Heroin

In 2016, the Centers for Disease Control and Prevention funded 12 states, under the Enhanced State Opioid Overdose Surveillance (ESOOS) program, to utilize state Emergency Medical Services (EMS) and emergency department (ED) syndromic surveillance (SyS) data systems to increase timeliness of state data on drug overdoses. A key aspect of the ESOOS program is the development and validation of case definitions for drug overdoses for EMS and ED SyS data systems. Kentucky's ESOOS team conducted a pilot validation study of a candidate EMS case definition for HOD, using data from the Kentucky State Ambulance Reporting System (KStARS). We examined internal, face validity of the EMS HOD case definition by reviewing pertinent information captured in KStARS data elements; and we examined external agreement with HOD cases identified Kentucky’s statewide hospital billing database.

Objective:

The aims of this project were 1) to assess the validity of a surveillance case definition for identifying heroin overdoses (HOD) in a NEMSIS 3 compliant, state ambulance reporting system; and 2) to develop an approach that can be applied to assess the validity of case definitions for other types of drug overdose events in similar data state data systems.

Early detection of heroin overdose clusters is important in the current battle against the opioid crisis to effectively implement prevention and control measures. The New York State syndromic surveillance system collects hospital emergency department (ED) visit data, including visit time, chief complaint, and patient zip code. This data can be used to timely identify potential heroin overdose outbreaks by detecting spatial-temporal case clusters with scan statistic.

Objective:

To utilize syndromic surveillance data timely detecting herion overdose outbreaks in the community.

Philadelphia is in the midst of a drug epidemic that killed 702 Philadelphians in 2015, 907 in 2016, and is on trajectory to kill 1,200 in 2017. Opioids are involved in the majority of fatal overdoses, contributing to 80% of overdose deaths in 2016. In 2016, the age-adjusted death rate for opioid-involved overdoses was 40.4 deaths per 100,000 residents, up from 17.9 deaths per 100,000 residents in 2010. Despite the epidemiologic work accomplished to date, gaps in knowledge still exist, especially for vulnerable populations such as those with serious mental illness or those who were ever incarcerated, homeless, or within the juvenile justice system. Matching individuals who died of an overdose across city systems could provide insight into missed opportunities for interventions. Findings will help inform policy for those systems that serve clients at highest risk for overdose.

Objective:

To match fatal overdose information across city data sources to understand which systems overdose decedents may have interacted with prior to their death

Overdose deaths involving opioids (i.e., opioid pain relievers and illicit opioids such as heroin) accounted for at least 63% (N = 33,091) of overdose deaths in 2015. Overdose deaths related to illicit opioids, heroin and illicitly-manufactured fentanyl, have rapidly increased since 2010. For instance, heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. Unfortunately, timely response to emerging trends is inhibited by time lags for national data on both overdose mortality via vital statistics (8-12 months) and morbidity via hospital discharge data (over 2 years). Emergency department (ED) syndromic data can be leveraged to respond more quickly to emerging drug overdose trends as well as identify drug overdose outbreaks. CDC’s NSSP BioSense Platform collects near real-time ED data on approximately two-thirds of ED visits in the US. NSSP’s data analysis and visualization tool, Electronic Surveillance System for the Notification of Community-based Epidemics (ESSENCE), allows for tailored syndrome queries and can monitor ED visits related to heroin overdose at the local, state, regional, and national levels quicker than hospital discharge data.

Objective:

This paper analyzes emergency department syndromic data in the Centers for Disease Control and Prevention's (CDC) National Syndromic Surveillance Program’s (NSSP) BioSense Platform to understand trends in suspected heroin overdose.

Like many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.

Objective:

Compare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.

Opioid overdoses are a growing cause of mortality in the United States. Medical prescriptions for opioids are a risk factor for overdose. This observation raises concerns that patients may seek multiple opioid prescriptions, possibly increasing their overdose risk. One route for obtaining those prescriptions is visiting the emergency department (ED) for pain-related complaints. Here, two hypotheses related to prescription seeking and overdoses are tested. (1) Overdose patients have a larger number of prior ED visits than matched controls. (2) Overdose patients have distinct patterns of pain-related complaints compared to matched controls.

Objective:

Identifying text features of emergency department visits associated with risk of future drug overdose.

Nationally and in Wisconsin, heroin is the leading cause of opioid related death and hospitalization. Opioids are commonly prescribed for pain. Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids. In 2015, more than 15,000 people died from overdoses involving prescription opioids. Approximately, three out of four heroin users report having abused prescription opioids prior to using heroin. In Wisconsin from 2010 to 2014 the number of deaths involving any opioid increased by 51% and for heroin increased by 192%. Through the federal government funding and support Wisconsin has established a statewide tool to help combat the ongoing prescription drug abuse epidemic by providing valuable information about controlled substance prescriptions that are dispensed in the state. PDMP is continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.

Objective:

Using the Wisconsin Enhanced Opioid Surveillance System, the present study evaluates the heroin hospitalization risk among the opioid recipients using the Prescription Drug Monitoring Data (PDMP) with following specific objectives: 1. Evaluate the risk of heroin overdose hospitalization following the prescription of opioid. 2. Assess the time elapsed between last prescribed opioid and first heroin overdose hospitalization. 3. Identify the main predictors of heroin overdose hospitalization among prescribed opioid users.