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Overdose

Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

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.

Submitted by elamb on
Description

Mirroring public health response to infectious disease outbreaks, many public health departments are taking an outbreak management approach to respond to drug overdose surges 1-3. The Marion County Public Health Department (MCPHD) has developed an overdose response plan (ORP) integrating drug overdose surveillance and community stakeholder response strategies. Effective drug overdose surveillance requires accurate and reliable data streams. This work assessed data sources utilized for county overdose surveillance and provided recommendations to improve overdose surveillance.

Objective: To assess the data sources used to monitor overdose events in Marion County and improve community overdose surveillance.

Submitted by elamb on