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The Convergence of the Opioid Crisis and COVID-19: A Silent Epidemic, Overshadowed

Team members from the Florida Bureau of Public Health Laboratories pose wearing masks holding a sign that says "End Overdose."

by Nicholas Ancona, MPH, specialist, Opioids Biosurveillance, APHL

Over 93,000 Americans died from a drug overdose in 2020—a 30% increase from 2019. Despite an overall decline in emergency department visits that year, non-fatal drug and opioid-involved overdose visits continued to rise. 2020 saw “the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999,” according to Dr. Nora Volkow, director of the National Institutes of Health National Institute on Drug Abuse. Why the sudden surge in overdoses? Public health measures to counter the spread of COVID-19, such as social distancing and facility closures, strained and prevented access to vital treatment and support services for individuals struggling with addiction.

Public health laboratories are uniquely poised to respond to the opioid epidemic and have been doing so successfully for several years. Through relationships with clinical partners and by providing high-quality, definitive laboratory testing of blood and or urine specimens, public health laboratories deliver vital data on exposure to specific drugs and their components. These data provide valuable insight into the recent drug history of patients with non-fatal overdoses, filling a major gap in many state-wide overdose surveillance systems. Testing also reveals community trends in exposure to potent synthetic opioids and other additives, which are continuously introduced into the drug supply.

Critical biosurveillance at public health laboratories has continued throughout the COVID-19 pandemic despite constrained workforce capacity, limited resources and challenges in acquiring specimens for testing from overwhelmed hospital networks. A key factor to many laboratories’ success is their collaborations with state and local public health programs, hospitals and community groups all working in tandem, within the larger response to the opioids epidemic.

  • The California Department of Public Health Laboratory is working to expand its opioids biosurveillance activities by increasing their testing capabilities and exploring partnerships with local health departments, such as Fresno County Public Health. In the event of a surge in overdoses in Fresno, the state laboratory will now be able to test the county’s clinical specimens and provide valuable drug usage data, helping to inform the actions of key community stakeholders.
  • The Florida Bureau of Public Health Laboratories recently partnered with a local hospital to increase the laboratory’s access to samples from non-fatal overdose patients, which will expand their ability to track patterns and provide actionable data.
  • Since 2017, the Minnesota Department of Public Health Laboratory has worked with the Minnesota Injury and Violence Prevention program on a collaborative surveillance system, the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity (MNDOSA). MNDOSA tracks laboratory and epidemiological data on drug-related overdoses in the state, and shares its reports with submitting hospitals and the Minnesota Poison Center so that the data reaches those who can take action when needed. MNDOSA is always working to include more hospitals in the state to expand their reach. 
  • The Rhode Island State Health Laboratories began collecting and testing urine specimens associated with non-fatal overdoses in July 2019. Since then, the laboratory has analyzed 18 months’ worth of biosurveillance data to track drug usage trends in the state; identifying such patterns allows for more informed responses and helps guide future action. The laboratory’s experience testing opioids-related specimens has also helped them develop the capability to quickly identify novel drugs and determine their impact on non-fatal overdoses.
  • The South Carolina Public Health Laboratory has had tremendous success expanding their specimen collection capabilities by engaging emergency department partners to provide de-identified urine specimens for opioids testing. The laboratory has engaged 29 hospitals in memoranda of agreements, with 25 already submitting specimens. In July 2021, the laboratory received 629 specimens—the highest number since starting the biosurveillance program—and sample volumes are expected to increase as more hospitals join this program.

APHL supports opioids biosurveillance programs through development of technical resources (such as the APHL Model Opioids Biosurveillance Strategy for Public Health Practice), facilitation of training opportunities and the APHL Opioids Community of Practice, a forum for laboratories to share successes and challenges related to their opioid work. Visit to learn more. 

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