FROM THE BENCH
Biosurveillance Shows Fentanyl ’ s Role in Rhode Island ’ s Overdose Epidemic
By Louis Marchetti , PhD , TC ( NRCC ), chief of operations , Rhode Island State Health Laboratories
In 2019 , the Rhode Island Department of Health ( RIDOH ) established a statewide surveillance initiative to better understand the role of opioids in the ongoing overdose epidemic . Through collaborations with local hospital partners , the Rhode Island State Health Laboratories ( RISHL ) implemented biosurveillance as part of the public health surveillance for opioid overdoses . Initially , hospitals were required to submit residual urine specimens from all individuals who received treatment at a hospital emergency department and were believed to have experienced an opioid related overdose event . Urine specimens from 1,354 unique overdose encounters were received and tested by the RISHL over a two-year timeframe and the findings were published in Addiction . |
Percent of Positive Opioid Specimens |
100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 %
January
February
March
April
May
June
July
2022 Month of Overdose
Samples with Opi Detects
* Data for December 2022 are provisional , as of 2 / 14 / 2023 .
|
August |
September
October
Fentanyl
|
November |
December * |
50 45 40 35 30 25 20 15 10 5 0 |
Number of Positive Opioid Specimens |
Urine specimens were initially chosen due to availability ; however , while urine provides great insight into the patient ’ s drug usage history , it is not the ideal specimen to elucidate the agents that gave rise to the overdose event that resulted in the hospital visit . In October 2021 , RISHL rolled out the next phase of its biosurveillance efforts .
RISHL has expanded its scope beyond opioids to include stimulant and CNS depressant panels and altered its specimen submission guidance to require residual blood specimens , along with any available preliminary drug screening results , be submitted through this program . In addition to providing valuable insight into Rhode Island ’ s overdose epidemic , these efforts also helped to inform APHL ’ s
Opioid Biosurveillance Taskforce ( OBTF ) model strategy .
Methodology
Since the program ’ s inception , RISHL greatly expanded its capacity for confirmatory analyses by tandem mass spectrometry . Rhode Island ’ s opioid panel consists of more than 40 opioids , opiates and metabolites in addition to
Figure 1 : Rhode Island fentanyl trends and opioid positive specimens by month , January-December 2022 .
Percent of Positive Opioid Specimens
40 %
35 %
30 %
25 %
20 %
15 %
10 %
5 %
0 % January February March April May June July August September October November December *
Month of Overdose
All Fetanyl Analogs Acetyl Fentanyl Carfentanil Valeryl Fentanyl p-Fluoro Fentanyl p- Fluoro ButyrylFentanyl Sufentanil
* Data for December 2022 are provisional , as of 2 / 14 / 2023 .
Figure 2 . Rhode Island fentanyl analog trends by month , January-December 2022
This work was made possible by the Centers for Disease Control and Prevention through the Overdose Data to Action cooperative agreement . The author also wishes to acknowledge RIDOH Epidemiologist Kristen St . John for assisting in the data aggregation .
8 LAB MATTERS Spring 2023