diagnostic methods, o r selected intensive laboratory o r clinical research projects. No tuition required. 3. One year Clinical Toxicology fellowships which provide intensive training and clinical experience with all aspects of diseases caused by toxic substances and drugs and management of associated disorders. Upon completion of the one-year program, the physician is expected to be able to organize a clinical toxicology program in his community. Limited number of stipends are available. 4. Seminars and workshops organized periodically to provide 2-3 day intensive training in well-defined areas of special clinical inter est. Programs are supported by registration and are open to all interested persons. Recent programs have been: Emergency Treatment of Poisoning and Drug Overdose and Drug Abuse, May 1-2, Chicago, 1972.
NEWS ITEM
113
Institutional Consortium on Endemic Lead Poisoning, May 3-4, Chicago, 1972. Advances in Analytical Toxicology, December 3, 4, 5, Houston,
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1973.
Clinical Perspectives on Non-Narcotic Drug Abuse, May 20-22, Houston, 1974. Workshops on Psychodrama in Drug.Abuse Treatment, May 22, 23, Houston, 1974. I C T SERVICE PROGRAMS I C T POLYDRUG ABUSE T R E A T M E N T PROGRAM Physical Facilities The ICT Polydrug Abuse Treatment Program is operated by the Institute of Clinical Toxicology and is located on the ninth floor of Center Pavilion Hospital, immediately adjacent to the Texas Medical Center in Houston, Texas. The unit is a controlled access facility with six single rooms and four double rooms for a total of fourteen beds. Ten of these beds are funded through a grant from the National Institute on Drug Abuse (NIDA) for the study and treatment of nonnarcotic drug abuse. In addition to administrative and secretarial offices, there are two conference rooms, an examination room and EEG and observation room, a dining and recreational area and a psychodrama stage. The total floor space is 7500 square feet. Professional Staff The treatment program is staffed 24 hours a day, seven days a week Each shift employs a minimum of one nurse and two orderlies, and the day shift is supplemented with two psychiatric nurses. Other members of the professional staff include the following: Eric G. Comstock, M.D., Principal Investigator and Clinical Toxicologist Betsy S. Comstock, M.D., Co-Principal Investigator and Psychiatrist Travis Peterson, ACSW, Program Manager Gary Byrd, M.D., Psychiatrist Harlan Nevin, M.D., Internist Thomas Faulkner, Ph.D., Toxicology Laboratory Director
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114
James W. Hayden, Ph.D.,
Toxicologist
Freeda Biggs, RN, MSN, Nursing Supervisor
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Margaret McDermott, ACSW, Social Worker Dona Dooyema, RN, MSN, Group Therapist and Psychodrama Leader Treatment Protocol The ICT Polydrug Abuse Treatment Program serves as a detoxification facility for individuals dependent on nonnarcotic drugs. Included in this nonnarcotic category are sedatives, hypnotics, stimulants, and tranquilizers. Individuals dependent on alcohol or narcotics (e.g., heroin) are treated only if there is a simultaneous dependency on a nonnarcotic drug. The Detoxification schedule proceeds through the following steps: 1. Admission and initial maintenance. During this period the patient is admitted to the Unit, and urine and blood specimens are collected and sent to the toxicology laboratory for screening. The patient is maintained for approximately one day on the implicated drug of abuse while he is given an extensive examination which includes an EKG, chest x-ray, and appropriate clinical laboratory work. Also during this period, the patient is interviewed by one of the two psychiatrists at the Unit. 2. Titration to toxicity. When the clinical and toxicologic data have been evaluated, the patient is "titrated" to a state of mild intoxication in order to determine his tolerance to his drug of abuse. In this procedure, the patient is given one to two times the normal therapeutic dose of the drug per hour until clinical signs of intoxication become apparent (e.g., nystagmus for sedative drugs). Blood samples are collected during the titration, at toxicity, and after toxicity until the next dose of drug is administered. 3. Withdrawal. The results of the titration procedure are used to determine a maintenance dosage of the abused drug, then this dosage is decreased approximately 10% per day until-the patient is drug free. Blood samples are collected as necessary during this period for half-life estimation o r as a guide to the EEG sleep studies. After a minimum of usually two days of drug-free maintenance the patient is discharged to an appropriate community agency. 4. Follow-up. Patients are asked to return to the Unit at a specified time after discharge. During this visit a urine specimen is collected for analysis by the Toxicology Laboratory. Throughout the entire detoxification procedures the patient is exposed to intensive psychotherapy in the form of group therapy and
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psychodrama. Clinical conferences are held regularly to achieve maximum integration among the various disciplines involved in the evaluation and treatment of the patient. Analytical Toxicology Laboratory Texas Southern U n i v e r s i t y S c h o o l of P h a r m a c y The School of Pharmacy of Texas Southern University maintains a Toxicology Laboratory for the identification and quantitative determination of dangerous drugs and heavy metals. The laboratory occupies approximately 700 sq. ft. and is equipped with a variety of analytical instruments including gas chromatographs, ultraviolet, visible and infrared spectrophotometers, a spectrophotofluorometer, a liquid scintillation counter, and an atomic absorption spectrophotometer. Capability is also provided for the identification of toxic substances by thin layer chromatography. The laboratory performs a dual function in providing toxicology services for patients hospitalized at the ICT Treatment Unit and the H a r r i s County Psychiatric Hospital and in serving as a research faculty for the investigation of diseases of toxic origin in man. Emergency Drug Abuse and Poisoning Consultation Program The staff of the Institute is available to provide consultation for physicians, drug treatment programs, and the lay public concerning significance of drug issues and treatment guidance for medical emergencies. The Institute maintains elaborate files on toxicology. Outreach consultation allows fellows to attend drug abuse emergencies in local emergency rooms and to assist in the continuing c a r e in intensive treatment facilities under the guidance of the Director. Alcohol and Heroin Detoxification P r o g r a m A short-term detoxification program for heroin and alcohol addiction is carried out in 14 inpatient beds at the H a r r i s County Psychiatric Hospital under the direction of Eric Comstock, M.D. Ten to 14 days are used for pharmacologic detoxification while group therapy and individual counseling is utilized to give insight into the addictive phenomenon and to develop plans for continuing c a r e in other community agencies.
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L i t e r a t u r e Surveillance on T r e a t m e n t The combined efforts of the staff of the institute are used to identify publications occurring in the current medical literature which make significant contributions to the state of the art of treatment of diseases related to drugs and other toxic substances. Commentary of these publications appears in the section of the Clinical Toxicology Bulletin titled "Current Commentary." Occupational Toxicology Services Inpatient and outpatient facilities are available for diagnosis and treatment of diseases related to occupational exposure to potentially hazardous substances. The toxicology and clinical laboratory provide analyses of toxic substances and other biologic parameters useful in the monitoring of occupational hazards. Medico- Legal and F o r e n s i c Toxicology The staff of the Institute provides consultation and research relevant to toxic substances in the medical-legal and forensic context. Drug Investigation Facilities and staff are available for evaluation of safety and efficacy of sedative, hypnotic and psychotropic drugs in humans. Bioavailability, pharmacokinetic and sleep EEG studies regularly are performed.
COURSES
-
ACADEMIC YEAR 1 9 7 4 - 7 5
101 Introduction to Clinical Toxicology
- 20 hr
Lecture course covers diseases caused by toxic substances and associated medical and psychopathology, information sources, clinical and laboratory diagnostic techniques and principles of treatment, Course is designed for medical students and pharmacy students. 102 Drug Abuse and Addiction - 20 hr Lecture course covers the phenomenon of habituation and addiction,
NEWS ITEM
117
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substances commonly abused and their effects, review of treatment including inpatient residential and outpatient modalities. Subjects include solvents, alcohol, opiates and nonopiate drugs. Course is designed for students of medicine, pharmacy, social work, and public health.
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103 Occupational Toxicology and Economic Poisons 20 hr Lecture course covers prevention, diagnosis and treatment of common occupational hazards including solvents and other organics, metals, pesticides, and herbicides, Clinical and laboratory methods for surveillance of populations at risk are discussed. Course is designed for undergraduate and graduate biomedical disciplines.
104 Pharmacology of Tolerance and Addiction - 20 h r Lecture course on assessment of addictive potential of drugs in animals and man, clinical, pharmacologic and neuropsychiatric collates of addiction, and pharmacology and pharmacokinetics of drugs in human tolerance. Course is designed for students of medicine, pharmacy, and pharmacology.
105 Analytical Toxicology - 20 hr Lecture course on principles of chemical and instrumental analysis of drugs and other toxic substances, their metabolites and biologic effects of diagnostic significance and their interpretation. Course is designed for experienced medical technologists and students of medicine, pharmacy and biomedical sciences. 106 Seminar on Current Literature - 4 h r per month 50 to 100 selected reprints of current publications on diagnosis and treatment of poisoning and drug abuse are received by the Institute each month. A two-hour evening seminar is held biweekly for review and discussion of the most significant current contributions. Attendance is open to any interested person. 201 Practice of Clinical Toxicology
Six week full time clerkship for medical students provides experience with inpatient and outpatient programs for treatment of drug abuse, emergency toxicology, and attendance of the occupational toxicology clinic. 202 Epidemiology of Drug Abuse
Six week full time clerkship devoted to studies on incidence of drug abuse in various populations including schools, colleges, emergency rooms, crisis clinics, and other community social service agencies.
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Data collection consists of record reviews and client social and drug history interviews. Accumulated data contribute to the current awareness program of surveillance of drug abuse trends in the Houston area. The program is open to students of public health, social service, pharmacy, and nursing. 203 Special Research Six week full time research clerkship allows the student to pursue intensively a highly restricted research project in any area associated closely with the ongoing research programs of the Institute and to compile a report on his project. The subject area may be either clinical laboratory or basic science. Eligibility is determined individually. 301 Clinical or Laboratory Training Programs, 4 wk, tuition - $350 Specialized programs providing intensive training in highly restricted aspects of clinical or laboratory activities are provided on an individually designed basis for professionals currently engaged in service delivery. The purpose is to supplement o r to generate specific skills. Typical areas are chemotherapy of addiction, psychotherapeutic techniques for inpatient drug abuse treatment, trace element analysis, radioimmunoassay, thin layer and gas chromatographic analysis of drugs and their metabolites, and gas chromatographicmass spectrometric analysis of drugs. Registration limited to one person per subject area per month. Tuition is required to cover supplies and staff time displacement. Training is on a one-to-one basis with an ICT staff member. 12 wk full time, tuition - free Twelve-week training programs are designed in accordance with individual needs to provide supplementary training for professionals currently active in service delivery. The full spectrum of training resources of the Institute are available. A tuition-free 12-week program is possible by the expectation that clinical services delivered by the trainee will offset staff time required. 303 Clinical Toxicology Fellowship - One-year full time, stipend $12.000 The one-year clinical toxicology fellowship is designed to build upon previous postgraduate medical training for physicians wishing to pursue a career in service and research in clinical toxicology. The fellow will rotate through the full spectrum of activities of the Institute, will assume primary patient c a r e responsibilities under '
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the supervision of the Director and the clinical staff and will assist in preparation and delivery of teaching programs. It is anticipated that this program will prepare the physician for certification in clinical toxicology when a certifying mechanism is developed by the American Academy of Clinical Toxicology. The program will f i r s t be available for the academic year 1974-75.
304 Research in Toxicology One-year full time postdoctoral program for .nonphysician graduates in pharmacy and biomedical sciences. Stipend to be determined. A one- to two-year program designed to assist in the development of a career in research in basic sciences and/or clinical investigation in areas related to human toxicology, analytical toxicology, drug research, pharmacology, and neurophysiology of tolerance and addiction. Training and research activities are individually designed in consultation by applicant with appropriate staff members. CONSULTING FACULTY The following is a list of the Consulting Faculty of the Institute of Clinical Toxicology: Julian D. Acland Walsall WS 2 9 PS England
Fred W. Clayton, D.V.M. Bethesda, Maryland
Herbert C. Anderson, Jr. Raynesford, Montana
Betsy S. Comstock, M.D. Houston, Texas
Emilio Astolfi, M.D. Bueonos Aires, Argentina
Joseph H. Davis, M.D. Miami, Florida
John Autian, Ph.D. Memphis, Tennessee
Walter J. Decker, Ph.D. Fort Sam Houston, Texas
Newton C. Birkhead, M.D., Ph.D. Tuckahoe, New York
David G. Doherty Oak Ridge, Tennessee
Jules Bohnn, M.D. Houston, Texas
William Campbell Douglass, M.D. Sarasota, Florida
John Kennedy Brown, Ph.D. Stockton, California
John Doull, M.D., Ph.D. Kansas City, Kansas
Robert Bucklin, M.D., J.D. L a Jolla, California
S. Albert Edwards, Pharm. D. Houston, Texas
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Matthew J. Ellenhorn, M.D. Beverly Hills, California
William J. Kinnard, Ph.D. Baltimore, Maryland
Henry W. Elliott, M.D., Ph.D. Orange, California
J a n e t P. Kramer, M.D. Wilmington, Delaware
Thomas Faulkner, Ph.D. Houston, Texas
Yves Lacasse, M.D. St-Zotique, Montreal
David C. Fenimore, Ph,D. Houston, Texas
Robert F. Lash, M.D. Knoxville, Tennessee
Nancy Elizabeth Gary, M.D. New York, New York
Lawrence J. Lesko, Ph.D. Boston, Massachusetts
George R Gay, M.D. San Francisco, California
H a r r y Shepherd Lipscomb, M.D. Houston, Texas
Vernon A. Green, Ph.D.
Kansas City, Missouri
J a m e s Lumeng, M.D. Honolulu, Hawaii
J a m e s Guilford, Ph. D. Houston, Texas
George D. Lundberg, M.D. Los Angeles, California
William T. Haeck, M.D. Jacksonville, Florida
Charles B. Maclean, Ph.D. E. Lansing, Michigan
William B. Harrell, Ph.D, Houston, Texas
Matilda S. McIntire, M.D. Omaha, Nebraska
J a m e s W. Hayden, Ph.D. Houston, Texas
Ewen Garth McQueen, Ph. D., M.R., B.S., F.R.C.P. Dunedin, New Zealand
Robert C. Hoppe, M.D. Philadelphia, Pennsylvania Page Hudson, M.D. Chapel Hill, North Carolina
Peter I. Jatlow, M.D. New Haven, Connecticut
Joel B. Mann, M.D. Miami, Florida Anthony P. Markello, M.D. Buffalo, New York
Roy Elton Joyner, M.D. Houston, Texas
Joseph F. Martin&, M.D. Augusta, Maine
Sidney Kaye, Ph.D. San Juan, Puerto Rico
Henry Matthew, M. B., Ch. B. Edinburg, Scotland
Milton 0. Kepler, M.D. Houston, Texas
George Edward Mawer Manchester, England
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NEWS ITEM Howard C. Mofenson, M.D. Mineola, New York
G. Alan Robison, Ph.D. Houston, Texas
F e r r i n Moreland, Ph.D. Houston, Texas
Joseph C. Schoolar, Ph.D., M.D. Houston, Texas
Albert S. Moraczewski, O.P., Ph. D. Houston, Texas
Edward C. Senay, M.D. Chicago, Illinois
E. Napke, M.D. Ottawa, Ontario Harlan Nevin, M.D. Houston, Texas
Harrison E., Ph.D. Rochester, New York Milan Slavik, M.D., Ph.D. Bethesda, Maryland
R Thomas Solis, M.D. Houston, Texas
Frederick A. Oehme, D. V. M. Manhattan, Kansas
David E. Smith, M.D. San Francisco, California
JohnE. Ott, M.D. Denver, Colorado
Joseph T. Sobota, M.D. Kalamazoo, Michigan
John E. Overall, M.D. Galveston, Texas
Jane H. Speaker, Director Philadelphia, Pennsylvania
John J. Pepper, M.D. Nutley, New J e r s e y
Herbert Eli Spiegel, Ph.D. Nutley, New J e r s e y
Albert L. Picchioni, P b D . Tucson, Arizona
John J. Spikes, Ph.D. Houston, Texas
Richard T. Rappolt, Sr., M.D. San Francisco, California
William Q. Sturner, M.D. Dallas, Texas
Gerald Ratinov, M.D. Houston, Texas
Daniel T. Teitelbaum, M.D. Denver, Colorado
David S. Rausten, M.D. National City, California
F o r e s t S. Tennant, Jr., M.D. M.P.H. Los Angeles, California
Osvaldo Norbert0 Re, M.D. Northridge, California
Clinton H. Thienes, M.D., Ph.D. Sherman Oaks, California
Helmut M. Redetzki, M.D. Shreveport, Louisiana
Mark Thomas, M.D. Des Moines, Iowa
Thomas A. Rejent Buffalo, New York
M. J. Valaske, Capt., MC, USN Bethesda, Maryland
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Carlos Vallbona, M.D. Houston, Texas
James E. Weaver, Ph.D. Cincinnati, Ohio
Kenneth L. Vaux, Dr. Theo. Houston, Texas
Patrick R. Wells, Ph.D. Houston, Texas
William C. Waggoner, Ph.D. New Brunswick, New Jersey
Donald R. Wesson, M.D. San Francisco, California
Jack E. Wallace, Ph.D.
Charles L. Winek Pittsburgh, Pennsylvania
San Antonio, Texas
