Written by Kristi
A GROUP OF MORE THAN 45
EXPERTS convened in Washington, DC July 18-19, 2019 to present the latest
information on the ongoing threats from opioids and other emerging drugs.
Hosted by the National Institute of Justice (NIJ), in partnership with the
Forensic Technology Center of Excellence (FTCoE) at RTI International, the
National Opioid and Emerging Drug Threats Policy and Practice Forum focused on
forensic, public safety, and health responses to the epidemic.
A number of themes emerged from
the panels of experts who spoke over the course of the two-day conference.
These key points included backlogs and workforce shortages; the value of
real-time data; and the importance of opening up communication between all of
the public entities touched by the opioid epidemic—from law enforcement to
forensic investigations, and from social workers to public-health
The transient nature of illicit
drugs challenges law enforcement, laboratories, and public health agencies.
It’s a simple fact that you can’t find something if you’re not looking for it.
Unfortunately, the overdose risk of opioids puts pressure on public agencies to
identify these substances in real time, even as they are evolving.
While real-time identification
of new drugs isn’t exactly a reality, information-sharing and diligent testing
can help get very close to that goal. At the forum in July, Emily Lockhart, senior
forensic chemist with the DEA’s Special Testing and Research Laboratory, cited
two programs at the DEA that assist laboratories with analytical preparedness: the
Reference Materials Program, which supplies reference materials to all DEA
laboratories; and the Emerging Trends Program, which issues a quarterly
Emerging Threat Report through the National Drug Early National Warning System
website (NDEWS), chemical analysis of
novel materials, and ongoing monitoring of “substance unconfirmed” reports.
While these DEA programs look
at the chemical analysis of the substances themselves, others are working to
understand the body’s reaction to these drugs—and the implications of that on
toxicology screens, as well as life-saving measures such as administration of
naloxone. Dr. Michael H. Baumann with the Designer Drug Research Unit said that
novel synthetic opioids are presenting a particular challenge.
“We have the rapid appearance
of synthetic opioids that have not been approved for medical use, and we don’t
know what they do. We have no idea the toxicology of this plethora of
substances,” said Baumann. He added that because of the way they are
metabolized, analogs may not show up on a drug screen unless the toxicologist
is specifically looking for them.
For some agencies, managing
backlogs and increasing drug-testing capabilities will be key to tracking the
continued spread of opioids and other emerging drug threats. In one case
example, Dr. Jennifer AL Smith, director of the Department of Forensic Sciences
(DFS) in Washington, DC, shared the experience of her agency’s move to begin
in-house drug testing. Prior to Smith’s 2015 arrival as director at the lab,
all of Washington DC’s drug evidence was being sent off for testing by the DEA.
In all, only about 19% of all seized evidence was actually analyzed. Smith and
other policymakers recognized that if the district had been able to test that
other 81% of evidence, they would have been better able to track the emergence
of new illicit drugs such as synthetic cannabinoids and fentanyl.
Working with DC Health, the
laboratory received a joint grant from the Centers for Disease Control and
Prevention (CDC) focusing on surveillance testing. “This is something I tell my
colleagues: talk to the public health folks—you may be able to come and be a
part of that public service,” said Smith.
By doing their own drug testing
in their new in-house lab, DFS was able to develop actionable intelligence on
emerging drugs. The agency now releases alerts that might be of interest to law
enforcement, as a basic “be-on-the-lookout” notice for novel substances that
have been detected in their laboratory. In one example, DFS released an alert
in November 2018 on counterfeit oxycodone pills containing fentanyl. In
February 2019, a factory in Pittsburgh, Pennsylvania was found where the pills
were being manufactured. “This is the reason we push this information out in
different ways,” said Smith.
Throughout the two-day forum,
it was made clear that the opioid epidemic is not a law enforcement issue as
much as it is a public health issue. Identifying illicit drugs and arresting
the people who possess them does not stop the underlying issue, which is
addiction. Because of this, multiple approaches are needed—from laboratories to
health care providers to social workers—to track and, ideally, prevent the
spread of these drugs.
“The United States has an
addiction epidemic with a fentanyl crisis,” said Thomas Synan with the Newtown
(Ohio) Police Department.
RxStat, a drug surveillance
system developed in New York in 2011, monitors in real time opioids and other
drugs and their associated consequences. The system has developed into a
partnership between 30 different agencies, from public health to public safety,
and from city to state organizations. “All of them are looking at the same map
at the same time with the same goal and trying to find ways we can reduce
(overdoses),” said Chauncey Parker, director of the New York/New Jersey
High-Intensity Drug Trafficking Area. “Always asking that question, What can we
do to reduce overdoses and save lives?”
Another kind of system that is
ideal for public health and public safety partnerships is prescription drug
monitoring programs (PDMPs). According to Dr. Chris Delcher, an epidemiologist
and associate professor at the University of Kentucky’s Department of Pharmacy
Practice and Science, nearly 2 million health professionals are registered to
use state-based PDMPs, and health professionals made more than 460 million PDMP
queries in 2018. That was a 56% increase from 2017 and a 651% increase from
2014. And in Florida, 73.6% of law enforcement reported using the state’s PDMP
in an investigation.
Another key example of a
program working as a partnership between multiple stakeholders is the Drug
Monitoring Initiative (DMI). New Jersey State Trooper Adam Polhemus, a founding
member of the DMI, said the program took an all-hazards, all-threats approach
to gathering data on emerging trends and drug activity trends. It includes
crime-related data sets on drug seizures, lab results, law enforcement Narcan
deployments, drug arrests, shooting, and gun recovery; and health and human
services-related data sets on EMS Narcan deployments, drug-related emergency
room visits, toxicology, PMPs, addiction treatment admissions, and urinalysis results
from corrections and probation.
While the program began in New
Jersey, Polhemus said there are eight other states that have adopted the DMI
program, and there are 34 other states that have expressed interest. “We have a
tool kit and online training coming in the fall that will allow those entities
to do so,” said Polhemus.
Another effort discussed at the
forum was NPS Discovery, a website
operated by the Center for Forensic Science Research and Education that works
to rapidly disseminate information on emerging drugs. Utilizing surveillance
from seized drugs at the border and mail ports of entry, postmortem databases,
and biological information from mass overdose outbreaks, the website posts
real-time trend reports, emerging trends and outbreak reports, analytical
monographs, and more.
A program from the DEA, the National Forensic Laboratory
Information System (NFLIS), collects and disseminates results of forensic
analyses and other related information from local, regional, and national
entities. As of February 2019, NFLIS-Drug contains the drug-analysis data from
50 state laboratory systems and 104 local or municipal labs. The DEA has
recently expanded the NFLIS program to include public and private toxicology
laboratories (NFLIS-Tox) and medical examiner and coroner offices (NFLIS-MEC).
“Our office was individually
calling medical examiners’ offices to get death reports because we had seen a
news report or heard of an aggregated death or clusters of death,” said DeMia
Pressley, DEA program officer. “That can be time consuming. We were hoping that
with these two new data collections, we would have a means of an ongoing
dataset so we could get to this process for emergency scheduling much faster.”
Yet another resource is the National Drug Early Warning System (NDEWS).
This project monitors emerging drug-use trends and encourages
information-sharing in three ways: 1) The NDEWS Network, a virtual community of
more than 1,500 experts from a variety of fields, along with concerned
citizens, who share information on emerging drugs and drug trends; 2) Sentinel
Community Sites, ranging in size from a city to a county to an entire state,
where epidemiologists monitor and provide regular updates and annual reports;
and 3) HotSpot Studies, where experts work together to identify a trend or
question of concern, research it, and provide information on all available data
and existing research that is available.
Opening the panel discussion on
the need for more forensic pathologists and medicolegal investigators in the
United States, Dr. Jonathan L. Arden, 2019 president of the National
Association of Medical Examiners (NAME) did not mince words.
“Since forensic pathology was
established, there has been a critical shortage of forensic pathologists,” said
Arden. “That has not changed except to get worse over the years. We have now
reached a point of being on the cusp of an existential crisis of forensic
Arden described medical
examiners and coroners as standing on the front lines of emerging threats like
the opioid crisis. And yet the demand for these professionals is far outpacing
their supply. According to Arden, there are currently 400-500 full-time
forensic pathologists working in the United States. Based on NAME accreditation
standards, the estimated number of forensic pathologists needed to deal with
the current opioid epidemic is closer to 1,200-1,500.
The reason for the shortage?
“Crushing student debt burden,” said Arden. Government salaries are half of
private-sector salaries. Plus, entering the medical-examiner field requires an
extra year of training with reduced earnings compared to the private sector…
all with the same student debt load.
MJ Menendez, a member of the
NAME Strategic Planning Committee, listed a number of steps that could be taken
to attract more people to the field of forensic pathology, including visa
waivers, fellowships, and loan forgiveness. She also made an impassioned plea
before the forum. “I come to these meetings over and over again, and since 2003
we have made no progress on these issues,” she said. “That is because somehow…
the fact of the fundamental problem being so prevalent and serious—it hasn’t
made it into people’s souls. What I want you to do today is decide whether you
are going to take this message into your soul. It is going to take every one of
us, taking at least one step out to talk to a policymaker or legislator, a
funder, a public authority, to change this problem.”
The archived webcast of the
2019 National Opioid and Emerging Drug Threats Policy and Practice Forum will
be made available on the Forensic Technology Center of Excellence website soon.
You can find the full agenda, speaker bios, and more here.
Kristi Mayo is the
editor/publisher of Evidence Technology Magazine.