Drug Overdose Testing: A Data Collection and Reporting Emergency

过量流行是由非法芬太尼和芬太尼类似物推动的，通常与合成模拟物结合在一起。这个 添加新的精神活性物质(NPS)，这是对新物质的广泛分类，构成了不同范围的 包括兴奋剂和致幻剂在内的化学品以及与苯二氮卓类和阿片类药物有关的研究化学品 非法药物市场的种类、数量和数量进一步增加了毒品供应的复杂性。吸毒的人想知道他们的 并将调整其使用，并采取更多的预防措施作为回应。不幸的是，测试、检测和 报告在医疗保健系统内不存在物质暴露，包括NPS在过量剂量下的准确暴露 临床毒理学测试方案。急诊科(ED)评估药物暴露的标准是尿药 筛选测试(UDS)。UDS在分析选择性和范围方面存在限制，这可能导致不正确的提供程序 关于毒品接触的假设。此外，UDS省略了对NPS和其他药品的评价，包括 主动削减，可能会增加过量服药的风险，导致药物暴露和供应安全的图景不完整。我们的目标 评估急诊科目前的毒理学测试方案，以积极影响患者、提供者和 公共卫生成果，包括临床护理、药品供应监测和减少危害宣传。具体目标是 建议的研究是：(1)评估标准医院UDS在测试不断发展的药物中的药物暴露的有效性 与四重飞行时间质谱仪相比，供应以非法合成物质为主 (LC-QTOF-MS)毒理学试验；(2)确定ED非致命性药物的LC-QTOF-MS毒理学试验结果 服药过量病例与罗德岛吸毒过量死亡的死后毒理学测试结果相匹配 国家意外药物过量报告系统(SUDORS)评估未来早期药物供应的申请 生物监测；(3)生物用药反馈对患者的可行性和可接受性。 因吸毒过量就诊后的毒理学检测结果。我们将招募100名非致命性意外的ED患者 罗德岛医院一年多的药物过量比较标准护理的毒理学测试结果 医院UDS检测LC-QTOF-MS的方法非致命性药物过量的LC-QTOF-MS毒理学测试结果将 与非故意阿片类药物相关药物过量死亡(SUDORS)的毒理学测试结果进行比较，以评估 在急诊室治疗的非致命性药物过量的毒理学测试结果是否反映了导致过量药物的物质 死亡。我们还将评估将详细的毒理学数据纳入减少危害的可行性和可接受性。 努力。入选患者将从非致死时间起提供综合毒理学检测结果 服药过量，并完成对服务的可接受性跟踪调查。这些目标结合在一起可以告知地方、州、 和国家非法药物供应监测工作，改善患者外联工作，并指导未来的医院方案 药物过量毒理学测试。

The overdose epidemic is driven by illicit fentanyl and fentanyl analogues, often combined with synthetic simulants. The addition of new psychoactive substances (NPS), a broad classification of new substances constituting a diverse range of chemicals including stimulants and hallucinogens as well as research chemicals related to benzodiazepine and opioid classes, to the illicit drug market further complicates the drug supply. People who use drugs want to know what is in their drugs and will adjust their use and take more preventative actions in response. Unfortunately, the ability to test, detect and report substance exposure including NPS at overdose accurately within the healthcare system does not exist given current clinical toxicology testing protocols. The Emergency Department (ED) standard for drug exposure evaluation is urine drug screen testing (UDS). UDS has limitations in analytical selectivity and scope which can lead to incorrect provider assumptions regarding drug exposure. Additionally, UDS omits evaluation of NPS and other pharmaceuticals, including active cut, that can increase overdose risk, resulting in an incomplete picture of drug exposure and supply safety. Our goal is to evaluate current toxicology testing protocols in the Emergency Department to positively impact patient, provider, and public health outcomes including clinical care, drug supply surveillance, and harm reduction outreach. The specific aims for the proposed study are: (1) Evaluate the utility of standard hospital UDS to test for drug exposure in the evolving drug supply dominated by illicit synthetics via comparison to liquid chromatography quadruple time-of-flight mass spectrometry (LC-QTOF-MS) toxicology testing; (2) Determine whether LC-QTOF-MS toxicology testing results from ED non-fatal drug overdose cases match findings in post-mortem toxicology testing from drug overdose fatalities using the Rhode Island State Unintentional Drug Overdose Reporting System (SUDORS) to assess future application for early drug supply biosurveillance; and (3) Measure feasibility and acceptability to patients of biological drug checking feedback using toxicology testing results after an ED visit for drug-overdose. We will enroll 100 ED patients with non-fatal unintentional drug overdose at Rhode Island Hospital over one year comparing toxicology testing results from a standard-of-care hospital UDS protocol to LC-QTOF-MS. Results of LC-QTOF-MS toxicology testing in non-fatal drug overdose will then be compared to toxicology testing results from unintentional opioid-involved drug overdose fatalities (SUDORS) to evaluate whether toxicology testing results from non-fatal drug overdoses treated in the ED reflect substances causing overdose death. We will also evaluate the feasibility and acceptability of incorporating detailed toxicology data into harm reduction efforts. Enrolled patients will be provided results of comprehensive toxicology testing results from the time of non-fatal drug overdose and complete a follow up acceptability survey on the service. Together these aims can inform local, state, and national illicit drug supply surveillance efforts, improve patient outreach and guide future hospital protocols for drug-overdose toxicology testing.