FEATURE
The Rhode Island Department
of Health exercised its regulatory
authority to mandate the submission
of biological specimens (urine
samples) to the state laboratory,
but it was the relationships with
individual hospital laboratories
that made it work.”
Ewa King, PhD
Clinical Laboratory Scientist Jenna Wolanski reviews opioids test results from urine samples.
Photo: RIDOH State Health Laboratories
laboratory, with the help of funding
received through the CDC Cooperative
Agreement for Emergency Response:
Public Health Opioid Crisis Response
Grant, implemented a confirmatory
opioids panel in early 2019. By June 2019,
the laboratory had asked all hospitals
to send urine samples from overdose
patients. The laboratory has since added a
fentanyl panel using TOM kits.
“The statewide surveillance system
implemented in Rhode Island is still
unique in its scope,” said Ewa King,
PhD, director of Rhode Island’s state
health laboratories. “The Rhode Island
Department of Health exercised its
regulatory authority to mandate the
submission of biological specimens (urine
samples) to the state laboratory, but it was
the relationships with individual hospital
laboratories that made it work.”
All LRN-C laboratories can also get
involved in opioid biosurveillance, even
if they don’t conduct testing in-house,
Liebreich said. For example, laboratory
outreach coordinators can alert hospitals
to drugs recently identified in overdose
patients and discuss procedures for
sample submission to the laboratory.
Beyond LRN-C Laboratories
LRN-C laboratories are not the only
public health laboratories involved in
the opioid crisis. The forensic laboratory
at the Wisconsin State Laboratory of
Hygiene is one of a handful of US forensic
laboratories housed in a public health
laboratory, rather than a law enforcement
agency. The laboratory recently began
to implement an opioid biosurveillance
program, analyzing specimens from
impaired drivers while also receiving
reports of fatal overdoses from medical
examiners.
“We consider ourselves the bookend,”
Miles said. “I think the US has focused
on one side of it or the other. It’s rare for
us to have that continuous examination
of opioids—or any other drug of abuse,
for that matter.” Now, the US is playing
“catch-up” to improve its knowledge of
overdoses and their causes, she said.
Because forensic laboratories analyze
specimens from impaired drivers, results
can point out emerging drug trends in
a particular community. In Wisconsin,
positive tests for PCP have highlighted a
new drug threat in the community. “We
know if we’re seeing it in our drivers, it’s
probably been in the population before we
actually saw it.”
The Wisconsin laboratory had also been
exploring Neonatal Abstinence Syndrome
(NAS) testing (see sidebar), but the project
was put on hold due to the coronavirus
pandemic. “We thought it would be a
natural fit to have the forensic section test
the blood spots from newborns—not as a
way to formulate any charges, but to get
a better understanding of the exposure of
neonates to drugs of abuse,” Miles said.
Challenges, but Progress
One of the major challenges for opioid
biosurveillance is also a common one:
funding. But federal grants are becoming
available. Minnesota was one of 14 LRN-C
laboratories participating in a threeyear
Overdose Data to Action (OD2A)
cooperative agreement from CDC’s
National Center for Injury Prevention
and Control (NCIPC) in collaboration
with their state health departments.
OD2A builds prevention and surveillance
capacity targeting the drug overdose
epidemic, according to Grant Baldwin,
PhD, MPH, director of the NCIPC’s
Division of Overdose Prevention. The
funding supports innovative surveillance
strategies. Other laboratories, including
Minnesota, employed a federal grant to
purchase new equipment through the
CDC Public Health Crisis Surge Support
Program.
In Wisconsin, the laboratory strengthened
its partnership with the state’s Division of
Public Health, which provided the funding
for its opioid biosurveillance program.
6 LAB MATTERS Spring 2020
PublicHealthLabs
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