A novel robotic wastewater analysis system to quantify opioid exposure and treatment in residential communities

摘要 新冠肺炎继续为阿片使用障碍(OUD)患者带来重大挑战。在.期间 大流行，在美国38个司法管辖区中的37个司法管辖区和紧急情况下，阿片类药物过量使用率增加了50%以上 与阿片类药物相关的过量医疗服务电话增加了50%。电话数量的增加一直是 与之相对应的是，拒运费增加了70%。与阿片类药物相关的发病率，特别是滞留和 药物辅助治疗(MAT)的依从性和复发越来越难以衡量 减少了个人与OUD与医疗系统的整体交互，并放松了规则 丁丙诺啡和美沙酮处方和因扩大远程医疗而免除面对面药物测试 能力。以废水为基础的流行病学是一种可行的、非侵入性的方法来测量 新冠肺炎和垫子的盛行。分析了上游居民区和 在污水处理厂的下游已经被证明是一种可行的方法 持续监测新冠肺炎和阿片类药物消费情况。通过衡量以下方面的趋势 随着时间的推移，对新冠肺炎负担影响的洞察可以与 因此，可以纵向评估新冠肺炎对联合国毒品和犯罪问题办公室的持续影响。这 紧急竞争性修订扩展了我们在家长资助方面的工作，在那里我们开发了一种创新的 方法测量和可视化废水网络中的阿片类药物及其关键代谢物。在第一阶段 在父母的资助中，我们优化了一种基于废水的阿片类药物测试，该方法既适用于废水 污水处理厂以及社区层面的检修井。我们还围绕样例开发了最佳实践 统计人口迁移和提供商业阿片类药物分析产品的收集方法 对于城市来说。在新冠肺炎大流行期间，我们分别开发了SARS-CoV-2废水检测方法 并模拟了基于废水的新冠肺炎患病率估计值预测临床发病率上升的能力 病例和住院情况。这一紧迫的竞争修订将把新冠肺炎废水检测纳入 Bibot Analytics的商业废水分析产品组合。通过创新开发标准 测量SARS-CoV-2和废水中阿片类药物使用(垫和非法阿片类药物)的操作程序 网络，我们将演示开发地图和仪表板的可行性，这些地图和仪表板提供对 OUD、MAT和新冠肺炎的交叉点。我们的研究将加强公共卫生工作，监测 通过开发可持续的技术，在社区一级预防阿片类药物流行和COVID流行 在新冠肺炎疾病负担波动的背景下，测量患有OUD的易感个体使用MAT的情况。 OMB编号0925-0001/0002(03/16修订版批准至2018年10月31日)页面续格式页面

ABSTRACT COVID-19 continues to create significant challenges for individuals with opioid use disorder (OUD). During the pandemic, opioid overdose rates increased by more than 50% in 37 of 38 US jurisdictions and emergency medical service calls for opioid related overdose have increased by 50%. This increase in calls has been mirrored by a 70% increase in refusal to transport rates. Opioid related morbidity, especially retention and adherence to medication assisted treatment (MAT) and relapse are increasingly difficult to measure given decreased overall interaction of individuals with OUD with the healthcare system and relaxed rules around buprenorphine and methadone prescribing and waivers of in-person drug testing due to expanded telehealth capabilities. Wastewater-based epidemiology is a feasible, noninvasive method to measure both the extent of COVID-19 and the prevalence of MAT. Analysis of wastewater both upstream in neighborhoods and downstream at wastewater treatment plants has been demonstrated as a feasible method to conduct continuous surveillance of the penetrance of COVID-19 and opioid consumption. By measuring trends in wastewater over time, insights into the effects of the burden of COVID-19 can be mapped in conjunction with drugs of abuse, thereby permitting a longitudinal assessment of the ongoing effects of COVID-19 on OUD. This urgent competitive revision expands our work in the parent grant where we have developed an innovative method to measure and visualize opioids and their key metabolites in wastewater networks. In the first phase of the parent grant, we optimized a wastewater-based opioid assay that can be applied both to wastewater treatment plants as well as community level manholes. We also developed best practices around sample collection methodology to account for population migrations and deliver a commercial opioid analysis product for cities. During the COVID-19 pandemic, we have separately developed a SARS-CoV-2 wastewater assay and modeled the ability of wastewater-based COVID-19 prevalence estimates to foreshadow rises in clinical cases and hospitalizations. This urgent competitive revision will integrate COVID-19 wastewater testing into the Biobot Analytics portfolio of commercial wastewater assay products. By innovatively developing standard operating procedures to measure SARS-CoV-2 as well as opioid use (MAT and illicit opioids) in wastewater networks, we will demonstrate the feasibility of developing maps and dashboards that lend empiric insight into the intersection of OUD, MAT and COVID-19. Our research will enhance public health efforts at monitoring the opioid epidemic and COVID pandemic at the community level by developing sustainable techniques that measure use of MAT in the context of fluctuating COVID-19 disease burden in vulnerable individuals with OUD. OMB No. 0925-0001/0002 (Rev. 03/16 Approved Through 10/31/2018) Page Continuation Format Page