Drug Overdose

Since 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana, and the gap continues to widen1. While federal funding opportunities are available for states, it often takes years for best practices to be developed, shared, and published. Similarly, local health departments (LHDs) may experience lengthy delays to receive finalized county health statistics. Indiana collects and stores syndromic emergency department data in the Public Health Emergency Surveillance System (PHESS) and uses the Electronic Surveillance System for the Early Notification of Community-based Epidemics version 1.21 (ESSENCE) to monitor public health events and trends. In July 2017, the Indiana Overdose Surveillance Team (IOST) developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in ESSENCE at the county level. ISDH is enhancing these alerts by mapping the data in GIS and providing spatiotemporal data to LHDs to inform more targeted intervention and prevention efforts.

Objective: This poster presentation shares Indiana's approach of alerting local health departments (LHDs) with near real-time drug overdose data and how this process has been enhanced through mapping and analysis with a geographic information system (GIS).

The opioid epidemic is a multifaceted public health issue that requires a coordinated and dynamic response to address the ongoing changes in the trends of opioid overdoses. Access to timely and accurate data allows more targeted and effective programs and policies to prevent and reduce fatal and nonfatal drug overdoses in California. As a part of a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance grant, the goals of this surveillance are to more rapidly identify changes in trends of nonfatal drug overdose, opioid overdose, and heroin overdose emergency department visits; identify demographic groups or areas within California that are experiencing these changes; and to provide these data and trends to state and local partners addressing the opioid crisis throughout California. Emergency department (ED) visit data are analyzed on an ongoing quarterly basis to monitor the proportion of all ED visits that are attributed to nonfatal drug, opioid, and heroin overdoses as a portion of the statewide opioid overdose surveillance.

Objective: To track and monitor nonfatal emergency department opioid overdoses in California for use in the statewide response in the opioid epidemic.

As a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance (ESOOS) funded state, Kentucky started utilizing Emergency Medical Services (EMS) data to increase timeliness of state data on drug overdose events in late 2016. Using developed definitions of heroin overdose for EMS emergency runs, Kentucky analyzed the patterns of refused/transported EMS runs for both statewide and local jurisdictions. Changes in EMS transportation patterns of heroin overdoses can have a dramatic impact on other surveillance systems, such as emergency department (ED) claims data or syndromic surveillance (SyS) data.

Objective: The aim of this project was to explore changing patterns in patient refusal to transport by emergency medical services for classified heroin overdoses and possible implications on heroin overdose surveillance in Kentucky.

Black Hoosiers, the largest minority population in Indiana, make up almost 10% of the state's population, and accounted for 8% of the total resident drug overdose deaths from 2013-2017 compared to whites at 91%. However, a closer look at race-specific mortality rates might reveal racial inequalities. Therefore, the purpose of this project was to analyze drug overdose morality rates among white and black Hoosiers to discover possible racial inequalities and to discover trends in drug involvement in overdose deaths among blacks.

Objective: To understand trends in race-specific mortality rates between blacks and whites to discover any racial inequalities that might exist for drug overdose deaths. To delve into the types of drugs that are prominently involved in black drug overdose deaths from 2013-2017 in the state of Indiana.

Timely and accurate measurement of overdose morbidity using emergency department (ED) data is necessary to inform an effective public health response given the dynamic nature of opioid overdose epidemic in the United States. However, from jurisdiction to jurisdiction, differing sources and types of ED data vary in their quality and comprehensiveness. Many jurisdictions collect timely emergency department data through syndromic surveillance (SyS) systems, while others may have access to more complete, but slower emergency department discharge datasets. State and local epidemiologists must make decisions regarding which datasets to use and how to best operationalize, interpret, and present overdose morbidity using ED data. These choices may affect the number, timeliness, and accuracy of the cases identified.

Objective: Epidemiologists will understand the differences between syndromic and discharge emergency department data sources, the strengths and limitations of each data source, and how each of these different emergency department data sources can be best applied to inform a public health response to the opioid overdose epidemic.

Drug overdose deaths are increasing nationally and in Minnesota (MN). This is only a fraction of the overall burden that recreational drug use exacts on emergency departments (ED) and hospitals. In addition to opioids and other drugs, three outbreaks of synthetic cannabinoids and cathinones have occurred in MN recently. ICD codes do not adequately identify patients treated for drug use. Also, toxicology data for these patients are limited: routine toxicology testing is not performed at hospitals as results are not timely enough to be useful for clinical care. Even when such testing is performed, hospital laboratories are unable to detect newer synthetic drugs. In order to more quickly respond to clusters of substance use, identify substances causing atypical symptoms or severe illness, and understand the burden of overdoses and substance use in MN, the MN Department of Health (MDH) developed the MN Drug Overdose and Substance Abuse Pilot Surveillance System (MNDOSA). MNDOSA data collection began in November 2017 and includes two pilot sites in Northeastern MN, and one in the Twin Cities Metropolitan Area.

Objective: Implement a novel surveillance system for recreational substance use, including toxicology testing, to enable situational awareness and more accurately assess the health care burden related to recreational substance use.

Drug overdoses are now the leading cause of accidental death in the United States, with an estimated 60,000 deaths in 2016. Nationally, EMS overdose responses with naloxone administration have nearly doubled from 2012 to 2016 from 573.6 to 1004.4 per 100,000 EMS events. Resuscitation using the opioid antagonist, naloxone is recommended in cases of suspected opioid ODs, and has been increasingly used by EMS agencies, law enforcement, healthcare providers, and Good Samaritans. While naloxone can save lives, it is not clear how often its use is appropriate; delivering the right care to the right patient at the right time. It has been suggested that community paramedic programs teamed with recovery services may help link OD patients to recovery and rehabilitation services and establish mechanisms for follow-up care. Prior to implementing community EMS programs, it is important to understand the EMS utilization patterns of the OD population. I-EMS interactions may present an opportunity for behavioral intervention and linkage to services to prevent future OD and death in the opioid-using population. Accurately documenting substances involved in drug overdose deaths has been of increasing interest to Marion County and Indiana with a recent law requiring toxicology testing 5,6. This project linked individual-level data across public health information systems to assess the appropriateness of naloxone administration, the frequency of I-EMS service utilization until final death outcome among the I-EMS OD deceased cohort, and underlying causes of death among the cohort.

Objective: To characterize the appropriateness of naloxone administration, causes of death, and history of Indianapolis Emergency Medical Services (I-EMS) service utilization among the drug overdose population in Marion County, Indiana between 2011 to 2017.

In North Carolina there has been an escalation of poisoning deaths. In 2011, the number of fatal poisonings was 1,368 deaths, with 91% classified as drug overdoses with the majority of those due to opioid analgesics.[1] Far greater numbers of drug overdoses result in hospitalization, emergency department (ED) or outpatient clinic visits, or resolve without the individual seeking medical attention. Although public health authorities have long employed death data for drug overdose surveillance in NC, little attention has been paid to the use of ED data for this purpose. Through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC collects information on 99.5% of all acute-care ED visits across the state, primarily for syndromic surveillance purposes. Despite the timeliness and completeness of this data system, drug overdose surveillance is a challenge due to lack of a standardized definition for the positive identification of opioid overdoses. In this study we used NC DETECT ED data to describe visits due to drug, and more specifically, opioid overdoses. Objective: To describe the epidemiologic characteristics for emergency department visits due to drug overdoses in North Carolina.

During March-May 2013, 14 overdose deaths occurred in RI that were caused by acetyl fentanyl, a novel synthetic opioid about five times more potent than heroin1. Ten of these deaths were clustered in March, causing a significant increase over baseline of monthly illicit drug overdose deaths in RI1. Overdose deaths are well described in RI by forensic toxicology testing results. However, the overall number of ED visits associated with this event was unknown. We used RODS data retrospectively to characterize overdose related ED visits in RI and to analyze trends.

Objective

Determine if the Rhode Island (RI) Real-time Outbreak and Disease Surveillance (RODS) system (a syndromic surveillance system) identified an increase in overdoses during a known cluster of illicit drug overdose deaths in RI and characterize emergency department (ED) overdose visits during the 15 month period prior to and including the known cluster.