Lab Matters Spring 2023 | Page 11

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an extensive library of fentanyl analogs . Additional testing is directed by available screening data where CNS depressant and stimulant panels may also be leveraged to further elucidate the potential causative agents that gave rise to the overdose encounter .
Snapshot of Rhode Island ’ s 2022 Opioid Analyses
From January to November 2022 , RISHL received 469 specimens from suspected opioid-related overdoses representing ~ 25 % of reported nonfatal overdoses statewide . Of these , 361 encounters ( 76 %) were confirmed positive for an analyte within the opioid panel . Preliminary analysis of 2022 data sheds light on the continued contribution of fentanyl and fentanyl analogs in nonfatal overdose events . Of the 361 confirmed opioid related encounters , 272 ( 78 %) were positive for fentanyl , its metabolite norfentanyl or a fentanyl analog ( Figure
1 ). The data are expressed as a percentage derived from total monthly submissions ranging from a high of 89 % in February to a low of 75 % in August . During this same timeframe , p-flurofentanyl , an analog first detected in Rhode Island in October 2021 , was also observed in 43 ( 12 %) confirmed opioid-related overdoses ( Figure 2 ). Carfentanil , acetylfentanyl , valerylfentanyl and sufentanil were also observed ; however , a statistical breakdown is not described here in keeping with RIDOH ’ s small number policy .
Ongoing Challenges
Since switching specimen types from urine to blood , RISHL has experienced a decrease in specimen submission . While the external impacts of COVID-19 on hospital infrastructure have certainly played a role , this decrease is mostly attributed to blood not being collected as routinely as urine in the hospital emergency department in addition to hospital partners having a shorter specimen retention policy for blood . Outreach is often required to address submission shortfalls and bridge the loss of institutional knowledge resulting from staff turnover .
Laboratory-based surveillance of nonfatal overdoses continues to provide many public health and safety benefits . Timely and accurate data pertaining to the nature of circulating opioids have been used to provide the public with health advisories to empower harm reduction efforts and modify risk behaviors . This biomonitoring framework also paves the way for a potential reporting mechanism directly to the individual , which could further enable safe practices or act as a catalyst for seeking addiction treatment . g

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