Analytical Chemists are the Key to Managing the Opioid Epidemic

The opioid crisis continues to kill more than 50,000 Americans each year. In “The Opioid Epidemic: Moving Toward an Integrated, Holistic Analytical Response,” the authors describe the key role that analytical chemistry must play in fighting this scourge. They cite analytical labs around the country as the major resource essential for timely, science-based identification of new opioid analogs. Opioid analogs are likened to a series of epidemic clusters that pop up in specific localities before spreading to the remainder of the states and potentially the rest of the world.

The CDC’s National Syndromic Surveillance Program is a well-honed process for spotting outbreaks of new infections, but the timeline is too long to be very useful. Plus, the medical examiner/coroner may have trouble determining the cause of death. Is the death due to illicit drug use or prescription drug abuse or unexpected, but natural, causes? Patient histories and autopsies can help, but require days to months to collect and evaluate. By then, the body count will probably confirm the tragedy. The authors support creation of a national syndromic drug poisoning program that would be useful in early identification and mitigation of risk.

Analytical labs also have an important role. Like no other, analytical chemists have the skills and tools to identify new drug analogs (see below). Plus, many labs astutely manage large files of data for qualitative and quantitate analysis. The data and reports are routinely transmitted electronically. The first three items below list recent accomplishments. It seems possible to satisfy the six identified needs.

Recent advances and identified needs to address remaining capability gaps

Recent advances:

  • Development of novel search algorithms (e.g., Hybrid Similarity Search)
  • Development of state and regional data integration systems
  • Enhancement of communication between analytical communities of toxicology and drug chemistry.

Identified needs:

  • Provide quicker access to analytic reference materials and methods
  • Provide guidance for reporting presence of impurities and complex mixtures
  • Develop improved metabolite prediction capabilities, toxicity assays, and potency and drug impairment data
  • Improve guidance for emergency room and clinical sample collection, protocols for sharing samples, and required clinical testing
  • Equip clinical testing laboratories with the ability to identify novel synthetic opioids as part of a national syndromic surveillance capability to alert regional public health officials and potentially save lives.
  • Provide access to high-quality, real-time, national-level data on chemical composition, drug toxicity and overdoses, MDI and toxicological test results, and analysis of seized materials by law enforcement to track drug trends.

This paper seems to be a work-in-progress report. The authors see the needs and are aware of similar programs such as recognition of infectious diseases with the CDC. The FDA is effective in identifying risks in foods and prescription drugs. The problem with the illicit street drugs is the immediacy and morbidity. As chemists, we can do a lot about immediacy, which might have a positive impact on morbidity. Longer term, research may develop drugs that provide the craved psychotropic effects without endangering health.

Robert L. Stevenson, Ph.D., is Editor Emeritus, American Laboratory/Labcompare; e-mail: [email protected]

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