LOOKING AT A
BIGGER PICTURE
FOR OPIOIDS
In Rhode Island, the State Health Laboratories began testing specimens linked to nonfatal opioid overdoses to eliminate a blind spot in public health surveillance.
LOOKING AT A
Looking at a Bigger Picture
for Opioids
On average, 130 Americans die every day from an opioid overdose, according to the US Centers for Disease Control and Prevention (CDC). But, as CDC points out, for every fatal overdose there are many nonfatal overdoses. Without laboratory data on those who leave the emergency room alive, the US is fighting the rapidly evolving opioid epidemic with incomplete information.
APHL’s Opioid Biosurveillance Task Force was created to close this gap. The task force—an interdisciplinary team of epidemiologists, national health officials and scientists from commercial, forensic and public health laboratories—convened its first in-person meeting in early 2019. It aims to help states institute testing programs for biological specimens (primarily urine samples) taken from individuals who present at hospital emergency departments with symptoms of opioid overdoses.
This is new territory that needs to be explored.
Looking at a Bigger Picture for Opioids
On average, 130 Americans die every day from an opioid overdose, according to the US Centers for Disease Control and Prevention (CDC). But, as CDC points out, for every fatal overdose there are many nonfatal overdoses. Without laboratory data on those who leave the emergency room alive, the US is fighting the rapidly evolving opioid epidemic with incomplete information.
APHL’s Opioid Biosurveillance Task Force was created to close this gap. The task force—an interdisciplinary team of epidemiologists, national health officials and scientists from commercial, forensic and public health laboratories—convened its first in-person meeting in early 2019. It aims to help states institute testing programs for biological specimens (primarily urine samples) taken from individuals who present at hospital emergency departments with symptoms of opioid overdoses.
“The idea is that if we have more information on nonfatal opioid overdoses, we can move our understanding of the problem upstream … before people are dying,” said Ewa King, PhD, director of Rhode Island Department of Health (RIDOH) State Health Laboratories and chair of the new task force.
We recognize that public health laboratories have a role to play to help end this epidemic.
King said, “We need to know: What drugs are out there on the street? How are people combining drugs? Are some combinations of drugs different in fatal versus nonfatal overdoses? That information would give us a body of knowledge that really does not exist at the moment, and that is what we are after.”
Such data could be used to discern drug use trends, inform public education efforts, identify novel opioids and evaluate the effectiveness of interventions.
This is new territory that needs to be explored.
RIDOH State Health Laboratories—an APHL member—has been a pioneer in opioid biosurveillance. Although the laboratory has not yet accumulated sufficient data to draw conclusions, King said, “We’ve tested specimens from individuals with more than five drugs in their system at the same time. And those are people who survived.” The most commonly detected drugs so far are prescription and illicit opioids (especially fentanyl and illicit fentanyl analogs), tranquilizers, amphetamines and cannabinoids.
A second task force focus is neonatal abstinence syndrome (NAS) resulting from opioid exposure in utero. Among other things, the task force provided input on a case definition for NAS and debating the optimal tests and specimen types to use for newborn opioid assessment. (Since it is difficult to draw blood or collect urine samples from newborns, some advocate testing an infant’s first feces.) “This is new territory that needs to be explored,” said King.
Apart from the task force, APHL created a toolkit to help laboratories gain US Drug Enforcement Administration registration, sponsored a webinar on the safe handling of fentanyls in the laboratory and helped jumpstart the development of opioid surveillance data systems for public health laboratories.
As King said, “We recognize that public health laboratories have a role to play to help end this epidemic.”
We recognize that public health laboratories have a role to play to help end this epidemic.
“The idea is that if we have more information on nonfatal opioid overdoses, we can move our understanding of the problem upstream … before people are dying,” said Ewa King, PhD, director of Rhode Island Department of Health (RIDOH) State Health Laboratories and chair of the new task force.
King said, “We need to know: What drugs are out there on the street? How are people combining drugs? Are some combinations of drugs different in fatal versus nonfatal overdoses? That information would give us a body of knowledge that really does not exist at the moment, and that is what we are after.”
Such data could be used to discern drug use trends, inform public education efforts, identify novel opioids and evaluate the effectiveness of interventions.
RIDOH State Health Laboratories—an APHL member—has been a pioneer in opioid biosurveillance. Although the laboratory has not yet accumulated sufficient data to draw conclusions, King said, “We’ve tested specimens from individuals with more than five drugs in their system at the same time. And those are people who survived.” The most commonly detected drugs so far are prescription and illicit opioids (especially fentanyl and illicit fentanyl analogs), tranquilizers, amphetamines and cannabinoids.
The main product of the APHL task force will be a collection of best practices around opioid biosurveillance addressing:
- Recommended testing platforms, generally employing tandem mass spectrometry.
- Availability of calibration and quality control standards, including those available free-of-charge through CDC.
- Safety procedures for working with drugs, especially fentanyl and analogs.
- Staffing requirements.
- Guidance on ascertaining legal authority for access to overdose patient specimens.
- Recommended testing platforms, generally employing tandem mass spectrometry.
- Availability of calibration and quality control standards, including those available free-of-charge through CDC.
- Safety procedures for working with drugs, especially fentanyl and analogs.
- Staffing requirements.
- Guidance on ascertaining legal authority for access to overdose patient specimens.
A second task force focus is neonatal abstinence syndrome (NAS) resulting from opioid exposure in utero. Among other things, the task force provided input on a case definition for NAS and is debating the optimal tests and specimen types to use for newborn opioid assessment. (Since it is difficult to draw blood or collect urine samples from newborns, some advocate testing an infant’s first feces.) “This is new territory that needs to be explored,” said King.
Apart from the task force, APHL created a toolkit to help laboratories gain US Drug Enforcement Administration registration, sponsored a webinar on the safe handling of fentanyls in the laboratory and helped jumpstart the development of opioid surveillance data systems for public health laboratories.
As King said, “We recognize that public health laboratories have a role to play to help end this epidemic.”
Top Left: Clinical Laboratory Scientist Jenna Wolanski reviews opioids test results from urine samples. Photo: RIDOH State Health Laboratories
