Evaluation of an illegal drug toxicity surveillance system - British Columbia, Canada, 2019

  • Public health surveillance
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Background:
In 2016, British Columbia (BC) declared a public health emergency due to an increase in drug-related overdoses and deaths, primarily driven by illicit drugs. This allowed for rapid public health response, including surveillance of urine samples submitted by outpatient clinics for drug screening to private laboratories. Fentanyl positivity and analogue trends were identified and led to drug alerting and harm reduction messaging. This evaluation identifies current surveillance system advantages, limitations and reporting needs for future urine toxicology surveillance development.

Methods:
We used CDC guidelines for evaluating surveillance systems and assessed the system’s utility, acceptability, timeliness, and representativeness. The population under surveillance were outpatients who submitted a urine drug screen sample to a participating laboratory. We conducted an online survey with end-users of the data (including public health and law enforcement). Five-point Likert scales were used to assess selected attributes. Open ended questions assessed limitations and benefits of the surveillance system. Qualitative data was analyzed using thematic content analysis.

Results:
Thirty-seven of 93 end-users completed the survey (40%). They agreed or strongly agreed that this surveillance system was useful (84%), acceptable (89%), and timely (73%). Half found the data representative for their population of interest. Eighty-six percent of respondents reported that the system increased their awareness of toxic analogues circulating in the street drug supply. Limitations reported include: difficulty in interpreting data for public health action, biases in the population tested, and under-representation of geographic regions.

Conclusion:
Respondents valued this system for its ability to inform on opioids being used in the community, and help plan public health messaging and harm reduction services. However, the system needs to improve its geographical representativeness and expand the population under surveillance. Since this surveillance system currently leverages outpatient clinical testing data, additional urine toxicology surveillance in new populations should be developed, especially in under-represented regions.

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