Opioid

In 2017, FL Department of Health (DOH) became one of thirty-two states plus Washington, D.C funded by the Center for Disease Control and Prevention (CDC) under the ESOOS program. One of the objectives of this funding was to increase the timeliness of reporting on non-fatal opioid overdoses through syndromic surveillance utilizing either the emergency department (ED) or Emergency Medical Services (EMS) data systems. Syndromic case validation is an essential requirement under ESOOS for non-fatal opioid-involved overdose (OIOD). FL's ESOOS program conducted OIOD validation and quality monitoring of EMS case definitions, using data from FL's Emergency Medical Services Tracking and Reporting System (EMSTARS). We examined measurement validity with OIOD cases identified from FL's statewide hospital billing database, FL Agency for Health Care Administration (AHCA).

Objective: Assess the validity of Florida (FL) Enhanced State Opioid Overdose Surveillance (ESOOS) non-fatal syndromic case definitions.

West Virginia continues to lead the nation in drug overdose deaths per capita. In 2016, the age-adjusted rate of drug overdose deaths was 52 per 100,0001. In the same year, there were roughly 64,000 overdose deaths in the United States, a 21.5% rate increase from 20151. The drug overdose epidemic in West Virginia has taken a significant toll on individuals, families, communities, and resources. As part of a rapid response plan to help reduce the burden of overdose deaths, the West Virginia Department of Health and Human Resources conducted an investigative report to study 830 overdose related deaths that occurred in 2016 and identify opportunities for intervention in the 12 months prior to death. Utilization of EMS among decedents was analyzed to determine demographic differences between decedents at different time points of EMS contact: EMS contact at death only; EMS contact 12 months prior to death only; and both EMS contact at death and 12 months prior to death.

Objective: Opioid and illicit substance abuse continues to have major public health implications in the state of West Virginia. By analyzing the Emergency Medical Service (EMS) utilization history of drug overdose decedents, opportunities to improve surveillance of fatal and non-fatal drug overdoses can be identified which can help lead prevention efforts of fatal drug overdoses in the state.

California continues to face a serious public health crisis with the opioid epidemic having substantial health and economic impacts. The epidemic is dynamic and rapidly changing, involving both prescription opioids influenced by prescribing and dispensing patterns as well as illicit opioids influenced by the availability of heroin and recently, the increased availability of fentanyl. The complexity of the issue necessitates data-informed actions through multi-sector, strategic collaboration at both the state and local levels to address the problem comprehensively. With nearly 2,000 opioid overdose deaths per year and wide variation of overdose rates across counties and demographic groups, there is a need for integrated, timely, actionable data for use by state policy makers, local opioid safety coalitions, media, community stakeholders, and the public to monitor and combat this dynamic epidemic at the state and local level. Using fatality data from the California Opioid Overdose Surveillance Dashboard1, the opioid overdose epidemic is described along with the differential geographic and demographic impacts.

Objective: Demonstrate the use of timely, actionable data from a data visualization tool, the California Opioid Overdose Surveillance Dashboard, which integrates statewide, geographic- and demographic-specific data, by describing the changes in opioid overdose deaths in California.

The opioid drug overdose crisis presents serious challenges to state-based public health surveillance programs, not the least of which is uncertainty in the detection of cases in existing data systems. New Jersey historically had slightly higher unintentional drug overdose death rates than the national average, but by 2001 dramatic increases in drug overdose deaths in states like West Virginia began to drive up the national rate (Figure 1). Although the rise in New Jersey's fatal overdose rates has mirrored the national rate since 1999, the rate has dramatically increased since 2011- from 9.7 per 100,000 (868 deaths) to 21.9 per 100,000 in 2016 (1,931 deaths), an increase of 125% in five years.1 The New Jersey Department of Health has been funded by the Centers for Disease Control and Prevention (CDC) to conduct surveillance of opioid-involved overdoses through the Enhanced Surveillance of Opioid-Involved Overdose in States (ESOOS) program, and to conduct syndromic surveillance through the National Syndromic Surveillance Program (NSSP); this has presented a collaboration opportunity for the Department's surveillance grantee programs to use existing resources to evaluate and refine New Jersey’s drug overdose case definitions and develop new indicators to measure the burden of overdose throughout the state and to facilitate effective responses.

Objective: Link syndromic surveillance data for potential opioid-involved overdoses with hospital discharge data to assess positive predictive value of CDC Opioid Classifiers for conducting surveillance on acute drug overdoses.

When the opioid epidemic began in the early 1990s, pills such as oxycodone were the primary means of abuse. Beginning in 2010, injection use of, first, heroin and then synthetic opioids dramatically increased, which led the number of overdose deaths involving opioids to increase fivefold between 1999 and 2016.1 It would be expected that BBP rates would rise with this increase in injection use, and, nationally, there has been a rise in acute hepatitis C (HCV) rates, although the other two main BBPs, acute hepatitis B (HBV) and acute human immunodeficiency virus (HIV) have been flat and declining, respectively.2,3 In this study, we compared New Jersey's reported incidence of these three BBPs (acute HBV, acute HCV, and HIV) over five years (2013-2017) with syndromic surveillance data for opioid use over the same time period in order to test the hypothesis that emergency department (ED) visits for opioid use could be used as a predictor of BBP infection.

Objective: To utilize New Jersey's syndromic surveillance data in the study and comparison of trends in injection opioid use and infection with selected bloodborne pathogens (BBPs) over the years 2013-2017.

The number of unintentional overdose deaths in New York City (NYC) has increased for seven consecutive years. In 2017, there were 1,487 unintentional drug overdose deaths in NYC. Over 80% of these deaths involved an opioid, including heroin, fentanyl, and prescription pain relievers.1 As part of a comprehensive strategy to reduce overdose mortality in NYC, the NYC Department of Health and Mental Hygiene’s (DOHMH) Overdose Education and Naloxone Distribution (OEND) Program makes naloxone kits available to laypeople free-of-charge through registered Opioid Overdose Prevention Programs (OOPPs). Naloxone kits contain two doses of naloxone and educational materials. The OEND Program distributes kits to registered OOPPs, which then dispense kits to individuals via community-based trainings. In this context, distribution refers to kits shipped to programs, whereas dispensing refers to kits given to individuals. Increased NYC funding has enabled recruitment of more OOPPs including syringe exchange programs, public safety agencies, shelters, drug treatment programs, health care facilities, and other community-based programs and greater dispensing of naloxone kits to laypeople. Naloxone distribution has undergone a dramatic expansion, from 2,500 kits in 2009 to 61,706 kits in 2017.2 In 2018, DOHMH aims to distribute more than 100,000 kits to OOPPs. In order to target naloxone dispensing to neighborhoods in NYC with the highest overdose burden, we developed a tracking system able to capture individual-level geographic data about naloxone kit recipients. Prior to the development of the tracking system, DOHMH collected quarterly, aggregate-level naloxone dispensing data from OOPPs. These data included only the OOPPs™ ZIP Codes but not recipient residence. OOPP ZIP Code was used as a proxy for kits dispensed to individuals. Without individual-level geographic information, however, we could not determine whether naloxone kit dispensing reached people in neighborhoods with high overdose mortality rates. To overcome these barriers, DOHMH developed a comprehensive but flexible individual-level data collection method.

Objective: Describe the development of an individual-level tracking system for community-based naloxone dispensing as part of New York City's (NYC) comprehensive plan to reduce overdose deaths. We present data from the first year of the initiative to illustrate results of the tracking system and describe the potential impact on naloxone dispensing program.

Political discourse surrounding matters of public health is exigent because human life is at stake this is unquestionably the case with respect to widespread opioid addiction. While intravenous drug use itself is described as a health concern, the spread of diseases such as hepatitis C and HIV through the sharing of needles is a disease surveillance emergency. This research centers on municipal-level decision making in the community of greater Lafayette, Indiana. Here, the mayors of sister cities West Lafayette and Lafayette hold different positions regarding a clean needle exchange program operated by the county health department.

Objective: This abstract proposes a poster presentation aimed at explaining rhetorical framing as a technique for articulating and identifying cases in healthchare policy.

In 2016, there were approximately 63,000 deaths nationally due to drug overdose. This trend continues to increase with the provisional number of US deaths for 2017 being approximately 72,000 (1). This increase in overdose deaths is fueled largely by the opioid class of drugs. The opioid epidemic began in the 1990s with a steady rise in prescription opioid overdoses. However, after 2010 a rise in heroin overdose deaths also began to occur. In addition to the heroin deaths increasing, there was a sharp rise in overdose deaths due to synthetic opioids including illicitly manufactured fentanyl beginning in 2013 (2). In Missouri, ER visits follow similar trends with heroin overdose visits greatly increasing after 2011. While PDMPs help function as data sources that provide information on the licit drug supply, they cannot give much knowledge on the illicit supply. Because of this, drug seizure data from law enforcement can provide a much-needed tool in understanding the supply of illicit substances and their impact on a county™'s morbidity.

Objective: To evaluate the relationship between heroin and non-heroin opioid seizures reported by law enforcement and the number of ER visits due to heroin and non-heroin opioid poisoning in selected counties in Missouri.

The National Institute for Drug Abuse Report, Common Comorbidities with Substance Use Disorders, states there are many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.(1) Prescription opioids are amongst the most commonly used drugs that lead to illicit drug use.(2)Much of the data about the starting point of the prescription opioid addiction is in the patient health history and is recorded within the provider electronic health record and administrative systems.Description: There are a variety of addiction and misuse risk screening tools available and selecting appropriate tools screening can be confusing for providers. Examples of common screening tools: Opioid Abuse Risk Screener (OARS), Opioid Risk Tool (ORT), Screener and Opioid Assessment for Patients with Pain (SOAPP), Current Opioid Misuse Measure (COMM), Diagnosis, Intractability, Risk, and Efficacy (DIRE). These opioid risk screening tools are interview based and vary in how they survey for psychosocial factors. The screening tools are useful, but are meant only to alert the provider to conduct further investigation.(3) Understanding how the comorbidities recorded in the patient's clinical interactions may help improve risk assessment investigations and ongoing monitoring programs. Studying the chronic pain patients' longitudinal clinical, operational, and laboratory records provides the basis for better study controls than those using population based on emergency department admission and mortality events.

Objective: Assessing mental health and opioid addiction comorbidities among chronic pain patients using a large longitudinal clinical, operational, and laboratory data set.

In North America we experience the highest rate of drug related mortality in the world. In the US, overdose is now the leading cause of death among adults under 50. Each day more than 115 people in the United States die due to an opioid overdose. The opioid overdose national crisis is rapidly evolving due to changes in drug availability and the presence of adulterated fentanyl in some areas leading to a critical need for innovative methods to identify opioid overdoses for both surveillance and intervention purposes. As an effort to strengthen our understanding of the epidemic through surveillance of Emergency Medical Services (EMS) we have developed a set of clinical indicators that identify opioid overdose within the information provided by an Electronic Patient Care Reporting (ePCR), Computer Aided Dispatch (CAD), ProQA systems and Hospital Medical Records.

Objective: To develop a set of clinical indicators of opioid overdose using Emergency Medical Services (EMS) records that included data from Computer Aided Dispatch (CAD), ProQA systems, Electronic Patient Care Reporting (ePCR) and Hospital Medical Records.