Lab Matters Fall 2018 - Page 15

FROM THE BENCH MNDOSA Methodology MDH PHL is providing laboratory analysis support for MNDOSA. Utilizing LC-QQQ (Agilent 6460) technology, they have developed three methods that look for over 200 different drugs of abuse. The multi-drug panel includes the most commonly abused drugs of abuse (amphetamine, methamphetamine, cocaine, etc.), the designer drug panel targets the synthetic cannabinoids and cathinones, and the opiate panel targets the synthetic opiates. Each sample analyzed for the program is extracted three times and spiked with method- specific internal standards to aid in proper identification. The drug panels were purchased from PinPoint Testing LLC and supplied to MDH in 96 well plates. While specimens are dedicated for public health surveillance use only and laboratory test results are not included in the patient’s medical record, MDH followed CLIA requirements in completing the method validations. To complete the validations, MDH chemist Matt Wogen spent months optimizing the LC separation, MS parameters and extraction efficiency for each matrix, compound and internal standard. Due to the large number of compounds of interest, over 100,000 different peaks were processed. With the changing landscape of synthetic drugs, there is a consistent need to update the panel of compounds, requiring regular revalidation of the methods. Reporting and Collaboration MNDOSA data collection began in November 2017; preliminary data were first presented to the advisory group and MNDOSA partners in February 2018. The MNDOSA team at MDH provides quarterly aggregate reports with preliminary data to all members of the advisory group on a quarterly basis, as well as weekly hospital-specific reports to each participating hospital. According to Environmental Laboratory Section manager Paul Moyer, MS, who oversees the area performing the testing at Minnesota’s state laboratory, collaboration across divisions within the state health department has proven critical to development of the pilot. Particularly vital are connections with the Injury and Violence Prevention Section. Moyer recommends that other laboratories make time to meet with their colleagues in Injury Prevention to discuss opioid and substances of abuse. “These individuals have a potential interest in accurate data on the effects of chemical exposure. At the very least, it will be useful to have met each other. You never know what will happen down the line.” @APHL • Determine the burden of substance use/ overdoses associated with recreational drug use in select emergency departments and hospitals in Minnesota • Identify clusters of drug overdoses • Identify substances causing clusters, unusual or atypical clinical presentation and severe illnesses to inform approaches to treatment and prevention • Describe the populations most affected to focus and guide prevention efforts MNDOSA has applied for additional funding to continue and expand the pilot to additional hospitals. As well as the hospitals in Duluth, the pilot includes a Twin Cities Level I trauma center, and more hospitals are expected to participate in the coming months. MNDOSA plans to evaluate pilot data against other data sources and assess the feasibility of expanding to other parts of the state. n For more information about MNDOSA, contact project coordinator Terra Wiens or Paul Moyer. Thus far, MNDOSA stakeholders are excited about the potential for further analyses. The data have already enabled them to see demographic characteristics and suspected substances. PublicHealthLabs MNDOSA Objectives: APHL.org Fall 2018 LAB MATTERS 13