Emergency Department Substance Use Surveillance System

This project seeks to further refine and geographically expand a methodology for obtaining drug early warning indicators through broader testing of urine samples that were previously collected and tested as part of an existing drug test protocol. This method was initially developed using local criminal justice populations – including persons in pre-trial or lock-up, parolees or probationers, and drug court participants. A similar methodology is promising for use in other venues, such as in trauma units and emergency departments, where biological samples are often collected from patients. Before the specimens are discarded, the project will re-test them for an expanded panel of drugs, including xylazine, fentanyl, methamphetamine, and other new psychoactive substances (NPS); to determine what old and new illicit drugs are detected or missed by conventional testing protocols, and how the drug patterns might vary by subpopulation and geography. Bypassing the expense of collecting the original specimens and re-using those that have already been tested with known results yields a relatively inexpensive and timely picture of emerging drugs in a given subpopulation and locality. Hospital and de-identified nationally representative patient electronic health records (EHRs) should be collected and analyzed to put re-tested urine positivity results into a larger regional and national context of drug exposure and consequences. ONDCP is seeking to apply this testing methodology and insight from supplemental EHR investigations to emergency department and other hospital-system populations in locations throughout the United States to reinforce best practice guidelines, testing standardization, and build local and national surveillance capacity.