Opioid-related deaths have risen sharply in the U.S. in recent years. In 2017, the Department of Health and Human Services declared the opioid crisis to be a public health emergency—one disproportionately affecting historically marginalized communities—and the crisis has worsened since then.
In response to the rising epidemic, UMBC researchers have partnered with the University of Maryland School of Medicine (UMSOM) to develop a device that could help prevent opioid overdose deaths. The device is a non-invasive CO2 monitor designed to more effectively detect and reverse an opioid overdose in real time. It was recently awarded a one-year grant of more than $500,000 from the National Institutes of Health (NIH).
“Opioid-related death is a serious problem for the country. We hope this new device will help to directly address this issue,” said the study’s co-PI Xudong Ge, research professor of chemical, biochemical, and environmental engineering (CBEE).
Meeting an urgent need
The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics reported that during a 12-month period ending in April 2021, more than 100,000 drug overdoses were recorded in the U.S., with nearly 76,000 deaths attributed to opioid usage. In a separate 2022 report, the CDC noted the severity of this impact among underserved communities of color. Between 2019 and 2020 alone, overdose death rates increased 44 percent amongst Black populations and 39 percent in American Indian and Alaska Native populations.
“If you look at the statistics, the people who are dying from opioid overdoses largely come from underserved minority communities. They are the ones that need the most help,” said Thelma Wright, associate professor of pain medicine at UMSOM, who developed the idea for the study.
As a pain medicine physician, she said she was aware of how medically-prescribed opioids have contributed to the rise in overdose death rates. In 2016, Wright began to conceptualize a way to non-invasively monitor if a patient is about to die from an opioid overdose and ways to immediately administer naloxone, an opioid antagonist that can quickly reverse an overdose.
Despite administering naloxone to people experiencing opioid overdose, to reverse their respiratory depression, many overdose cases are fatal because the naloxone was not administered in time, Wright shared.
“When someone is dying from an overdose, they cannot get the antidote from their medicine cabinet to administer it to themselves. I asked around if there was a sensitive monitor that could immediately detect an opioid overdose, and there was nothing,” said Wright. “I needed to find some sort of parameter that would signal respiratory depression due to an overdose, and the most accurate parameter happened to be a carbon dioxide (CO2) monitor.”
Evolving CO2 monitoring research
Opioids stimulate receptors in the brain and can cause a decrease in pain perception. When brain receptors are overstimulated, the brainstem can then become desensitized to rises in CO2 levels. As a result, the opioid user could experience respiratory depression, loss of protective airway reflexes, and respiratory arrest.
Ge, who serves as the assistant director of UMBC’s Center for Advanced Sensor Technology (CAST), has spent more than a decade researching and developing non-invasive CO2 sensor systems. During the pandemic, Ge, along with Govind Rao, a professor of CBEE and the director of CAST, co-authored a study published in Medical Engineering & Physics analyzing the effects of face coverings on transdermal CO2 levels. The study demonstrated the potential effectiveness of monitoring CO2 levels through the use of wearable transdermal CO2 sensors.
“The original CO2 monitoring device is large, about the size of a suitcase,” said Ge. Wright approached Ge and Rao to develop a miniaturized, wearable version that could address some of the shortcomings of other devices available today.
Ge explains that traditional non-invasive CO2 monitors that are used on the skin heat up to about 42 degrees Celsius, or more than 107 degrees Fahrenheit. Because of the high heat, they can leave burns on skin and cannot be worn for an extended amount of time. The monitors tend to work at a slower speed and can come with a price tag averaging about $25,000.
Along with miniaturizing the device, Ge aims to create a monitor that is safer and more comfortable, delivers data more efficiently, and is more affordable for the average consumer.
Developing the device
When a patient wears the CO2 device and experiences respiratory depression due to an overdose, the device will trigger an alarm that will automatically inject naloxone. In order to validate the study’s proof of principle, the initial phases of the study will start with developing and testing CO2 sensor prototypes. The test results will then be compared to data from a similar FDA-approved device that they are hoping to improve on.
“We will run side by side tests to see how accurate our device is and then do challenge studies, like holding your breath, breathing into a bag, or exercising to get the subjects’ CO2 levels up in the body to see if we are able to detect it,” says Rao. “We will incorporate some elements of machine learning to detect the signal accurately, to make sure that there are no false positives or false negatives.”
The investigators have hired UMBC postdoctoral researcher Preety Ahuja to work on the prototyping. If the study is granted additional funding, Wright and her team of researchers will test the sensor on animal subjects to validate whether the wearable transdermal CO2 alarm will be effective. The researchers also intend to develop a mobile app to gather and share the data provided by the monitor.
Rao looks forward to collaborating closely with Wright through this UMBC-UMSOM partnership, noting the significance of her work with underserved populations in Baltimore. He shares, “Dr. Wright is very keen and passionate about finding solutions and our UMBC team is very excited to be working with her.”