FEATURE
New Partnerships
Often, a state’s public health and forensic
laboratories don’t know that the other
exists. “They don’t realize that we have
the same instrumentation; a lot of times
public health laboratories could take some
of the burden off forensic laboratories and
vice versa,” Miles said. “We didn’t have all
the right people at the table at first, and
now we’re starting to realize who we need
there. It’s getting better, but we still have a
long way to go.”
Another challenge for biosurveillance
programs is building relationships with
hospitals. Public health laboratories rely
on hospital emergency departments to
supply them with the samples needed to
complete testing. This is where reinforcing
partnerships is paramount. Laboratories
need to emphasize that patient privacy
and confidentiality will be upheld.
Additionally, hospitals need to understand
the value that opioid biosurveillance
programs bring to public health and make
arrangements to potentially increase
hospital staff responsibilities.
In Minnesota, epidemiologists from
the state health department’s health
promotion and chronic disease group
are the liaisons. They communicate
directly with medical toxicologists at
local hospitals, which have established
processes for submitting routine
specimens through their newborn
screening programs. They can use these
same processes to ship collected samples
from non-fatal overdoses to public health
laboratories for drug testing.
But new for hospitals is the need to
develop a process for collecting specimens
from non-fatal overdose cases and train
emergency room physicians and nurses
on when and how to collect them.
Hospitals also need to add a code to
their emergency medical record system
that marks the specimen for collection
and shipment. Without it, clinicians will
need to make a note in the chart and the
hospital will have to create a system for
gathering that information.
Improving Public Health
Interventions
Although building an opioid surveillance
system may require several steps, the
resulting data analysis can inform public
health efforts. For example, messaging
can alert drug users about more
dangerous drugs entering the area.
“By knowing the potential potency of the
drug they are choosing to consume, the
hope is that users will use less or avoid
the substance altogether. Then they won’t
be at as much of a risk for an overdose,”
Peterson said. “If you don’t know what
you’re fighting against, if you don’t know
what drugs are in your community, you
have no idea what messaging you’re
supposed to give people outside of ‘don’t
do drugs.’”
However, public health laboratories are
in a unique position to fill an unmet
need of conducting testing in non-fatal
overdose cases. “This can help public
health practitioners and law enforcement
target evidence-based interventions to
save lives,” Baldwin said. In addition,
public health laboratories can work to
develop standardized testing algorithms
and methods to produce results that are
comparable across the country.
The opioid biosurveillance programs have
already generated useful communityspecific
data. In Minnesota, testing
confirmed that methamphetamine
was more widespread than heroin and
fentanyl. Tests also showed that some
people had more than 20 different drug
analytes in their body, showing extensive
poly-substance use.
To continue to learn more about newly
surfacing drugs, Minnesota has regular
conference calls with partners such as
the US Customs and Border Protection
and areas deemed High Intensity Drug
A visual depiction of the potency of heroin vs. fentanyl. Photo: Creative Commons
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Spring 2020 LAB MATTERS 7