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: 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
• 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

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.

过量的流行病是由非法芬太尼和芬太尼类似物驱动的，通常与合成模拟剂结合使用。这 添加新的精神活性物质（NP），这是对各种范围的新物质进行的广泛分类 包括兴奋剂和致幻剂在内的化学物质以及与苯二氮卓和阿片类药物有关的研究化学物质 班级，非法药物市场进一步使药物供应变得复杂。使用毒品的人想知道他们的什么 毒品并将调整其使用，并采取更多的预防措施。不幸的是，测试，检测和 在医疗保健系统中，不存在重量的报告物质暴露，包括当前的医疗保健系统中 临床毒理学测试方案。急诊科（ED）药物暴露评估标准是尿液药物 屏幕测试（UDS）。 UDS在分析选择性和范围上有局限性，这可能导致不正确的提供商 有关药物暴露的假设。此外，UDS省略了NP和其他药物的评估，包括 主动削减会增加过量的风险，从而导致药物暴露和供应安全性不完整。我们的目标 是评估急诊科中当前的毒理学测试方案，以积极影响患者，提供者和 公共卫生结果，包括临床护理，药物供应监测和减少伤害外展。具体目标 拟议的研究是：（1）评估标准医院UDS在不断发展的药物中测试药物暴露的效用 通过与液相色谱量产时间的质谱质谱法相比，非法合成质量主导的供应 （LC-QTOF-MS）毒理学测试； （2）确定LC-QTOF-MS毒理学测试是否由ED非致命药物产生 过量案例匹配验证后毒理学测试中的发现，使用罗德岛州的药物过量死亡 州无意的药物过量报告系统（SUDORS）评估未来的早期药物供应申请 生物监视； （3）使用使用生物药物检查反馈患者的可行性和可接受性 ED访问药物过量药物后的毒理学测试结果。我们将招募100名非致命性无意的ED患者 在罗德岛医院的药物过量一年，比较了毒理学测试结果 LC-QTOF-MS医院UDS方案。然后，非致命药物过量的LC-QTOF-MS毒理学测试将是 与毒理学测试的结果相比，无意的阿片类药物过量死亡（SUDORS）评估 在ED中治疗的非致命药物过量的毒理学测试是否反映了导致过量的物质 死亡。我们还将评估将详细毒理学数据纳入危害减少的可行性和可接受性 努力。从非致命时期开始，将提供注册的患者的综合毒理学测试结果 药物过量并完成对该服务的后续可接受性调查。这些目标共同通知当地的州， 以及国家非法药物供应监视工作，改善患者外展和指导未来的医院协议 药物过多的毒理学测试。