Opioid

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.

The Virginia Department of Health (VDH) utilizes syndromic surveillance ED data to measure morbidity associated with opioid and heroin overdoses among Virginia residents. Understanding which individuals within a population use ED services for repeated drug overdose events may help guide the use of limited resources towards the most effective treatment and prevention efforts.

Objective: To identify and assess the characteristics of individuals with repeated emergency department (ED) visits for unintentional opioid overdose, including heroin, and how they differ from individuals with a single overdose ED visit.

In 2017, 951 Missouri residents died from an opioid overdose, a record number for the state.1 This continues the trend from 2016, which saw an increase of over 30% in opioid overdose deaths compared to 2015. The Missouri Department of Health and Senior Services (MDHSS) manages several public health surveillance data sources that can be used to inform about the opioid epidemic. Opioid overdose deaths are identified through death certificates which are collected through the vital records system. MDHSS also manages the Patient Abstract System (PAS), which contains ED and inpatient hospitalization data from approximately 132 non-federal Missouri hospitals. PAS contains about 130 variables, which include demographic data, diagnoses codes, procedures codes, and other visit information. Records can have up to 23 diagnosis fields, which are coded using ICD-10-CM (International Classification of Diseases, Clinically Modified). The first diagnosis field is the primary reason for a visit.

Objective: Link emergency department (ED) with death certificate mortality data in order to examine the prior medical history of opioid overdose victims leading up to their death.

The severity of the nationwide opioid epidemic necessitates a fully-informed and evidenced-based response on the part of public health organizations. To support that aim, Pennsylvania applied for and received the Center for Disease Control and Prevention's Enhanced State Opioid Overdose Surveillance (ESOOS) grant.

Objective: Review strategies and policies employed to get independent C/MEs from a state with a de-centralized C/ME system to start reporting overdose death data to the Department of Health. Summarize flexibility needed to collect overdose death data from C/MEs with a variety of case management systems/methods. Preview how overdose death data is displayed on the Prescription Drug Monitoring Programs’ Interactive Data Report.

Drug overdose mortality is a growing problem in the United States. In 2017 alone over 72,000 deaths were attributed to drug overdose, most of which were caused by fentanyl and fentanyl analogs (synthetic opioids). While nearly every community has seen an increase in drug overdose, there is considerable variation in the degree of increase in specific communities. The Harris County community, which includes the City of Houston, has not seen the massive spikes observed in some communities, such as West Virginia, Kentucky, and Ohio. However, the situation in Harris County is complicated in mortality and drug use. From 2010 - 2016 Harris County has seen a fairly stable overdose-related mortality count, ranging from 450 - 618 deaths per year. Of concern, the last two years, 2015-2016, suggest a sharp increase has occurred. Another complexity is that Harris County drug related deaths seem to be largely from polysubstance abuse. Deaths attributed to cocaine, methamphetamine, and benzodiazipine all have risen in the past few years. Deaths associated with methamphetamine have risen from approximately 20 per year in 2010 - 2012 to 119 in 2016. This 6-fold increase is alarming and suggests a large-scale public health response is needed.

Objective: In this session, we will explore the results of a descriptive analysis of all drug overdose mortality data collected by the Harris County Medical Examiner's Office and how that data can be used to inform public health action.

Accuracy in identifying drug-related emergency department admissions is critical to understanding local burden of disease and assessing effectiveness of drug abuse prevention and overdose-reduction initiatives. In 2018 the Illinois Department of Public Health (IDPH) began implementation of a mandatory opioid overdose reporting law, applicable to all hospital emergency departments (ED). The mandate requires reporting of patient demographics, causal substance and antagonist ED administration within 48 hours of presentation. This reporting is not name-based. IDPH currently utilizes a near real-time syndromic surveillance (SyS) reporting system for all hospital ED, capturing most of the mandated criteria. Leveraging this existing system facilitates adherence to the mandate while imposing minimal additional burden of reporting on local hospitals. The Division of Patient Safety and Quality at IDPH has thus chosen to evaluate the completeness of overdose reporting and compliance with the opioid overdose mandate that have resulted from use of the current syndromic surveillance system.

Objective: To evaluate capacity of the BioSense ESSENCE platform and pre-defined overdose queries to identify emergency department admissions related to opioid overdose, in compliance with 2018 mandatory overdose reporting laws in Illinois.

In recent years, the number of deaths from illicit and prescription opioids has increased significantly resulting in a national and local public health crisis. According to the Texas Center for Health Statistics, there were 1340 opioid related deaths in 2015.1 In 2005, by comparison, there were 913 opioid related deaths. Syndromic surveillance can be used to monitor overdose trends in near real-time and provide much needed information to public health officials. Texas Syndromic Surveillance (TxS2) is the statewide syndromic surveillance system hosted by the Texas Department of State Health Services (DSHS). To enhance the capabilities of TxS2 and to better understand the opioid epidemic, DSHS is integrating both Texas Poison Center (TPC) data and Emergency Medical Services (EMS) data into the system. Much of the data collected at public health organizations can be several years old by the time it is released for public use. As a result, there have been major efforts to integrate more real-time data sources for a variety of surveillance needs and during emergency response activities.

Objective: To improve Texas Syndromic Surveillance by integrating data from the Texas Poison Center and Emergency Medical Services for opioid overdose surveillance.