The first statewide EDDS program in the nation was launched in Maryland in 2022. CESAR was awarded a grant by the State of Maryland’s Office of Overdose Response. MD-EDDS is now working with 20 hospitals across the state. Hospitals were selected so that all areas of the state are represented. Participating hospitals provide de-identified extracts of patients’ electronic health records (EHRs) and can participate in expanded urine drug screening and targeted urinalysis studies to learn more about the drugs to which their patients have been exposed.

EHR Data Extraction: The EHR extracts contain a limited data set of information on patient urine drug test results, chief complaints, diagnostic codes, and basic demographic information. The EHR data are used to track quarterly trends in the urinalysis results for all drugs included in the hospital's standard panel thus providing trends and patterns in the drugs to which Emergency Department (ED) overdose patients have been exposed.

Targeted Urinalyses: In FY2023, 14 hospitals participated in a fentanyl dipstick sub study to assess patient exposure to fentanyl in hospitals that did not include fentanyl in their standard test panels. Results from this study were used by local legislators and advocates to support the Josh Siems Act. The Act was passed during the 2023 legislative session and now requires all hospitals in Maryland to include fentanyl when urine drug screens are conducted as a part of standard diagnostic procedures.

Expanded Urine Screening: In FY2024, all hospitals participating in MD-EDDS will have the opportunity to provide up to 100 de-identified patient urine specimens to the EDDS collaborating lab for re-testing for an expanded panel, including synthetic opioids and xylazine. The expanded re-testing of a sample of patients’ de-identified urine specimens enables MD-EDDS to identify drugs involved in local ED cases that might be added to each hospital’s testing protocols.

MD-EDDS findings are disseminated on CESAR’s website and can be used to help inform patient treatment and to update testing protocols. EDDS is also a key part of the State’s drug surveillance system.

Table 1: MD-EDDS Hospitals

Source: CESAR August 2023

Additional Findings:

• High/Low Ranges from Hospital EHRs for Opiates, Marijuana, Cocaine, and Amphetamine/Methamphetamine through 2023 (April 26, 2024)
   
• Table 1: EHRs Submitted by the 20 Hospitals Participating in MD-EDDS
  Table 2: MD-EDDS Hospitals with Series Highs and Lows for 4 Drugs in 2023 (May 22, 2024)
   
• Preliminary Fentanyl dipstick testing results are available here (March 3, 2023)
   
• Selected Findings from the Electronic Health Records (EHRs) Submitted by 17 Hospitals
  Participating in the MD-EDDS Program (September 6, 2023)
   
• MD EDDS Bulletins:
  • Xylazine Detected in Hospital Patients Across Maryland (July 9, 2024)
  • Josh Siems Act in Action: MD-EDDS Finds 23-81% of Overdose Patients in 16 Hospitals Across Maryland Tested Positive for Fentanyl (July 9, 2024)
  • Meritus (December 4, 2023)