president's / executive director’s message
get addicted, then they may switch to
street drugs. At the same time, synthetic
opioids, such as fentanyl derivatives,
are much more powerful than older
drugs, including fentanyl itself and even
heroin. Smaller doses can be deadly.
And these days, synthetic opioids are
not just diverted from pharmaceutical
use, but are being produced specifically
for the street market. What was once
seen as a law enforcement issue has
become a public health problem.
Stepping Up to the Front Lines
of an American Tragedy
APHL President Ewa King and APHL Executive Director Scott
Becker discuss a potential role for public health laboratories to help
mitigate a nationwide epidemic of opioid addiction and overdose.
Ewa King: Scott, I am excited to serve
as APHL’s president. And I am proud of
the indispensable work public health
laboratories do to support state health
agencies every day. Among many public
health issues laboratories engage in,
environmental health topics deserve
additional attention. Over the last
decade, we have made great progress
in highlighting the important role of
biomonitoring in environmental public
health. Importantly, we have seen an
emergence of the National Biomonitoring
Network. Biomonitoring, which involves
testing for environmental chemicals in
clinical samples, has not always been
seen as a core function of public health
laboratories. Another issue I hope to
highlight during my presidency is one
that has also not yet fully engaged the
public health laboratory: the opioid
overdose crisis we are experiencing
nationwide. The rate of overdose deaths
2
LAB MATTERS Summer 2017
involving prescription opioids or heroin
has quadrupled since 1999. Overdose
deaths involving synthetic opioids (other
than methadone) jumped 80% between
2013 and 2014, and another 72% between
2014 and 2015. Sadly, according to the
CDC, overdose is now the leading cause
of injury-related deaths in the United
States, surpassing motor vehicle crashes.
Scott Becker: This is an American
tragedy that touches many families.
As I understand it, the problem has
been ongoing for many years, but was
originally concentrated in marginalized
populations and considered a social or
law enforcement issue.
King: That’s right. Now the demographics
are all-encompassing. It’s all ages and
all sectors of society. Opioids have
been prescribed for pain treatment
and some would argue that they have
been over-prescribed; when people
In Rhode Island, we at the State Health
Laboratories are very aware of this
problem. Our laboratory includes the
forensic toxicology laboratory that
supports the Office of the State Medical
Examiners, located in the same building.
We conduct the tests that ascertain
whether a death is due to overdose
and, if so, what drugs were involved.
In our small state, there were 336
accidental drug-related overdose deaths
in 2016, compared with 138 in 2009.
Becker: So far, the public health response
to the crisis has focused on opioid
prescribing practices, medication-assisted
treatment for the addicted and the use
of drugs like naloxone to reverse an
overdose-in-process. But there are roles
that public health laboratories can play.
At APHL, we are planning to establish a
community-of-practice that can serve as
a think tank to bring laboratory leaders
together to discuss opioid issues in their
states and to identify resources we can
offer up across the laboratory system
to help with this problem. I imagine, at
some point, there could be guidelines
developed, sharing of laboratory
methods and educational efforts. APHL
can also look at the epidemic from
an advocacy perspective to ensure
funds are available to states and to
laboratories that are taking on this issue.
King: I really do feel the public health
laboratory should have a greater role
helping to determine the extent of the
problem. At the moment, surveillance
consists mainly of recording instances
of fatal overdoses. But in most cases
people don’t die from addiction
overnight; they take drugs over many
PublicHealthLabs
@APHL
APHL.org