Opioid

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.

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.

Opioid overdoses have emerged within the last five to ten years to be a major public health concern. The high potential for fatal events, disease transmission, and addiction all contribute to negative outcomes. However, what is currently known about opioid use and overdose is generally gathered from emergency room data, public surveys, and mortality data. In addition, opioid overdoses are a non-reportable condition. As a result, state/national standardized procedures for surveillance or reporting have not been developed, and local government monitoring is frequently not specific enough to capture and track all opioid overdoses. Lastly, traditional means of data collection for conditions such as heart disease through hospital networks or insurance companies are not necessarily applicable to opioid overdoses, due to the often short disease course of addiction and lack of consistent health care visits. Overdose patients are also reluctant to follow-up or provide contact information due to law enforcement or personal reasons. Furthermore, collected data related to overdoses several months or years after the fact are useless in terms of short-term outreach. Therefore, given the potentially brief timeline of addiction or use to negative outcome, the current project set to create a near real-time surveillance and treatment/outreach system for opioid overdoses using an already existing EMS data collection framework.

Objective: To develop and implement a classifcation algorithm to identify likely acute opioid overdoses from text fields in emergency medical services (EMS) records.

Tennessee has experienced an increase of fatal and non-fatal drug overdoses which has been almost entirely driven by the opioid epidemic. Increased awareness by medical professionals, new legislation surrounding prescribing practices, and mandatory use of the state's prescription drug monitoring program has resulted in a decrease of opioid prescriptions and dosages. Paradoxically, emergency department discharges and inpatient hospitalizations due to opioid overdoses have continued to increase. The Tennessee Department of Health, Office of Informatics and Analytics (TDH OIA) has developed visualizations and reports for opioid overdose surveillance data to enhance communication and timely response by health partners. Through opioid overdose surveillance reporting data briefs we aim to focus not on big data analytics, but rather meaningfully targeted data briefs that illustrate mindful data points and visualizations. These data briefs provide information that is actionable to support decision making across the spectrum of partners involved in responding to Tennessee's opioid epidemic.

Objective: Through opioid overdose surveillance data briefs, we aim to focus on creating meaningful targeted reports that incorporate mindful data points and visualizations for diverse audiences. Data briefs provide information that is actionable to support decision making across the spectrum of partners involved in responding to Tennessee's opioid epidemic. Additionally, visualizations and reporting of opioid overdose surveillance data create pathways and processes for sharing data and opportunities to collaborate with others expertise that enrich communication among multi agency collaborators and interdepartmental partners.

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.

Unlike other health threats of recent concern for which widespread mortality was hypothetical, the high fatality burden of opioid overdose crisis is present, steadily growing, and affecting young and old, rural and urban, military and civilian subpopulations. While the background of many public health monitors is mainly infectious disease surveillance, these epidemiologists seek to collaborate with behavioral health and injury prevention programs and with law enforcement and emergency medical services to combat the opioid crisis. Recent efforts have produced key terms and phrases in available data sources and numerous user-friendly dashboards allowing inspection of hundreds of plots. The current effort seeks to distill and present combined fusion alerts of greatest concern from numerous stratified data outputs. Near-term plans are to implement best-performing fusion methods as an ESSENCE module for the benefit of OHA staff and other user groups.

Objective: In a partnership between the Public Health Division of the Oregon Health Authority (OHA) and the Johns Hopkins Applied Physics Laboratory (APL), our objective was develop an analytic fusion tool using streaming data and report-based evidence to improve the targeting and timing of evidence-based interventions in the ongoing opioid overdose epidemic. The tool is intended to enable practical situational awareness in the ESSENCE biosurveillance system to target response programs at the county and state levels. Threats to be monitored include emerging events and gradual trends of overdoses in three categories: all prescription and illicit opioids, heroin, and especially high-mortality synthetic drugs such as fentanyl and its analogues. Traditional sources included emergency department (ED) visits and emergency management services (EMS) call records. Novel sources included poison center calls, death records, and report-based information such as bad batch warnings on social media. Using available data and requirements analyses thus far, we applied and compared Bayesian networks, decision trees, and other machine learning approaches to derive robust tools to reveal emerging overdose threats and identify at-risk subpopulations.

The number of overdose deaths involving illicit opioids such as heroin and illicitly-manufactured fentanyl (IMF) is now higher than deaths involving prescription opioids. Adolescents misusing prescription opioids are more likely to use heroin. Although nonmedical use of prescription opioids (NUPO) among adolescents is decreasing, there is still relatively high prevalence of this behavior. Such high prevalence, along with the evolving epidemiology of the drug overdose epidemic as well as the association between NUPO and heroin use, signal that NUPO in adolescents is still an important issue. Understanding the interrelationships between NUPO and illicit opioid use in adolescents can inform prevention efforts. The purpose of this study is to: 1) present the magnitude of the drug overdose problem in adolescents, 2) compare the prevalence of heroin use and injection drug use (IDU) between students reporting NUPO and those not reporting NUPO, and 3) determine whether a dose-response relationship exists between these behaviors among adolescents. This information will be beneficial when focusing on adolescents at risk for heroin use by helping to determine whether any NUPO is associated with heroin use or if such risk is only noted at a higher frequency of NUPO behavior.

Objective: Given the evolving opioid overdose epidemic, we examined the interrelationships between nonmedical use of prescription opioids and illicit opioid use in adolescents.

Clark County, Indiana is geographically located in between the urban area of Louisville, Kentucky and Scott County, Indiana. Scott County is the site for the largest HIV outbreak in the history of the United States, directly related to high rates of IV drug abuse. The unique geographic location of Clark County in combination with the recent HIV and Hepatitis C outbreaks in Clark and neighboring counties has greatly informed the development of an effective response to overdoses and the opioid epidemic in general. Furthermore, Clark County has a unique population distribution, with a population of over 125,000 and a land area of over 300 square miles. Despite this large area, over 80% of the population lives within 9 miles of the southern border of the county. This leads to a mix of both urban and rural challenges. There are several areas of the county that have greater than 15 minute emergency response times, which is often the difference between life and death in an overdose situation. These factors led to the development of the Clark County Rapid Response Project. The rapid response project is a community-based, multidisciplinary framework to address the opioid addicted patient, from initial use to successful recovery. The project uses data driven technology to initiate the care of opiate overdose patients and administer lifesaving interventions.

Objective: To use novel technologies to develop a rapid response framework to reach opioid overdose patients in an area which is challenging from both a geography and population distribution standpoint.