TY - JOUR
T1 - A risk-based approach to community illicit drug toxicosurveillance
T2 - operationalisation of the Emerging Drugs Network of Australia – Victoria (EDNAV) project
AU - Syrjanen, Rebekka
AU - Schumann, Jennifer L.
AU - Lyons, Tom
AU - McKinnon, Ginny
AU - Hodgson, Sarah E.
AU - Abouchedid, Rachelle
AU - Gerostamoulos, Dimitri
AU - Koutsogiannis, Zeff
AU - Fitzgerald, John
AU - Greene, Shaun L.
AU - on behalf of the EDNAV Project Research Group
N1 - Funding Information:
The authors thank Dr Jared Castle, Dr Linda Glowacki and Mr Matthew Di Rago from the Victorian Institute of Forensic Medicine for their analytical assistance. We additionally thank all EDNAV project site investigators: Dr Ali Al Joboory, Dr Elyssia Bourke, Dr Paul Buntine, Mr Christian Cinel, Miss Angela Dean, Dr Martin Dutch, Dr Karin Eggink, Miss Rebecca Fawcett, Prof Andis Graudins, Mr Liam Hackett, Dr Hans Hollerer, Dr Rajan Kailainathan, Miss Aisling Kiely, A/Prof Jonathan Knott, Dr Jason Kwok, Dr Hwee Min Lee, Miss Nicole Lowry, Dr Jacqueline Maplesden, Dr Danny Marhaba, Dr David McCreary, Mr Joseph Miller, Prof. Biswadev Mitra, Miss Kelly Mullins, Mrs Nola Poulter, A/Prof Joe-Anthony Rotella, Miss Abha Somesh, Dr Julian Stella, Miss Amanda Tyers, Dr Jay Weeraratne and Miss Cassandra Yankoff for their ongoing project input and assistance. The authors also thank the State Coroner of Victoria, Judge John Cain, for approval to publish information on the coronial case.
Funding Information:
The authors acknowledge funding from the Victorian Department of Health and the National Health and Medical Research Council (GNT2001107).
Publisher Copyright:
© 2023
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: The Emerging Drugs Network of Australia – Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. Methods: Risk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 – August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. Results: A total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. Conclusions: Continued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making.
AB - Introduction: The Emerging Drugs Network of Australia – Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. Methods: Risk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 – August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. Results: A total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. Conclusions: Continued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making.
KW - Early warning system
KW - Harm reduction
KW - Illicit drug
KW - Multi-disciplinary
KW - Public health
KW - Surveillance
KW - Toxicology
KW - Toxicosurveillance
UR - http://www.scopus.com/inward/record.url?scp=85176572091&partnerID=8YFLogxK
U2 - 10.1016/j.drugpo.2023.104251
DO - 10.1016/j.drugpo.2023.104251
M3 - Article
C2 - 37952318
AN - SCOPUS:85176572091
SN - 0955-3959
VL - 122
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 104251
ER -
