Lab Matters Spring 2021 | Page 19

US Centers for Disease Control and Prevention ’ s ( CDC ’ s ) Laboratory Response Network ( LRN ) for Chemical Threats .
“ With our years of experience testing unknown samples , this was definitely in our wheelhouse ,” he said of developing MNDOSA . “ The skill sets we ’ ve developed as an LRN lab really helped us build this surveillance from the ground up .”
Casting a Wider Net
In Minnesota , emergency room visits for nonfatal opioid-involved overdoses increased between 2018 and 2019 , as did opioid overdose deaths . In 2019 , most of those overdose deaths involved synthetic opioids . Nationally , drug overdoses are the leading cause of injury-related death in the US , with more than 70,000 Americans dying from overdose in 2019 , according to the most recent CDC statistics .
In general , Peterson said , MNDOSA ’ s expanded surveillance approach gives laboratory scientists the ability to cast a larger net when searching for and identifying substances potentially involved in overdoses . The enhanced testing helps paint a clearer picture into the circumstances surrounding drug overdoses and co-occurring substance use issues , helping public health officials and their partners better target prevention and response resources . The data also provide ER physicians additional awareness in the care provided to overdose patients .
For example , Peterson said MNDOSA testing found that people who experience a drug overdose often have multiple substances in their system , indicating that polysubstance use is prevalent . In 2019 , MNDOSA analyzed 183 clinical specimens from 97 emergency department overdose encounters at a hospital system in Northern Minnesota . One hundred different drugs were detected , with multiple drugs present in all specimens . Fentanyl was found in approximately 30 % of specimens and methamphetamine in over 60 %, Peterson said .
“ That was the most eye-opening part — we expected polysubstance use , but not to that magnitude ,” he said . “ The data showed us that we have a polysubstance use problem — not just an opioid problem — and we if we build just an
As of February 2020 , over 2,800 hospitalized EVALI cases or deaths had been reported in the US . However , in the initial days of the investigation , the cause of the lung injury was unknown and it was difficult to track who was most at risk . Through work performed at multiple public health and federal laboratories , the likely culprit of this outbreak was determined to be Vitamin E Acetate , a diluent that was added to illicit THC-containing vaping products . Programs like MNDOSA allow public health laboratories to provide useful information for a variety of investigations , and can yield a better understanding of how emerging chemicals may be impacting the health of communities around the nation .
opioid response , we ’ re not addressing the complete picture .”
A Different Approach
MNDOSA is also unique because it collects specimens related to nonfatal overdoses as opposed to focusing on deaths , helping to fill an existing gap in substance use data . At one point , MNDOSA was receiving up to 10 overdose-related specimens a week from its clinical partner in Duluth , but with the arrival of COVID-19 , capacity expectedly slowed down . Still , Peterson said , MNDOSA was able to “ build a better picture of what was being consumed in that area .”
While MNDOSA piggybacks off the laboratory ’ s existing capacity in chemical threat response , Peterson noted that its approach is quite different from traditional LRN testing , which tends to be very specific and focused . Since its launch , MNDOSA data has helped public health officials measure the impact of overdose and substance use on Minnesota hospitals , raise awareness of new drug overdose clusters in near real time , identify substances being used in the community , and identify residents most at-risk and in need of prevention services .
The Future of MNDOSA
By summer 2021 , MNDOSA will pivot away from a targeted testing approach and move to non-targeted acquisition using high-resolution instrumentation . While the current targeted panel is impactful , any substance not included in the testing panel will not be detected . This means emerging substances could be missed and the drug panel becomes outdated quickly . By transitioning to high-resolution instrumentation , scientists will be able to search against a more expansive library and be more adaptable to emerging substances .
Initially , adopting this high-resolution method will expand MN PHL ’ s capacity to over 800 different drugs or drug metabolites . If the internally developed library does not identify a substance , scientists may have enough information to generate a “ best guess ” or presumptive identification that could ideally be confirmed with reference materials . This allows the laboratory to keep pace in near real time as the illicit drug market continues to evolve .
“ Transitioning to high-resolution instrumentation gives us more power to make identifications because we won ’ t be restricting our scope to only certain substances ,” Peterson said . “ Being able to identify new threats is much more challenging if you ’ re only looking for traditionally used substances .”
As of spring 2021 , MNDOSA was still in its pilot phase and organizers were working to bring on additional hospital partners .
“ The hope is that we can expand our partnerships and start identifying substances involved in overdoses in multiple geographical locations . Collecting data from more locations will provide a more complete picture of what kind of drugs are being used and potentially how they are flowing through our state ,” he said . n
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