by: Kelly Hack

The National Drug Early Warning System (NDEWS) funded at the Center for Substance Abuse Research by the National Institute on Drug Abuse (NIDA) presents a compelling methodology of leveraging an innovative overdose detection mapping application program (ODMAP) with collective partnerships to address the overdose epidemic of opioids.

In efforts to bridge the gap of public health and public safety, ODMAP provides real-time suspected overdose surveillance data across jurisdictions throughout the nation. The development of this online mapping portal provides first responders, hospitals, and other law enforcement agencies the ability to communicate and record vital information utilizing a time-sensitive approach.

Program Accessibility

Level 1-Data Collection and Agency Administration Interface:

The system was designed to minimize the effort and time required by a first responder to enter data including fatal or non-fatal overdoses and the extent to which naloxone or another reversal drug was administered.

Level-1-API Data Collection:

The Application Programming Interface (API) is an extended option for Level 1 users, providing an effective method for stakeholder agencies to contribute data without creating additional (manual) reporting or processes. The API integration connects with agency or state’s Record Management Software (RMS) to ODMAP with an automated assimilation of the two systems.

Level 2-National Map:

In efforts to monitor and measure the performance of criminal justice and public health functionality, the ODMAP dashboard is an available tool for decision-makers to view and analyze controlled unclassified information (CUI) at a nation level. This tool is exclusive to government agencies (state, local, federal, or tribal) serving the interests of public safety and health.

Statewide Implementation

Since ODMAP’s inception, the program has gained an increased popularity throughout the nation. The Illinois Law Enforcement Alarm System (ILEAS) and the Illinois Department of Public Health (IDPH) have developed a grant titled, “Empowering and Equipping Law Enforcement and Communities in Rural Illinois to Reduce Opioid Overdose,” requiring the onboarding of ODMAP.

Spike Alerts

In order to support the needs of communities,  health analysts developed ODMAP’s spike response framework, which notify agencies by email, if the total overdoses in an area exceeds a pre-determined threshold within a 24-hour period. Spike alerts can be established for an agency’s own county or surrounding counties as an early warning feature. 

An Innovative Initiative

As a laboratory who is invested in protecting and enriching lives, we support innovative developments that present effective advancements for addressing a drug epidemic that nationally has claimed over 72,000 overdose deaths. Mobilizing a cohesive and collaborative response to a complex drug crisis is imperative within our communities.  

For more information regarding ODMAP, visit www.odmap.org.

by: Kelly Hack

An alarming rise in benzodiazepine-related morbidity and mortality is a growing concern in the U.S., research has concluded that 919 benzodiazepine ambulatory visits occurred in 2003 and increased drastically to 1672 in 2015.¹ The reported ambulatory visits have resulted in a 127 percent increase in benzodiazepine-related deaths or injuries. Amid the opioid crisis, benzodiazepine use/abuse is significantly growing with more than 30 percent of overdoses involving opioids also involve benzodiazepines.²

To provide a better understanding of how powerful benzodiazepines are, the medical realm has defined the substance as a tranquilizer that acts on the central nervous system producing sedation and muscle relaxation. The following benzodiazepines are classified by their length of effect:

• Ultra Short Acting-Midazolam (Versed®) and Triazolam (Halcion®)
• Short Acting- Alprazolam (Xanax®) and Lorazepam (Ativan®)
• Long Acting-Chlordiazepoxide (Librium®) and Diazepam (Valium®)³

According to a 2018 study, 30 million Americans used benzodiazepines in the past year and of those more than 5 million misused them for purposes of a sleep aid or to get high.⁴ Benzodiazepines can lead to physical and psychological dependence. In fact, high doses of benzodiazepines can create signs and symptoms of acute toxicity or overdose including drowsiness, confusion, dizziness, blurred vision, weakness, slurred speech, difficulty breathing and even coma.³

Despite the risks associated with benzodiazepines, research and statistics are finding that there has been a spike in prescribing in lieu of the opioid crisis. A study from 2003-2015 indicated a substantial increase of primary care physicians (PCP’s) who are issuing prescriptions for benzodiazepines-3.6 percent to 7.5 percent.¹ Primary care physicians defined by the National Ambulatory Medical Care Survey (NAMCS) includes: family medicine, internal medicine, geriatric medicine and obstetrics and gynecology. The increased number of benzodiazepine visits suggests there is a growing number of patients being prescribed this drug, along with prescriptions written for long-term use.

In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepines.² In a 2016 study, researchers noted that when opioids and benzodiazepines are used simultaneously, a 570 percent increase in substance abuse treatment admissions occurred.⁴ Co-prescribing, which is defined as prescribing two or more drugs to the same patient is an apparent, yet overlooked contributing factor to the drug epidemic we are facing today.

In 2015, benzodiazepines were co-prescribed with an opioid in 19.2 percent of visits, opioids were co-prescribed with a benzodiazepine in 26.4 percent of visits.¹ As opioids lose favor among prescribers, it is imperative to be aware of the risks that are associated with benzodiazepines, especially when used in combination with an opioid. It is strongly advised that clinicians avoid prescribing benzodiazepines concurrently with opioids.

In 2016, the FDA required benzodiazepines to be “black box” labeled in efforts to warn patients about the drug’s side effects and the heightened risks when taken with opioids. As a Schedule III drug, benzodiazepines have an increased probability for dependency. Physicians are advised to prescribe with caution, to fully inform their patients of the risks involved with benzodiazepines and the threat of fatality when combined with an opioid.

Utilizing advanced drug testing, specifically for benzodiazepines can be a proactive approach in identifying potential at-risk behavior and preventing fatal outcomes. Advanced drug testing uses different specimen types to detect substances of abuse at different times. Depending on the specimen’s window of detection, short-term and long-term use can be identified as the following:

Short-Term:

• Urine- 2-3 days
• Oral Fluid-1-2 days
• Blood-1-2 days

Long-Term:

• Hair- 3 months
• Fingernail-3-6 months

Utilizing an accredited laboratory that offers extensive panels to test for drugs of abuse is imperative in counteracting the impending drug crisis of benzodiazepines.

References:

1. Agarwal, S. D. (2019, January 25). Patterns in Outpatient Benzodiazepine Prescribing in the United States. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2722576
2. National Institute on Drug Abuse. (2018, March 15). Benzodiazepines and Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
3. Benzodiazepine Abuse. (n.d.). Retrieved from https://www.webmd.com/mentalhealth/ addiction/benzodiazepine-abuse#1
4. Smith, M. (2019, February 06). After Opioids, Benzodiazepine Use Raises Concern. Retrieved from https://www.webmd.com/mental-health/addiction/news/20190206/after-opioidsbenzodiazepine- use-raises-concerns

Amy Alexander receives the 2018 Excellence in SPE Award! 

Amy Alexancer

We are very proud to announce that Amy Alexander, Research and Development Senior Forensic Analytical Chemist at USDTL, was selected as a 2018 Excellence in SPE Award winner. This award is sponsored by United Chemical Technologies (UCT) and was awarded at the 2018 annual Society of Forensic Toxicologists (SOFT) meeting held in Minneapolis, MN.  The award reflects recent outstanding contributions to the scientific literature in the field of Solid Phase Extractions in Forensic Science.  Specifically, UCT is recognizing the article “Discordant Umbilical Cord Drug Testing Results in Monozygotic Twins” where Amy served as the principal author.

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What you need to know about meconium collection.

by Michelle Lach, MSIMC

Meconium is the first stool of a newborn infant. It is produced in utero and consists of materials such as epithelial cells, bile, mucous, and more. In most newborns, meconium is generally passed in the first day or so of life, has no odor, and appears as a very dark, tar-like substance. This helps distinguish meconium from the next phase of passage called transitional stool. 

Transitional stool will start to have an odor and present with a more brown, green, or yellow color as the newborn starts digesting milk. When drug testing the meconium of a newborn, it is important to note this difference since only meconium is created during gestation and transitional stool is created after birth. Collection of any stool other than meconium for drug testing purposes may result in a rejected specimen.  

Unlike umbilical cord tissue, drugs are not distributed uniformly throughout the meconium specimen (see Figure 1). Because of this, the collection of the entire mass of meconium is highly encouraged to assure that there will be enough specimen to test, and that the maximum window of drug detection is achieved. It can take multiple passages of meconium before the newborn begins the transitional stool phase. 

We require a minimum of 3 grams of meconium to be able to properly run our tests, so collecting the entire passage of meconium from newborns that have been exposed to substances of abuse is highly critical since they tend to have lower birth weights and create less specimen in the first place. If there is not enough specimen to run the test, the results are reported out as QNS. Quantity Not Sufficient (QNS) is a result of not having a sufficient quantity (volume) of specimen to test for the panels ordered.