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.
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