Lab Matters Spring 2020 - Page 10

FEATURE APHL Helps Close the Gaps in Information 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—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 primary focus of the Task Force is to provide guidance to jurisdictions developing model surveillance systems for use in tracking non-fatal opioid overdoses at the state level. To accomplish this, it has been hard at work compiling a comprehensive Model Biosurveillance Strategy resource, which will include: • Recommended testing platforms, generally employing tandem mass spectrometry • 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. Opioid biosurveillance is also used in assessing neonatal exposure to opioids in utero through laboratory testing. This testing may help identify cases of Neonatal Abstinence Syndrome (NAS), a constellation of signs and symptoms of drug withdrawal. APHL task force members collaborated with the Council of State and Territorial Epidemiologists (CSTE) to develop the NAS case definition, which outlines the criteria needed for surveillance of this syndrome. During the coming year, the Task Force plans to explore issues associated with NAS. With input from Task Force members, 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. To assist laboratories in developing opioid biosurveillance programs, APHL also offers travel scholarships to vendor trainings and national biannual LRN-C Technical Meetings, where staff can receive training (Due to travel restrictions associated with the ongoing COVID-19 pandemic, these meetings and trainings have been postponed). — Gynene Sullivan Trafficking Areas, or HIDTAs. These calls alert the laboratory to newer street drugs such as kratom, which is legal in many states but has not yet been scheduled by the DEA. “People believe there are opioid-like medicinal uses for it and that it’s less dangerous than traditional opiates,” Peterson said. “Initially, we didn’t have kratom in our toxicology panel. That was one of those instances where we got information, expanded our testing capabilities and then went back to suspected exposures and were able to detect it.” In Rhode Island, King pointed to several important questions: What drug combinations are responsible for fatal overdoses? Do non-fatal overdoses differ in some way from fatal overdoses? Are fentanyl analogs still a problem? Because both the LRN-C and forensic toxicology laboratories are part of the Rhode Island State Health Laboratories, data can be compared relatively easily. In the Phoenix, Arizona area, epidemiologist Kate Goodin, MS, MPH, used drug testing analysis to work directly with the community. Her department worked with the DEA to learn about drug use activity in various communities. She then developed heat maps showing increased density of fatal overdoses to educate local leaders. “A lot of that was a call to action,” she said. “It showed it wasn’t just an urban core issue, which is some of the stigma.” (Goodin was epidemiology and data services program manager at the Maricopa County Department of Public Health in Arizona last year. She is now director of surveillance systems and informatics at the Tennessee Department of Health.) Reliable partners can include community organizations with a stake in the opioid epidemic—such as those that focus on criminal justice, homelessness and mental health. The harm reduction community is also actively engaged in epidemic response efforts through provision of needle exchange and safe injection site services. For example, Maricopa County has an intervention program called MOSAIC that provides incarcerated men and women intensive life-skills training. The program focuses on people who have histories of substance abuse. This partnership led to a new program in which Goodin’s department tracked volunteers who had recently been released from jail in order to collect data related to drug use. According to Goodin, because they’re not toxicologists, epidemiologists have a learning curve when interpreting the data. But that’s where solid partnerships with the public health laboratory come in. 8 LAB MATTERS Spring 2020 PublicHealthLabs @APHL