Overdose

Recreational drug use is a major problem in the United States and around the world. Specifically, drug abuse results in heavy use of emergency department (ED) services, and is a high financial burden to society and to the hospitals due to chronic ill health and multiple injection drug use complications. Intravenous drug users are at high risk of developing sepsis and endocarditis due to the use of a dirty or infected needle that is either shared with someone else or re-used. It can also occur when a drug user repeatedly injects into an inflamed and infected site or due to the poor overall health of an injection drug user. The average cost of hospitalization for aortic valve replacement in USA is about $165,000, and in order for the valve replacement to be successful, patients must abstain from using drugs.

Objective

To describe how the state syndromic surveillance system (NC DETECT) was used to initiate near real time surveillance for endocarditis, sepsis and skin infection among drug users.

Although Marin County ranks as the healthiest county in California, it ranks poorly in substance abuse indicators, including drug overdose mortality.1 Death certificates do not always include specific detail on the substances involved in a drug overdose.2 This lack of specificity makes it difficult to identify public health issues related to specific prescription drugs in our community. We analyzed 2013 drug overdose death toxicology reports to determine if they could improve the description of drug overdose deaths in our community and to describe associated data characteristics.

Objective

To describe the potential impact of using toxicology data to support drug overdose mortality surveillance.

Drug overdoses are an increasingly serious problem in the United States and worldwide. The CDC estimates that 47,055 drug overdose deaths occurred in the United States in 2014, 61% of which involved opioids (including heroin, pain relievers such as oxycodone, and synthetics).1 Overdose deaths involving opioids increased 3-fold from 2000 to 2014.1 These statistics motivate public health to identify emerging trends in overdoses, including geographic, demographic, and behavioral patterns (e.g., which combinations of drugs are involved). Early detection can inform prevention and response efforts, as well as quantifying the effects of drug legislation and other policy changes.

The fast subset scan2 detects significant spatial patterns of disease by efficiently maximizing a log-likelihood ratio statistic over subsets of data points, and has recently been extended to multidimensional data (MD-Scan).3 While MD-Scan is a potentially useful tool for drug overdose surveillance, the high dimensionality and sparsity of the data requires a new approach to estimate and represent baselines (expected counts), maintaining both accuracy and efficient computation when searching over subsets. 

Objective

We present the multidimensional tensor scan (MDTS), a new method for identifying emerging patterns in multidimensional spatio-temporal data, and demonstrate the utility of this approach for discovering emerging geographic, demographic, and behavioral trends in fatal drug overdoses. 

Overdoses of heroin and prescription opioids are a growing cause of mortality in the United States. Deaths from opioids have contributed to a rise in the overall mortality rate of middle-aged white males during an era when other demographics are experiencing life expectancy gains. A successful public health intervention to reverse this mortality trend requires a detailed understanding of which populations are most affected and where those populations live. While mortality is the most relevant metric for this emerging challenge, increased burden on laboratory facilities can create significant delays in obtaining confirmation of which patients died from opioid overdoses.

Emergency department visits for opioid overdoses can provide a more timely proxy measure of overall opioid use. Unfortunately, chief complaints do not always contain an indication of opioid involvement. Overdose patients are not always conscious at registration which limits the amount of information they can provide. Menu-driven registration systems can lump all overdoses together regardless of substance. A more complete record of the emergency department interaction, such as that provided by triage notes, could provide the information necessary to differentiate opioid-related visits from other overdoses. 

Objective

To identify heroin- and opioid-related emergency department visits using pre-diagnositc data. To demonstrate the value of clinical notes to public health surveillance and situational awareness. 

Nationally, deaths due to opioid overdose have continually increased for the past 15 years . Deaths specifically related to heroin increased more than four-fold between 2002 and 2014. Hospital inpatient discharge data provide information on non-fatal overdoses, but include a significant lag in reporting time. Syndromic ED visit data provide near real-time identification of public health issues and can be leveraged to inform public health actions on the emerging threat of drug overdose.

Objective

To develop and evaluate syndrome definitions for the identification of acute unintentional drug overdose events including opioid, heroin, and unspecified substances among emergency department (ED) visits in Virginia.