FROM THE BENCH
Connecticut Improves Opioid Surveillance
by Expanding Testing
By Susan Isch, division director, Chemical Sciences, Connecticut Department of Public Health Katherine A. Kelley Laboratory
The Connecticut Department of Public
Health Laboratory (CT PHL) has been
working with the US Centers for Disease
Control and Prevention (CDC) and other
public health laboratories throughout
the country for the past two years to
investigate, develop and expand testing
in support of the opioid crisis. In the
absence of approved and/or FDA cleared
methodologies, it was necessary to
establish and validate a robust protocol
that would provide data and support
to our partners. Early identification of
emerging drugs in the Connecticut drug
supply and providing data for the analysis
of trends in drug prevalence in impacted
populations are paramount in building a
successful program.
Chemists Damien Drobinski and Hien Diep analyze blood and urine for the presence of opioids and other illicit drugs utilizing a Sciex
5500+ Triple Quadrupole Mass Spectrometer. Photo: Mark Harkins
In response to the significant rise in
overdoses and deaths from prescription
drug opioids and opioid overdoses in the
state, CT PHL, in partnership with the CT
Department of Public Health (DPH) Office
of Injury and Violence Prevention, has
initiated a pilot biosurveillance project.
Starting the Conversation
Initial validation efforts were focused on
identifying specific drugs in blood using
the Liquid Chromatography Tandem Mass
Spectrometer utilized for our Laboratory
Response Network for Chemical Threats
(LRN-C) preparedness activities. The
platform was set up to detect 25 drugs of
concern in blood and had no capability
for the identification of unknown or
non-targeted compounds. Data generated
was to be used for surveillance purposes
only. This method required the samples
be prepared using solid phase extraction
(SPE) and was relatively labor intensive.
In April 2019, utilizing funding from
the CDC Cooperative Agreement for
Emergency Response: Public Health
Opioid Crisis Response procured by
the Connecticut Department of Public
Health (DPH) Office of Injury and
Violence Prevention, CT PHL purchased
a Sciex Quadrupole Time-of-Flight Mass
Spectrometer (TOF-MS). This enabled staff
to develop a robust and effective method
on an instrument dedicated entirely to
opioid testing.
The Next Step
After meeting with local emergency
room personnel and other public
health professionals, it was determined
that urine would be easier to procure
and beneficial in the identification of
non-targeted/unknown compounds. Prior
to specimen collection, CT PHL validated
a laboratory-developed method for the
identification of 35 selected prescription,
metabolites and illicit drugs in urine.
CT PHL began receiving specimens as
part of the pilot study to test for opioids
and other drugs of abuse on January 2.
This testing includes a comprehensive
list of 35 targeted opiates and opioids,
including fentanyl, in addition to cocaine,
cannabinoids, methadone and some
commonly prescribed prescription drugs
(e.g., benzodiazepines) of abuse. This
new method utilized a dilute-and-shoot
preparation eliminating the need for
SPE. However, the method does require
an enzyme hydrolysis step which is
necessary to break down potentially
interfering glucuronidated metabolites.
A more detailed validation procedure
was conducted for this platform to allow
testing for direct patient care in addition
to providing surveillance data. This newly
validated method also has considerable
potential for identifying emerging, novel
and/or not yet fully characterized drugs of
concern.
CT PHL plans to expand testing to include
blood and develop a more comprehensive
list of targeted drugs reported utilizing
the traceable opioid materials (TOM)
Kits facilitated by CDC’s LRN-C. These
reference materials provide more than 150
opioid standards, including more than 100
fentanyl analogues and are free of charge
to public health and other US-based
laboratories. Procuring standards and
reference materials has been one of
the challenges in developing methods,
and the availability of these kits will be
instrumental in addressing the growing
number of possible illicit drugs and
fentanyl analogs. Building capacity and
capability on multiple platforms will only
enhance future testing and provide more
information to health care providers and
public health professionals.
In the near future, CT PHL and the Office
of Injury and Violence Prevention hope
to expand this limited pilot study and
provide testing for more health care
facilities throughout Connecticut. n
18 LAB MATTERS Spring 2020
PublicHealthLabs
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