FROM THE BENCH
Enhanced Overdose Surveillance :
A Critical Asset in Minnesota ’ s EVALI Outbreak Investigation
In summer 2019 , public health officials around the United States began receiving reports of vaping-related novel lung injuries , which prompted public health departments to begin tracking and reporting hospitalized cases and / or deaths . In Minnesota — which
eventually confirmed three deaths related to e-cigarette , or vaping , product use-associated lung injury ( EVALI ) and about 150 probable or confirmed cases during the outbreak — investigators utilized an innovative pilot biosurveillance program within the state public health laboratory that is designed to capture a clear , more real-time picture of substances driving the ongoing drug overdose epidemic . Launched in 2017 , the
Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity ( MNDOSA ) combines drug overdose reporting with enhanced toxicology testing of clinical specimens . Its main goal : to provide a comprehensive picture of the drug landscape in close to real time .
MNDOSA : Experience to the Rescue
When the first patients with novel lung injuries arrived at Minnesota hospitals , the
Minnesota Public Health Laboratory ( MN PHL ) had already integrated the MNDOSA toxicology panel , capable of detecting 266 different drugs or their metabolites . Using the MNDOSA toxicology panel , MN PHL analyzed 73 EVALI-related clinical specimens from 64 emergency department encounters . Multiple substances were detected in every case , with the most prevalent being THC-COOH ( detected in 81 % of specimens tested ), an indicator of marijuana use . Cotinine , a nicotine biomarker , was detected in 50 % of specimens tested . This early clue , along with information from patient interviews , helped point public health investigators in the direction of illicit marijuana vaping devices . According to
a poster presented at APHL ’ s 2020 Annual Conference , Minnesota was able to quickly leverage the capacity it had
Coupling our toxicology findings with what we were identifying in the ( vaping ) cartridges really started to eliminate the idea that EVALI was a nicotine-vaping problem , but instead was an illicit THC vaping problem .”
Jason Peterson , MS
built with MNDOSA to “ rapidly respond to EVALI and provide relevant information about an emerging novel outbreak .”
“ Coupling our toxicology findings with what we were identifying in the ( vaping ) cartridges really started to eliminate the idea that EVALI was a nicotine-vaping problem , but instead was an illicit THC vaping problem ,” said Jason Peterson , MS , chemical threat preparedness coordinator in the Biomonitoring and Emerging Contaminants Unit at MN PHL . “ If we didn ’ t have the MNDOSA program up and running , analyzing those clinical samples from EVALI patients wouldn ’ t have happened as rapidly .”
What makes MNDOSA unique is it is not limited to tracking only opioid related overdoses , but was designed to also detect legacy drugs like methamphetamine and THC , and be expandable to include the emergence of new chemical overdose threats , such as the synthetic opioid isotonitazine . MN PHL was one of the first state laboratories to conduct enhanced overdose surveillance , scaling up significantly with the availability of more federal funding to respond to the opioid crisis . Peterson noted that MNDOSA was a natural fit for the laboratory , which had spent years building its capacity to test for known and unknown chemical agents of concern as a Level 1 laboratory
16 LAB MATTERS Spring 2021