Lab Matters Spring 2020 - Page 8

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 @APHL APHL.org