Lab Matters Fall 2018 | Page 14

FROM THE BENCH Closing the Data Gap on Overdoses in Minnesota By Paul Moyer, MS, Environmental Laboratory Section manager, Minnesota Public Health Laboratory; Stefan Saravia, MPH, CIH, Biomonitoring and Emerging Contaminants Unit supervisor, Minnesota Public Health Laboratory; Terra Wiens, MPH, CSTE epidemiology fellow, Injury and Violence Prevention Section, Minnesota Department of Health In 2010, emergency departments and law enforcement officials in Duluth, MN, began noticing an increasing number of patients using illicit synthetic drugs, sold by the local “Last Place on Earth” headshop. These patients presented with altered mental status, respiratory failure, agitation, paranoia and a variety of bizarre and violent behaviors. Alarmed by the increase in the number of patients exposed to these drugs, community leaders contacted the Minnesota Department of Health (MDH), which dispatched a team of epidemiologists to investigate. What happened next demonstrated the challenges of obtaining accurate surveillance data on drug overdoses. The MDH epidemiologists had difficulty identifying patients affected by illicit synthetic drug use in Duluth using patient medical records. For a variety of reasons, admission and discharge diagnoses in medical records often encompass the syndromes associated with the overdose (e.g., acute renal failure, acute respiratory The opioid epidemic is our Zika outbreak. Deaths are on the scale of a mass casualty event.” Paul Moyer, MS, Environmental Laboratory Section manager, Minnesota Public Health Laboratory failure) rather than identify the overdose itself. Since these syndromes may be associated with multiple diseases and conditions, they do not offer a reliable method of identifying patients affected by drug use or overdose. Fortunately, in this instance, a Duluth hospital had developed an internal method for identifying patients treated for drug overdoses, and the team of epidemiologists was able to use these data in their investigation. Launching MNDOSA Since this investigation in Duluth, other concerning trends in drug use have emerged in Minnesota communities. Starting in May 2017, multiple clusters of synthetic cannabinoid or cathinone use have occurred in Saint Paul and Minneapolis. These clusters have occurred primarily in homeless populations in the Twin Cities, with patients presenting to emergency departments with agitation, aggression and elevated heart rates. It was in the context of these clusters, as well as the increasing numbers of drug overdoses both in Minnesota and nationally, that the MDH launched a drug overdose surveillance system in 2017. The Minnesota Drug Overdose and Substance Abuse Pilot Project (MNDOSA) is designed to track data from recreational drug use, both fatal and non-fatal. This pilot, initially implemented at two hospitals in Duluth, aims to expand over time to identify patterns of substance abuse across the state and eventually to quantify the problem. An advisory group of representatives from Minnesota’s poison control system, hospital association, participating hospitals, toxicologists, MDH’s Injury and Violence Prevention Section, public health laboratory, and the State Epidemiologist oversee MNDOSA activities. Funding has come from a variety of sources, including the US Centers for Disease Prevention and Control’s Enhanced State Opioid Overdose Surveillance Program, the Council of State and Territorial Epidemiologists (CSTE) and the Substance Abuse and Mental Health Services Agency. MNDOSA combines both active and passive reporting systems. Hospitals participating in MNDOSA are asked to report emergency department and in-patient admissions for all patients where the primary diagnosis is attributed to the recreational use of drugs. For patients who die, are admitted to the hospital for in-patient care, have unusual or atypical clinical presentations or are suspected to be part of a cluster, blood and/or urine specimens are sent to the MDH Public Health Laboratory (PHL) for analysis. 12 LAB MATTERS Fall 2018 PublicHealthLabs @APHL