The Prescription, Recreational and Illicit Substance Evaluation (PRISE) program is a collaboration across multiple functional units of NSW Health including the Centre for Alcohol and Other Drugs, NSW Ministry of Health, the NSW Poisons Information Centre (NSW PIC), NSW hospital-based Clinical Toxicology services and NSW Health Pathology Forensic & Analytical Science Service (FASS). It provides access to extensive toxicology testing to NSW Health acute care services for cases of severe and unusual substance-related toxicity or clusters of overdoses, with rapid turnaround time.
The objectives of the PRISE program are to:
Routine urine drug screens available in Australian hospitals for patients presenting with suspected drug overdose allows for the detection of a limited range of drug classes (such as some opiates, cannabis, amphetamines, benzodiazepines and cocaine). These screens do not identify the individual substance involved or their concentration. In cases of severe and unusual toxicity or clusters of presentations, a detailed knowledge of the specific drugs involved in the episode is required to aid clinical management and public health responses.
Patients presenting to hospital with severe and unusual suspected drug-related toxicity are notified to the PRISE team, within the Centre for Alcohol and Other Drugs, NSW Ministry of Health. Common sources of passive notifications include acute care settings such as the clinical toxicology service, NSW PIC and ongoing care settings such as alcohol and other drugs clinics.
Active case finding is performed by the PRISE team from a range of sources including:
Following case notification, the decision to proceed with further specialised testing and interpretation is made by a clinical toxicologist and/or a public health professional.
The PRISE Program offers timely access and logistic support for comprehensive toxicology testing performed at FASS with rapid turnaround time triaged based on clinical and public health urgency.
Analytical techniques employed at FASS are constantly evolving to meet the needs of toxicology testing. These techniques are able to rapidly identify approximately 500 different drugs, including new psychoactive drugs (NPS) such as fentanyl analogues, unregistered benzodiazepines, synthetic cannabinoids and synthetic cathinones, as well as having the ability to identify “unknown" drugs. In some cases, physical samples brought in with the patient or seized by NSW Police are tested to facilitate drug identification.
Public health staff consider the patient's exposure history and the similarity with other cases across NSW (and interstate) during their investigations. Advice may be sought from the Standing Panel on Toxicity Risk, which includes representation from a range of experts in clinical toxicology, addiction medicine, emergency medicine, public health and community groups.
A Summary Program Activity Report for the PRISE Program outlines the key findings and results from 2018 to 2021.
Findings from the PRISE program contribute to NSW Health's early warning system - public drug warnings and clinical safety alerts.
