Drug Overdose Testing: A Data Collection and Reporting Emergency

药物过量检测：数据收集和报告紧急情况

• 批准号: 10507656
• 负责人: Rachel Wightman
• 金额: $ 24.17万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507656
• 关键词: Drug; Overdose; Testing; Data; Collection

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.

过量流行是由非法芬太尼和芬太尼类似物驱动的，通常与合成模拟物结合。的 增加了新的精神活性物质，这是一个新物质的广泛分类，构成了一系列不同的 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 非法药物市场的流入使毒品供应进一步复杂化。吸毒的人想知道他们的身体里有什么 药物，并将调整其使用，并采取更多的预防措施。不幸的是，测试、检测和 鉴于目前的情况，在医疗保健系统内不存在准确报告物质暴露（包括过量服用阿托伐他汀）的情况。 临床毒理学测试方案。急诊科（艾德）药物暴露评价标准为尿液药物暴露。 筛选测试（UDS）。UDS在分析选择性和范围方面存在局限性，可能导致提供者不正确 关于药物暴露的假设。此外，UDS省略了对阿司匹林和其他药物的评价，包括 积极削减，这可能会增加过量的风险，导致药物暴露和供应安全的不完整的图片。我们的目标 是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， 公共卫生成果，包括临床护理、药物供应监测和减少危害外展。具体目标为 建议的研究是：（1）评价标准医院UDS测试药物暴露的效用 通过与液相色谱法四重飞行时间质谱法的比较， （LC-QTOF-MS）毒理学检测;（2）确定LC-QTOF-MS毒理学检测结果是否来自艾德非致死性药物 药物过量病例与使用罗得岛药物过量死亡的尸检毒理学测试结果相匹配 国家意外药物过量报告系统（SUDORS），以评估未来早期药物供应的应用 生物监测;（3）测量生物药物检查反馈对患者的可行性和可接受性， 药物过量艾德访视后的毒理学检测结果。我们将入组100例艾德患者， 罗得岛医院一年多的药物过量，比较标准治疗的毒理学测试结果 LC-QTOF-MS的医院UDS方案。然后将非致死性药物过量的LC-QTOF-MS毒理学试验结果 与非故意阿片类药物过量死亡（SUDORS）的毒理学检测结果进行比较， 在艾德治疗的非致命药物过量的毒理学测试结果是否反映了导致过量的物质 死亡我们还将评估将详细的毒理学数据纳入危害减少的可行性和可接受性 努力将向入组患者提供从非致死性时起的全面毒理学检测结果 药物过量，并完成对服务的后续可接受性调查。这些目标可以共同告知地方，州， 和国家非法药物供应监测工作，改善患者服务，并指导未来的医院协议， 药物过量毒理学测试