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Overdose

Description

On April 14, 2016, British Columbia (BC)’s Provincial Health Officer declared a public health emergency due to a significant increase in drug-related overdoses and deaths in the Province. Despite the declaration, 161 suspected drug overdose deaths were reported across the Province in December 2016, a 137% increase over the number of deaths occurring in the same month of 2015. In response to the surge overdoses, Vancouver Coastal Health Authority (VCH), one of 5 health regions within BC, rapidly implemented a number of novel harm reduction initiatives. Overdose Prevention Sites (OPS) were opened on December 8, 2016. At these sites, people using illicit drugs are supervised by peers who can provide rapid intervention if an overdose occurs. The Mobile Medical Unit (MMU), a temporary state-of-art medical facility, was deployed on December 13, 2016 to reduce the congestion for the BC Ambulance Service (BCAS) and a major urban emergency department (ED). Following deployment of the MMU, services were transitioned to a permanent program at the Downtown Eastside Connections Clinic (DTES Connections) in the spring of 2017. DTES Connections was created to provide rapid access to addiction treatment. In order to keep pace with the rapidly increasing number of novel harm reduction initiatives, enhanced surveillance programs were implemented at VCH to monitor and evaluate these innovative harm reduction activities, including development of new surveillance programs for the MMU, OPS and DTES Connections, along with existing routine surveillance system from EDs and a Supervised Injection Site (Insite).

Objective:

To describe the use of multiple data sources to monitor overdoses in near real-time in order to evaluate response to the provincial overdose emergency

Submitted by elamb on
Description

In 2016, the Centers for Disease Control and Prevention funded 12 states, under the Enhanced State Opioid Overdose Surveillance (ESOOS) program, to utilize state Emergency Medical Services (EMS) and emergency department syndromic surveillance (SyS) data systems to increase timeliness of state data on drug overdose events. An important component of the ESOOS program is the development and validation of case definitions for drug overdoses for EMS and ED SyS data systems with a focus on small area anomaly detection. In fiscal year one of the grant Kentucky collaborated with CDC to develop case definitions for heroin and opioid overdoses for both SyS and EMS data. These drug overdose case definitions are compared between these two rapid surveillance systems, and further compared to emergency department (ED) hospital administrative claims billing data, to assess their face validity.

Objective:

The aim of this project was to assess the face validity of surveillance case definitions for heroin overdose in emergency medical services (EMS) and emergency department syndromic surveillance (SyS) data systems by comparing case counts to those found in a statewide emergency department (ED) hospital administrative billing data system.

Submitted by elamb on
Description

In 2016, the Centers for Disease Control and Prevention funded 12 states, under the Enhanced State Opioid Overdose Surveillance (ESOOS) program, to utilize state Emergency Medical Services (EMS) and emergency department (ED) syndromic surveillance (SyS) data systems to increase timeliness of state data on drug overdoses. A key aspect of the ESOOS program is the development and validation of case definitions for drug overdoses for EMS and ED SyS data systems. Kentucky's ESOOS team conducted a pilot validation study of a candidate EMS case definition for HOD, using data from the Kentucky State Ambulance Reporting System (KStARS). We examined internal, face validity of the EMS HOD case definition by reviewing pertinent information captured in KStARS data elements; and we examined external agreement with HOD cases identified Kentucky’s statewide hospital billing database.

Objective:

The aims of this project were 1) to assess the validity of a surveillance case definition for identifying heroin overdoses (HOD) in a NEMSIS 3 compliant, state ambulance reporting system; and 2) to develop an approach that can be applied to assess the validity of case definitions for other types of drug overdose events in similar data state data systems.

Submitted by elamb on
Description

Opioid ODs have been rising globally and nationally. The death rate from ODs in the United States has increased 137% since 2000, including a 200% increase of OD deaths involving opioids1. The pilot project, a collaboration across 3 states, allowed information sharing with Syndromic surveillance (SyS) partners across jurisdictions, such as sharing a standard SyS case definition and verifying its applicability in each jurisdiction. This is a continuation of the work from an initial pilot project presented during the ISDS Opioid OD Webinar series.

Objective:

The objective is to develop a standard opioid overdose case definition that could be generalized nationally

Submitted by elamb on
Description

Early detection of heroin overdose clusters is important in the current battle against the opioid crisis to effectively implement prevention and control measures. The New York State syndromic surveillance system collects hospital emergency department (ED) visit data, including visit time, chief complaint, and patient zip code. This data can be used to timely identify potential heroin overdose outbreaks by detecting spatial-temporal case clusters with scan statistic.

Objective:

To utilize syndromic surveillance data timely detecting herion overdose outbreaks in the community.

Submitted by elamb on
Description

The United States is in the midst of a drug crisis; drug-related overdoses are the leading cause of unintentional death in the country. In Colorado the rate of fatal drug overdose increased 68% from 2002-2014 (9.7 deaths per 100,000 to 16.3 per 100,000, respectively), and non-fatal overdose also increased during this time period (23% increase in emergency department visits since 2011). The CDC’s National Syndromic Surveillance Program (NSSP) provides near-real time monitoring of emergency department (ED) events across the country, with information uploaded daily on patient demographics, chief complaint for visit, diagnosis codes, triage notes, and more. Colorado North Central Region (CO-NCR) receives data for 4 local public health agencies from 25 hospitals across Adams, Arapahoe, Boulder, Denver, Douglas, and Jefferson Counties. Access to local syndromic data in near-real time provides valuable information for local public health program planning, policy, and evaluation efforts. However, use of these data also comes with many challenges. For example, we learned from key informant interviews with ED staff in Boulder and Denver counties, about concern with the accuracy and specificity of drug-related diagnosis codes, specifically for opioid-related overdoses.

Objective:

In order to better describe local drug-related overdoses, we developed a novel syndromic case definition using discharge diagnosis codes from emergency department data in the Colorado North Central Region (CO-NCR). Secondarily, we used free text fields to understand the use of unspecified diagnosis fields.

Submitted by elamb on
Description

Philadelphia is in the midst of a drug epidemic that killed 702 Philadelphians in 2015, 907 in 2016, and is on trajectory to kill 1,200 in 2017. Opioids are involved in the majority of fatal overdoses, contributing to 80% of overdose deaths in 2016. In 2016, the age-adjusted death rate for opioid-involved overdoses was 40.4 deaths per 100,000 residents, up from 17.9 deaths per 100,000 residents in 2010. Despite the epidemiologic work accomplished to date, gaps in knowledge still exist, especially for vulnerable populations such as those with serious mental illness or those who were ever incarcerated, homeless, or within the juvenile justice system. Matching individuals who died of an overdose across city systems could provide insight into missed opportunities for interventions. Findings will help inform policy for those systems that serve clients at highest risk for overdose.

Objective:

To match fatal overdose information across city data sources to understand which systems overdose decedents may have interacted with prior to their death

Submitted by elamb on
Description

Opioid overdoses are a growing cause of mortality in the United States. Medical prescriptions for opioids are a risk factor for overdose. This observation raises concerns that patients may seek multiple opioid prescriptions, possibly increasing their overdose risk. One route for obtaining those prescriptions is visiting the emergency department (ED) for pain-related complaints. Here, two hypotheses related to prescription seeking and overdoses are tested. (1) Overdose patients have a larger number of prior ED visits than matched controls. (2) Overdose patients have distinct patterns of pain-related complaints compared to matched controls.

Objective:

Identifying text features of emergency department visits associated with risk of future drug overdose.

Submitted by elamb on
Description

Nationally and in Wisconsin, heroin is the leading cause of opioid related death and hospitalization. Opioids are commonly prescribed for pain. Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids. In 2015, more than 15,000 people died from overdoses involving prescription opioids. Approximately, three out of four heroin users report having abused prescription opioids prior to using heroin. In Wisconsin from 2010 to 2014 the number of deaths involving any opioid increased by 51% and for heroin increased by 192%. Through the federal government funding and support Wisconsin has established a statewide tool to help combat the ongoing prescription drug abuse epidemic by providing valuable information about controlled substance prescriptions that are dispensed in the state. PDMP is continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.

Objective:

Using the Wisconsin Enhanced Opioid Surveillance System, the present study evaluates the heroin hospitalization risk among the opioid recipients using the Prescription Drug Monitoring Data (PDMP) with following specific objectives: 1. Evaluate the risk of heroin overdose hospitalization following the prescription of opioid. 2. Assess the time elapsed between last prescribed opioid and first heroin overdose hospitalization. 3. Identify the main predictors of heroin overdose hospitalization among prescribed opioid users.

Submitted by elamb on