PMID- 37952318 OWN - NLM STAT- MEDLINE DCOM- 20231216 LR - 20231216 IS - 1873-4758 (Electronic) IS - 0955-3959 (Linking) VI - 122 DP - 2023 Dec TI - A risk-based approach to community illicit drug toxicosurveillance: operationalisation of the Emerging Drugs Network of Australia - Victoria (EDNAV) project. PG - 104251 LID - S0955-3959(23)00298-0 [pii] LID - 10.1016/j.drugpo.2023.104251 [doi] 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. CI - Copyright (c) 2023. Published by Elsevier B.V. FAU - Syrjanen, Rebekka AU - Syrjanen R AD - Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia. FAU - Schumann, Jennifer L AU - Schumann JL AD - Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia; Monash University, Monash Addiction Research Centre, Frankston, Victoria, Australia. FAU - Lyons, Tom AU - Lyons T AD - The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, Australia. FAU - McKinnon, Ginny AU - McKinnon G AD - The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, Australia. FAU - Hodgson, Sarah E AU - Hodgson SE AD - Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia. FAU - Abouchedid, Rachelle AU - Abouchedid R AD - Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia. FAU - Gerostamoulos, Dimitri AU - Gerostamoulos D AD - Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia. FAU - Koutsogiannis, Zeff AU - Koutsogiannis Z AD - Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia. FAU - Fitzgerald, John AU - Fitzgerald J AD - The University of Melbourne, Melbourne School of Population and Global Health, Parkville, Victoria, Australia. FAU - Greene, Shaun L AU - Greene SL AD - Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia. Electronic address: shaun.greene@austin.org.au. CN - EDNAV project research group LA - eng PT - Journal Article DEP - 20231111 PL - Netherlands TA - Int J Drug Policy JT - The International journal on drug policy JID - 9014759 RN - 0 (Illicit Drugs) RN - KE1SEN21RM (N-Methyl-3,4-methylenedioxyamphetamine) RN - 0 (Analgesics, Opioid) SB - IM MH - Humans MH - *Illicit Drugs/analysis MH - Victoria/epidemiology MH - *N-Methyl-3,4-methylenedioxyamphetamine MH - *Substance-Related Disorders/epidemiology MH - Analgesics, Opioid OTO - NOTNLM OT - Early warning system OT - Harm reduction OT - Illicit drug OT - Multi-disciplinary OT - Public health OT - Surveillance OT - Toxicology OT - Toxicosurveillance COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/11/13 00:42 MHDA- 2023/12/17 09:46 CRDT- 2023/11/12 18:05 PHST- 2023/07/10 00:00 [received] PHST- 2023/10/22 00:00 [revised] PHST- 2023/10/25 00:00 [accepted] PHST- 2023/12/17 09:46 [medline] PHST- 2023/11/13 00:42 [pubmed] PHST- 2023/11/12 18:05 [entrez] AID - S0955-3959(23)00298-0 [pii] AID - 10.1016/j.drugpo.2023.104251 [doi] PST - ppublish SO - Int J Drug Policy. 2023 Dec;122:104251. doi: 10.1016/j.drugpo.2023.104251. Epub 2023 Nov 11.