Lab Matters Spring 2020 - Page 9

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 PublicHealthLabs @APHL APHL.org Spring 2020 LAB MATTERS 7