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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

基本信息

批准号：
10508494
负责人：
Rachel Wightman
金额：
$ 17.81万
依托单位：
RHODE ISLAND HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10508494
关键词：
Accident and Emergency department Autopsy Benzodiazepines Biological Centers of Research Excellence Chemicals Classification Data Data Collection Data Reporting Drug Exposure Drug Screening Drug user Emergency Department patient Emergency Situation Emergency department visit Enrollment Epidemic Evaluation Feedback Fentanyl Future Goals Hallucinogens Harm Reduction Healthcare Systems Hospitals Illicit Drugs Lead Liquid Chromatography Measures Opioid Outcome Overdose Patients Pharmaceutical Preparations Pharmacologic Substance Protocols documentation Provider Public Health Reporting Research Rhode Island Safety Services Stimulant Surveys System Test Result Testing Time Toxicology Urine acceptability and feasibility analog clinical care clinical toxicology drug market drug standard drug testing follow-up improved opioid overdose outreach overdose death overdose risk patient outreach response standard of care time of flight mass spectrometry

项目摘要

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使用。的