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.

药物过量流行是由非法芬太尼和芬太尼类似物造成的，通常与合成模拟物结合使用。这 添加新的精神活性物质 (NPS)，这是新物质的广泛分类，构成了多种 化学品，包括兴奋剂和致幻剂以及与苯二氮卓类和阿片类药物相关的研究化学品 类，使毒品供应进一步复杂化。吸毒者想知道自己体内含有什么 药物，并将调整其使用并采取更多预防措施作为应对。不幸的是，测试、检测和 鉴于当前情况，医疗保健系统内不存在准确报告物质暴露（包括过量服用 NPS）的情况 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方面存在限制，可能会导致提供者不正确 关于药物暴露的假设。此外，UDS 忽略了对 NPS 和其他药物的评估，包括 主动削减，可能会增加用药过量风险，导致药物暴露和供应安全的不完整情况。我们的目标 旨在评估急诊科当前的毒理学测试方案，以对患者、提供者和患者产生积极影响 公共卫生成果包括临床护理、药品供应监测和减少危害外展。具体目标为 拟议的研究是： (1) 评估标准医院 UDS 在测试不断发展的药物中药物暴露的效用 通过与液相色谱四重飞行时间质谱法进行比较，发现供应以非法合成物为主 （LC-QTOF-MS）毒理学测试； (2) 确定 LC-QTOF-MS 毒理学检测结果是否为 ED 非致命药物 用药过量病例与使用罗德岛州药物过量死亡者进行的尸检毒理学测试结果相符 国家无意药物过量报告系统（SUDORS），用于评估早期药物供应的未来应用 生物监测； (3) 使用生物药物检查反馈来衡量患者的可行性和可接受性 急诊科就诊药物过量后的毒理学检测结果。我们将招募 100 名非致命性非故意性急诊科患者 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 协议至 LC-QTOF-MS。非致命药物过量的 LC-QTOF-MS 毒理学测试结果将 与意外阿片类药物过量死亡 (SUDORS) 的毒理学测试结果进行比较来评估 急诊室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药物过量的物质 死亡。我们还将评估将详细毒理学数据纳入减害的可行性和可接受性 努力。入组患者将获得从非致命事件发生时起的综合毒理学检测结果 药物过量并完成服务的后续可接受性调查。这些目标共同可以为地方、州、 和国家非法药物供应监测工作，改善患者外展并指导未来的医院方案 药物过量毒理学测试。