The Toxicology Investigators Consortium Drug Overdose Toxico-Surveillance Reporting Program for Emergency Department...

The rapidly evolving overdose crisis often involves polydrug use. The Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program aimed to inform the epidemiology of opioid and stimulant overdoses presenting to the emergency department (ED) using structured patient interviews, medical record reviews, and the collection of blood specimens for qualitative analysis and quantitative drug concentrations.

ToxIC implemented DOTS at 17 medical centers in the United States during 2022-2024. ED patients (aged ≥13 y) who presented with a severe or life-threatening opioid and/or stimulant overdose were screened for eligibility and approached for informed consent. The Center for Forensic Science Research and Education conducted analyses using a panel of >1200 substances through liquid chromatography quadrupole time-of-flight mass spectrometry and quantitative measurements using liquid chromatography tandem quadrupole mass spectrometry. We computed descriptive statistics to summarize main outcomes.

During the 2-year sentinel surveillance program, 995 patients were included. Seventy percent (n = 694) of patients presented with a clinically suspected opioid overdose, 13.3% (n = 132) with a suspected stimulant overdose, and 17.0% (n = 169) with an undifferentiated overdose. Fentanyl was detected in most (86%; n = 600) patients with an opioid overdose presentation and 35% (n = 46) of patients with a suspected stimulant presentation. The median (range) fentanyl blood concentration in nonfatal overdoses was 4.5 (1.0-140.0) ng/mL. Mortality was 1.0% (n = 10).

The DOTS Reporting Program addressed a gap in public health overdose data by obtaining quantitative blood concentrations and information on the patient's drug use history that are often not captured in traditional surveillance systems. Future work should consider incorporating patient interviews and quantitative concentrations into overdose data collection to elucidate which drug(s) contribute to the overdose.