Analysis. Answers. Action. www.aphl.org
Public Health Laboratories: Biosurveillance to Inform the Opioid Response
An overview of APHL Opioids Biosurveillance Task Force (OBTF) activities
Ewa King, Ph.D.Associate Director of HealthRIDOH State Health Laboratories
Analysis. Answers. Action. www.aphl.org
Drug overdose deaths by state
Source: Annual Surveillance Report of Drug-Related Risks and Outcomes | United States CDC National Center for Injury Prevention and Control | 2018
Analysis. Answers. Action. www.aphl.org
Surveillance
Analysis. Answers. Action. www.aphl.org
Laboratories and overdose surveillance
Potentialopioid
surveillance data
Hospital Laboratories
Commercial Laboratories
GovernmentForensic
Laboratories
Public Health Laboratories
Analysis. Answers. Action. www.aphl.org
CSTE Case Definitions• Finalized July 31, 2019• Non-Fatal Overdoses
– Provides state/local jurisdictions with guidelines for ascertaining cases
– Combination of epidemiological and laboratory data
• Neonatal Abstinence Syndrome (NAS)– First step in establishing a laboratory role in
surveillance of this syndrome
Analysis. Answers. Action. www.aphl.org
Drug toxicology testing
Preliminary screening• Presumptive result• Classes of drugs
Confirmatory testing:• Specific/directed testing• Mass spectrometry
methodology preferred
Analysis. Answers. Action. www.aphl.org
Current issues in toxicology testing
• Scope of testing (list of analytes) not standardized
• Different methodologies• No clear reference laboratory system• Inadequate capacity • Inadequate capability to test for novel
analogs-”designer opioids”
Analysis. Answers. Action. www.aphl.org
Barriers to a standardized approach to opioids biosurveillance
• Expensive instrumentation • Expensive calibration/IS/QC standards for
isotope dilution LC/MS/MS• Differing accreditation requirements for
clinical vs. forensic laboratories• Regulatory oversight• Lack of standardization of methodology or
defined list of target analytes
Analysis. Answers. Action. www.aphl.org
Role of APHL in Opioids Biosurveillance
• What is APHL?– Membership association that works with state and local public
health and environmental laboratories nationally– Liaison to federal partners (CDC, FDA) and other stakeholders– Assesses and addresses the needs of public health laboratories in
the US and globally (provides resources and facilitates communications, meetings, and learning opportunities)
– APHL’s Opioids Biosurveillance work - Environmental Health Program portfolio
• OBTF: Meets quarterly via teleconference, periodically in-person
Analysis. Answers. Action. www.aphl.org
APHL Opioids Related Activities• Opioids Community of Practice
– Share ideas & experiences– Discuss laboratory methodology and project design– Presentations from subject matter experts
• OBTF– Model surveillance plan– Safety guidance– Toolkit for PHLs
• Facilitate learning opportunities– Webinars– Conferences & meetings– Technical training
• Data transfer and storage
Analysis. Answers. Action. www.aphl.org
OBTF Charge
• The Opioids Biosurveillance Task Force is charged by the APHL Board of Directors to:
• Design a model opioid biosurveillance program for nonfatal opioid overdoses
• Develop technical safety and guidance for laboratories and define and develop the roles of the public health laboratories in the area of Neonatal Abstinence Syndrome (NAS).
Analysis. Answers. Action. www.aphl.org
OBTF Composition• 16 individuals total
• 1 chair• 11 members
– CDC, toxicologists (ACMT), public health laboratorians, epidemiologists, private laboratory representation (Quest Diagnostics), and legislative counsel
• 4 organizational liaisons – CDC and CSTE representatives
Analysis. Answers. Action. www.aphl.org
How can the public health laboratories contribute to response?
• Opioids biosurveillance– Provide laboratory data for non-fatal overdoses
• Identify novel fentanyl analogs• Elucidate temporal & spatial trends• Inform and evaluate the efficacy of public health interventions
– Leverage LRN-C infrastructure• Specialized instrumentation• Technical skills and expertise• Relationships with clinical providers and poison centers
Analysis. Answers. Action. www.aphl.org
OBTF Activities to Date
• Development and dissemination of resources – DEA registration – Informed Consent & Human Subjects Review
• Informatics Infrastructure– Data Analytics Workgroup
• Model Surveillance Plan• Safe Handling of Fentanyls Video
Analysis. Answers. Action. www.aphl.org
Biosurveillance Strategy for Non-Fatal Opioids Overdoses• Guidance document developed in
collaboration with the OBTF and APHL staff
• Discusses screening and confirmatory testing, role of different toxicology labs, specimen collection strategies, results reporting, and partnership building (epidemiologists, clinicians)
Analysis. Answers. Action. www.aphl.org
Safe Handling of Fentanyls Video
• APHL webinar - Safe Handling of Fentanyls in the Laboratory (February 2019)
• Video – High-level overview of the major topics (Expected Completion, December 2019)– Routes of exposure– Risk assessment– Safe disposal of samples
• Safety Guidance (Expected Completion, Spring 2020)
Analysis. Answers. Action. www.aphl.org
Partner Engagement
APHL/OBTF participation on national opioids-related public health summits• American Medical Association• ESOOS Partner Meeting• National Center for Health Statistics opioid
mortality data
Analysis. Answers. Action. www.aphl.org
Partnership with forensic toxicologists
• Society of Forensic Toxicologists Annual Meeting
– October 13 – 18, 2019– 5 APHL members, 1 APHL staff in attendance
• Pre-meeting workshop– Provided attendees with strategies to help
public health and forensic laboratories collaborate on opioids response efforts
Analysis. Answers. Action. www.aphl.org
Acknowledgements• Thank you to the members of the OBTF, our public health
partners and APHL members and staff for their commitment and contribution to producing high quality laboratory information to inform public health action.
• This presentation was supported by Cooperative Agreement #5NU60OE000103 funding by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or the Department of Health and Human Services. 90% of the total cost of projects/programs were paid for with federal funds. 10% of the total cost of projects/programs were paid for with non-federal funds
Analysis. Answers. Action. www.aphl.org
This is a wonderful quote to illustrate my point, or a profound statement that should
be highlighted. It also serves to break up the monotony of
the usual slide progression. Be creative, but don’t clutter the page with too many words and keep roomy margins.
Top Related