Public Health Laboratories: Biosurveillance to …Analysis. Answers. Action. Public Health Laboratories: Biosurveillance to Inform the Opioid Response An overview of APHL Opioids Biosurveillance

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


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


Surveillance


Laboratories and overdose surveillance

Potentialopioid

surveillance data

Hospital Laboratories

Commercial Laboratories

GovernmentForensic

Laboratories

Public Health Laboratories


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


Drug toxicology testing

Preliminary screening• Presumptive result• Classes of drugs

Confirmatory testing:• Specific/directed testing• Mass spectrometry

methodology preferred


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”


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


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


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


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).


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


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


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


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)


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)

https://www.aphlnet.org/eweb/DynamicPage.aspx?webcode=EventInfo&Reg_evt_key=5b412cbc-a659-49f5-9c86-6563939018a2&RegPath=EventRegFees&FreeEvent=&Event=603-19SS%20Safe%20Handling%20of%20Fentanyls%20in%20the%20Laboratory&FundraisingEvent=0&evt_guest_limit=9999


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


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


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


Thank you!

Ewa King, [email protected]

mailto:[email protected]


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.

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Public Health Laboratories: Biosurveillance to …Analysis. Answers. Action. Public Health Laboratories: Biosurveillance to Inform the Opioid Response An overview of APHL Opioids Biosurveillance