Systems in US Public Health for Measuring Drug-Related Deaths

GRANT BALDWINDirector, CDC Division of Unintentional Injury Prevention

NOVEMBER 13, 2018

CURRENT STATUS & HOW TO IMPROVE

Rapid Increase in Drug Overdose Death Rates by County

SOURCE: NCHS Data Visualization Gallery

Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants

UNITED STATES 2015-2016

Seth, Scholl, Rudd, and BaconMarch 2018

52COCAINE

Death Rates

33PSYCHOSTIMULANTS

1 Year Change

CDC North Star

Prevent opioid-related harms & overdose deathsVISION

Pillars of CDC Activity

➢ Improve data quality and track trends

➢ Strengthen state efforts by scaling up effective public health interventions

➢ Supply healthcare providers with resources to improve patient safety

➢ Collaborate with public safety to respond quicker and more effectively

➢ Empower consumers to make safe choices

CDC Overdose Prevention in States Initiative

PDMPs System-Level Evaluate Policy Rapid ResponseSurveillance

More Specific, Timely, Localized, and Actionable DataEnhanced State Opioid Overdose Surveillance (ESOOS)

• Non-Fatal Data

– Use syndromic surveillance to establish an early warning system to detect sharp increases or decreases in non-fatal opioid overdoses.

• Fatal Data

– Capture detailed information on toxicology, death scene investigations, and other risk factors that may be associated with a fatal overdose.

• Data to Action

– Rapidly disseminate surveillance findings to key stakeholders working to prevent or respond to opioid overdoses

ESOOS

Morbidity

Emergency Department

Rapid ED collection

Case-level or aggregate data shared through

ESSENCE or directly with

NCIPC

Discharge/Billing Data

Case-level or aggregate data shared directly

with NCIPC

Emergency Medical Services

MortalityOpioid-involved deaths

Collected in SUDORS

Submitted Quarterly

Submitted Every 6 month

Data Streams

Current Time Horizon – 3 Months Non-Fatal and 8 Months Fatal

THIS IS A POLYSUBSTANCE EPIDEMIC

ODMAP

Visualizing the Burden

ODMAP

What happens when there is a spike of

overdoses in 24 hours?

Activating Community Response

Laboratory Response and Opioids

Correctly identify and accurately measure opioids - especially fentanyl and its analogs - across federal, state, local, and private clinical laboratories to rapidly detect, diagnose and prevent opioid overdoses and related harms

We need to be able to. . .

Opportunities to Enhance Lab Response in Addressing the Opioid Epidemic

➢ Provide accurate measurement of known fentanyl analogs that allows for comparability across labs.

➢ Ensure labs able to test for as many fentanyl analogs in current use as possible.

➢ Increase lab throughput given demand.

➢ Readily add new analogs to testing protocols/methods as they appear in the US.

➢ Leverage public and commercial labs data to inform response activities and target resources as needed.

➢ Integrate lab data into syndromic surveillance data.

➢ Couple law enforcement and public health data –including from labs - to get a comprehensive picture of epidemic and pivot resources.

Improving Reporting and Modernizing Cause of Death Coding for Enhanced Drug Overdose Surveillance

Harness data visualization to showcase the burden

SOURCE: http://preventoverdoseri.org/overdose-deaths/

Increase the number of states and hospitals within a state reporting through ESSENCE

Data Integration

PHOTO CREDIT: SRS Health

Leveraging web and other social media to provide early identification of emerging overdose threats

Timely And Accurate Data

Implement Innovative Strategies

Rapidly Deploy Resources

Rigorous Follow-up

Connecting Community

Infrastructure

COORDINATED

Prevention and Response Activities

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Questions

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