Overdose

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.

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.

On August 15, 2018, the Connecticut Department of Public Health (DPH) became aware of a cluster of suspected overdoses in an urban park related to the synthetic cannabinoid K2. Abuse of K2 has been associated with serious adverse effects and overdose clusters have been reported in multiple states. This investigation aimed to characterize the use of syndromic surveillance data to monitor a cluster of suspected overdoses in real time.

Objective: To describe the use of syndromic surveillance data for real-time situational awareness of emergency department utilization during a localized mass overdose event related to the substance K2.

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.

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.

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.

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.

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.

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.