president's / executive director’s message
months or years and then overdose
accidentally. One could envision a
surveillance program focused more on
living patients who can still be helped.
Becker: Absolutely. The focus of our
surveillance shouldn’t just be death
certificates. But I believe the public
health response is still ramping up.
ASTHO’s current president, for example,
has made preventing substance misuse
and addiction his presidential challenge
for 2017, and APHL has already hosted
a webinar on the opioid epidemic
featuring the ASTHO president, Alaska
Chief Medical Officer Jay Butler.
King: Public health laboratories have
developed sophisticated chemical
analysis capabilities through the years
of participation in the LRN-C; many
have applied these capabilities in
biomonitoring programs or studies. We
have the equipment, the technology
and the know-how that could be
applied to the problem of opioid
use. When we talk about all-hazards
response, well, opioid misuse is a
hazard that’s killing people every day.
Now that the epidemic is
officially a public health crisis,
public health laboratories need to
think about how we can and should
be involved.” – Ewa King, PhD
PublicHealthLabs
@APHL
Becker: I like that approach because it
recognizes that we have the tools at hand.
It’s a matter of dual use. We just need
to put our minds together to develop
the appropriate protocols and then do
the outreach within our own agencies.
Non-laboratorians don’t necessarily know
all that can be done in the public health
laboratory and would not naturally think
of engaging the lab. It’s an opportunity
for people to step u p and say we do
have something to offer. As you said,
Ewa, there is no surveillance system
for ongoing opioid misuse; it would be
useful to have a dialogue around that,
noting that public health laboratory drug
testing is another tool in the toolbox.
King: Now that the epidemic is officially
a public health crisis, public health
laboratories need to think about how we
can and should be involved. In Rhode
Island, we have a multidisciplinary task
force for opioid overdose prevention,
where I represent the State Health
Laboratories. I am not sure, however,
that all states have a multidisciplinary
approach like that pioneered by Dr.
Alexander-Scott, our director of health.
The laboratory component appears to be
largely unexplored elsewhere. Historically,
clinical drug testing has been mostly
performed for employment purposes or
for impaired driving; it takes time for
people to adjust their notions of what
belongs in the public health arena.
Becker: APHL can take a leadership role
on this issue as well. And we should.
It’s no different from HIV in terms of
its widespread public health impact.
However, it’s a non-infectious epidemic,
and that puts it, in the minds of some,
beyond our scope. I don’t buy that.
About a year ago, we asked CDC about
laboratory involvement in the crisis,
and the agency really wasn’t active in
the laboratory arena. That has changed:
some people in the federal laboratory
system are putting forth new ideas.
APHL is also looking to engage directly
with CDC’s Center for Injury Control
and Prevention, which has purview over
APHL.org
At APHL, we are planning to
establish a community-of-practice
that can serve as a think tank to
bring laboratory leaders together to
discuss opioid issues in their states
and to identify resources we can offer
up across the laboratory system to
help with this problem.
– Scott Becker, MS
this issue. There may be opportunities
for collaboration with other new
partners as well, such as the National
Association of Medical Examiners.
King: I am getting inquiries about what it
would take to bring opioid testing online
from other public health laboratories. We
have all been in this situation many times
before, when an issue suddenly becomes
a priority and we get a request asking
what infrastructure needs to be in place
and how much money is needed to bring
up a new testing program. It’s a good idea
to think about this in advance—before you
are asked—so you have an answer ready.
Becker: Individual labs will have to
make their own decisions, within
the context of their own state or
local response to the epidemic and
their own resources. Whether it’s
something they choose to do or not, it’s
a problem that won’t just go away. ■
Summer 2017 LAB MATTERS
3