Impact of the Opioid Epidemic on Drug Testing

Abstract

Background: This review provides a description of how the opioid epidemic has impacted drug testing. Methods: Four major service areas of drug testing were considered, including emergency response, routine clinical care, routine forensics, and death investigations. Results: Several factors that the opioid epidemic has impacted in drug testing are discussed, including specimens, breadth of compounds recommended for testing, time to result required for specific applications, analytical approaches, interpretive support requirements, and examples of published practice guidelines. Conclusions: Both clinical and forensic laboratories have adapted practices and developed new testing approaches to respond to the opioid epidemic. Such changes are likely to continue evolving in parallel with changes in both prescription and nonprescription opioid availability and use patterns, as well as emerging populations that are affected by the “waves” of the opioid epidemic.

Evaluation of “Real-Time” Fatal Drug Overdose Surveillance by King County Medical Examiner's Office, Seattle, Washington

“…Guidelines for certification of overdose deaths published by the National Association of Medical Examiners 25 recommend against using screening methods to certify deaths because of the inherent false-positive rates of these tests. 26,27 While this study certainly supports this recommendation, the results also indicate that RDC can be achieved in many cases by the RDC methodology described herein, adhering to a strict protocol relying on concurrence of information gathered from scene investigation, autopsy findings, screening autopsy blood and urine, and testing drug evidence collected from scenes. Over the 3-year period KCMEO certified 56% of 1797 overdose deaths within 1 to 3 days.…”

Evaluation of in‐house drug evidence testing by King County Medical Examiner's Office in “real‐time” fatal overdose surveillance

“…In response to the ever‐expanding drug overdose epidemic [1–7], medical examiners and coroners, public health agencies, and toxicology laboratories have initiated a variety of surveillance efforts to monitor the progression of the crisis with respect to overdose fatalities and the appearance of novel drugs appearing in communities across the US [8–28]. In 2018, the King County Medical Examiner's Office (KCMEO), a division of Public Health – Seattle and King County, in Seattle, Washington, initiated a “real‐time” surveillance project using toxicology screening methods for in‐house testing of decedents' blood and urine samples.…”

Medical examiner response to the drug overdose epidemic in King County Washington: “Real‐time” surveillance, data science, and applied forensic epidemiology

“…Seemingly limitless supplies of novel, inexpensive, highly purified, and potent substances [9][10][11][12][13][14][15][16] are aggressively marketed with near complete impunity throughout the United States [17][18][19] accompanied by drug-related violence within the United States [20][21][22][23][24] and south of its border in Mexico [25,26]. Confronted with burgeoning caseloads, death investigators and toxicology laboratories have been forced to adopt new operational strategies, sometimes forgoing autopsies and taking advantage of economies of scale by utilizing private toxicology laboratories instead of local ones [27][28][29][30][31]. Opportunities for adequate funding are constrained by limited public funding, paucity of grants for death investigation, and fierce competition for any funding [32].…”