A Data-Informed Response to Emerging Drugs

SPEAKER 1: Welcome to Justice Today, the official podcast of the Department of Justice's Office of Justice Programs, where we shine a light on cutting edge research and practices and offer an in-depth look at what we're doing to meet the biggest public safety challenges of our time. Join us as we explore how funding, science, and technology help us achieve strong communities.

FRANCES SCOTT: Well, hello and welcome to another episode of Justice Today. I'm Frances Scott. I'm a program manager in the Office of Investigative and Forensic Sciences at the National Institute of Justice. And we are here at the NIJ Research Conference, so if you hear any background noise, please excuse us. But we wanted to talk to some of our panelists from our panel on “Emerging Drug Crisis in America: A Criminal Justice and Public Health Nexus” that'll be happening later today. I'm joined by Ciena Bayard, the Method Development and Validation Program Manager from the D.C. Office of the Chief Medical Examiner. And Haley Greene, the Deputy Central Region Epidemiologist from the Virginia Department of Health. 

So new drugs are constantly emerging on the illicit scene. Conservative estimates put the number of new compounds being abused in the U.S. at over 200 since 2018 alone. This puts a strain on both forensic and public health systems to identify and combat these drugs, some of which may only be present for a few months before disappearing again. And so we're here to talk about our key take home message which is that accessible data consolidated from criminal justice and public health sources is key to fighting the emerging drug crisis in the U.S. 

Haley, how did Virginia Department of Health really get, you know, we think of Department of Health, we don’t necessarily think of drug overdoses. So how did Virginia Department of Health get involved with drug overdoses as a health crisis?

HALEY GREENE: Yeah, great question. Well, the issue was presented that drug overdoses have dramatically increased over the last two decades, and deaths from overdoses have significantly increased since 2013. And in 2016 when more than 63,000 Americans died from drug overdoses, a public health emergency was declared. The Centers for Disease Control and Prevention ended up funding 32 states including Virginia and the District of Columbia to improve data collection efforts on opioid involved overdoses with the objective to help inform local, regional, and state prevention and response efforts, while also improving the timeliness of reporting for action and response. So for reference, in Virginia alone, an average of four people died of an opioid overdose daily in 2020, which is a 17% increase from 2019. So some of the things that we've just been working on here lately and seen within our community.

FRANCES SCOTT: Wow. So yeah, 2016 was really this watershed moment. And I think lots of us, probably even some of the listeners, have seen the CDC chart that shows just the overdoses shooting up at an exponential level. 

So Ciena, your role at D.C. OCME actually arose from the emerging drug crisis. Can you talk about how that came about?

CIENA BAYARD: Yeah, I can definitely talk about that. In 2016, the Method Development Program was started because of the opioid crisis. However, the medical examiner's office was already working in NPS through the synthetic cannabinoids. Like way back in 2013, we developed a methodology for synthetic cannabinoids along with the partnership from pre-trial services, which is another toxicology agency within the District of Columbia. And pretty much directly after we put our method online, new--even more new synthetic cannabinoids came out. And so we had to go back into validation almost immediately. I don't know if anyone listening has ever done a validation but it's time-consuming and costly, so it's a very big mistake on our part. And I think if we had, at the time, better intelligence, we would not have had to go back into validation again because we would've had the information upfront. So when the opioids crisis started and the method development program started, we had a good footing on how to develop and validate methods, what documents and resources we needed in order to be able to research the information in order to have a robust method for our stakeholders.

FRANCES SCOTT: And when you're talking about, just for the listeners, in case any of that is new, NPS, novel psychoactive substances, that's the term of art for most of us when we're talking about these emerging drugs. And listeners may be familiar with the synthetic cannabinoids. That was sort of the K2 and Spice and those kinds of things, right? But even though these molecules sort of act like a marijuana compound and attach to the same brain receptors, perhaps, they can have little changes in the structure and then the method that you had spent the time developing would not necessarily pick up those new compounds as soon as they emerged, right?

CIENA BAYARD: Correct.

FRANCES SCOTT: And so, then you had the same problem now when the opioids were starting I imagine?

CIENA BAYARD: Yes. So for opioids, the analogs were changing so fast that it was very hard for us to be able to keep up. So we would go through the validation process and then another one will come about. And so we found ourselves really chasing the analogs and so we had to figure out different ways--a different way to kind of detect the fentanyl analogs instead of chasing each individual one.

FRANCES SCOTT: That's fascinating. Ciena, you mentioned, you know, you had to come to this new way of dealing with these opioid and fentanyl analogs, analogs being molecules that are similar--again, similar but a little bit different, similar in structure, maybe a couple of atoms moved here or there or added. And so is that still where we are now, here in 2023? Are we still chasing fentanyl analogs, or what's the situation? What are you seeing now?

CIENA BAYARD: Yeah. So fentanyl analogs are kind of--have kind of dropped off. We've been seeing fentanyl only for a while. There's--in the medical examiner's office, we're starting to see fentanyl and cocaine mix. And in the fentanyl analog that we do see most often is fluorofentanyl.

FRANCES SCOTT: And what's the--what's the sort of, you know, opioid overdose rate looking like? What does that demographic look like in D.C. now?

CIENA BAYARD: The D.C. demographic is a little bit different than what it is over in the country. So our demographics are males, African-American, and from the ages of 44 to 69. So we have an older population that is dying from opioid overdose and which is definitely different than the--than the rest of the country. In 2022, there were 458 opioid-related overdoses in the district. That's 38 deaths per month. And in the first two months of this year, we've had 63 deaths contributed to opioid use.

FRANCES SCOTT: So really kind of at the same--pretty similar rate.

CIENA BAYARD: Yeah, we're trending.

FRANCES SCOTT: Is that about where it was when we started this in sort of 2016, 2017? Are we seeing kind of the same rate of opioid deaths?

CIENA BAYARD: In 2016, 2017, it was lower. So we’re still continuing to climb.

FRANCES SCOTT: So Haley, I know that you're seeing some different things in emerging drugs in the Virginia area but, and I want to get to that in a minute, but I first want to ask you about the opioids. Are you seeing similar trends in overdoses in Virginia? You know, Virginia and D.C., obviously border each other. Are you seeing similar trends of the rates? Any demographic information that you know?

HALEY GREENE: Well, we are seeing several different trends especially throughout the commonwealth and it's important to say that no district is safe when it comes to opioid abuse because each district is affected differently. However, within the commonwealth overall, we have seen an increase in emergency department visits related to opioid use in the age groups 25 to around 55 as well. However, it appears the age groups 20 to 40 are experiencing more of the overdose deaths here within the most recent years, so that's something that we are beginning to look more into. We also have an available and accessible online dashboard that can show you the rates of emergency department visits and overdose deaths related to opioid use on our online website at VDH.virginia.gov. You could type in the search bar anything about opioids, and it will direct to you to our dashboard that can show you data in real time.

FRANCES SCOTT: So you're seeing, as Ciena was saying, you know, the District is seeing this much older population having these overdose deaths than the country, and what you're seeing is more matching the country writ large, kind of that younger demographic, you know, kind of almost 20 years younger group. So besides opioids, what is--what is Virginia dealing with right now in the public health sphere?

HALEY GREENE: Well, we are currently seeing an increase in reports of adverse illnesses following ingestion of Delta-8 THC products, especially in children. In fact, the University of Virginia Health System found that calls to Blue Ridge Poison Center for children accidentally consuming marijuana edibles nearly tripled in 2022 when compared to 2021. And the Director of the Virginia Poison Center at VCU, Dr. Robert Rose, has also shared data with our working group showing a two-fold increase in pediatric THC cases from 2021 to 2022. These events have also been associated with atypical symptoms of vomiting, low blood pressure, and low blood sugar. And the products are often typically marketed in a way that is appealing to children with bright colors, familiar packaging, and well-known characters. Typically these products are sold legally in tobacco shops in Virginia. However, lawmakers have recently voted to approve changes to a bill that adds regulation allowing for hemp-derived products to have more than two milligrams of THC but only if the ratio of CBD to THC is 25 to one.

FRANCES SCOTT: Yeah, I actually just saw a recent news report on--it was terrifying, on--I think a toddler in Virginia that had gotten into one of these products. And yeah, it looked exactly like, you know, I'm sure there's some trademark infringement there because it looked exactly like a, you know, a popular breakfast cereal unless you looked sort of at the small--the fine print. Just for the audience in case they're not familiar, so Delta-8 THC, you know, we're--we've heard Delta-9 THC. That's the primary psychoactive component in the cannabis, the marijuana plant. And there's regulations, of course, that it can't be over 0.3% because otherwise it's hemp, which is now legal since the Farm Bill of 2018. However, Delta-8 THC, which literally just moves one bond one place in the ring, in the molecule, is kind of in this legislative gray area. And so I know that that's been a problem kind of across the country. Are you all having any marijuana-related issues in the district?

HALEY GREENE: Yeah. Actually in fact, we have seen several clusters of illnesses within the central region. At one particular K through 12 school, we had a cluster of illness that was reported to us where they received a bag of Welch gummy--Welch's gummies. And we are not entirely sure if this was a product purchase that was similar to Welch's packaging or that's something that the child maybe put in a Welch's gummy container, but something that we've definitely been concerned about and looking into. We've also received another report within a school of a Nerds gummy candy rope and with on--within the packaging, it had a popular cartoon character, bright colors, something that would be really appealing towards children.

FRANCES SCOTT: So we have this emerging drug crisis. What's the solution? I mean, I kind of gave the key message right at the beginning, but from your point of view, Ciena, what helps you do your job? What are the data sources that you've mentioned, you know, kind of at the beginning if we had better intelligence, we could've done this differently? So do you have better intelligence now? Do you have better resources?

CIENA BAYARD: I do actually. Initially when we first started doing this, there were only a few places where we can find emerging trends. So it was like the DEA and mainly that's it. NFLIS maybe. But recently, we've been able to use the Center for Forensic Science and Research Education. The NPS Discovery documents are actually timely. They come out quarterly and it's very regular. One of the other resources that we use that is very important to the District of Columbia is our own Department of Forensic Sciences and their crime lab. We have in the District of Columbia a syringe exchange program. The Department of Forensic Sciences actually analyze the contents of the syringes. So that--and they come out with a monthly report as well. So every month, I'm able to see if there's any new analytes within the syringes, and I can order a reference material in order to be able to add those analytes to our testing methodologies.

FRANCES SCOTT: So that's fantastic. I mean, of course, we love to hear that NPS Discovery is a useful tool because that's an NIJ-funded award and product. And so that's a more national, that's a broader perspective, but I know they do have a variety of products as you mentioned, both the quarterly reports and then they'll also put out public health alerts and other drug monographs, things that are useful to kind of both of your populations if they're seeing new things. And then, it's fantastic that you have the local because as we already talked about, right, you already have demographic differences. It's not surprising if you're going to have, you know, maybe drug differences between what's being used and abused. And so having that connection with Department of Forensic Sciences is great so that you know, you know, really local what are we seeing being used here.

CIENA BAYARD: Not even--not only is it local, we're actually housed in the same building. So we're both in the consolidated forensics laboratory in D.C. and we have a direct partnership, so we can talk to each other face to face if necessary. And I guess we also work together in the opposite way. Okay. Sometimes they find new and emerging drugs and sometimes we find new and emerging drugs. So we're able to share that information between each other. And so it's a good opportunity for us to benefit the residents of the District of Columbia.

FRANCES SCOTT: That's fantastic. It's a wonderful use of the resources. So as you said, the D.C. residents are who's going to be benefit from that. So Haley, what about you? You mentioned VCU, you mentioned your working group. Talk about some of those things.

HALEY GREENE: We use several data sources to conduct surveillance for emerging drug crises but on a day-to-day basis, I use passive surveillance to report and monitor cases of unusual occurrence of disease of public health concern in addition to emergency department and urgent care visits in the central region of Virginia. And like Ciena mentioned, we really kind of had to establish our own policies and procedures. So throughout this time, we've had to rely on collaboration with our internal and external partners to conduct surveillance and respond to clusters of adverse illnesses related to drug use. And for instance, we utilize our poison control center partners to understand what we are seeing in the clinical setting while we utilize our working group to oversee the policies and procedures for VDH response and control related to emerging drug crisis. At this time, we are currently working with the Office of the Attorney General pertaining to guidance on how to respond to adverse illnesses related to THC consumption.

FRANCES SCOTT: And who all is on your working group?

HALEY GREENE: We have a variety of epidemiologists and individuals from our administration. Several infectious disease epidemiologists, enteric disease foodborne epidemiologists. We have substance use prevention epidemiologists, and we even have our friends from the Virginia Department of Agriculture and Consumer Sciences and a few others that I may be forgetting as well.

FRANCES SCOTT: Well, that's fantastic. Well, so as we all know, you know, the emerging drug crisis is a big problem. There's constantly moving targets, although some of them have slowed down. I think we're all seeing that the fentanyl analogs have fallen off a little bit and we're mostly just seeing fentanyl. But there's still new things, new things in the marijuana department, new benzodiazepines that are showing up, all kinds of new drugs that are showing up. So it can be challenging to get your arms around that problem, so I want to thank you both for sharing how Virginia Department of Health, D.C. OCME are using some of these, you know, really thinking outside the box and figuring out ways to get the best and most timely data for the residents of your areas. So thank you all and thank you all for listening. Please follow us on Spotify, Apple, or wherever you get your podcasts and stay tuned for future episodes.

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