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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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Florida Enhanced State Opioid Overdose Surveillance Program (FL-ESOOS)

FL-ESOOS Program

Dr. Karen Card - Principal Investigator

The Opioid Epidemic in Florida  

Data from the Florida Department of Health’s Bureau of Vital Statistics indicates Florida’s unintentional and undetermined drug overdose deaths more than doubled from 2014 to 2016, with 2,175 deaths in 2014, 2,805 in 2015, and 4,672 in 2016. Furthermore, Florida’s opioid overdose rate has tripled since the turn of the century according to Florida’s Statewide Drug Policy Advisory Council 2016 Annual Report, and “there has been a substantial increase in deaths associated with fentanyl and heroin-related drug use.”

Florida passed two important laws in the fight against opioid abuse and misuse: the Prescription Drug Monitoring Program, section 893.055, Florida Statutes, and the Pill Mill Law on Opioid Prescribing and Utilization, section 458.3265, Florida Statutes. Despite the success of the Prescription Drug Monitoring Program and increased regulation of opioid prescriptions, the Department recognized the increasing rate of opioid-involved drug overdose deaths as a growing public health issue. In Spring 2017, Florida’s Governor Scott and the state surgeon general recognized a statewide public health emergency for the opioid epidemic. Additionally, in 2017 the Florida Legislature passed House Bill 249 requiring reporting of controlled substance overdoses.

National Program 

In 2016, the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control established the Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality Program (ESOOS). The program enables states to develop and adapt surveillance systems to address the rising rate of opioid overdoses. ESOOS specifically focuses on heroin and synthetic opioids, such as illicitly manufactured fentanyl, by providing more timely and comprehensive data on fatal and non-fatal opioid overdoses and associated risk factors.

In Fiscal Year (FY) 2016, via increased funds appropriated by Congress to the CDC’s overarching Overdose Prevention in States effort, approximately $4.3 million was allocated to fund ESOOS. Twelve states were funded in the program’s first round of implementation in 2016 (see footnote 1). In FY 2017, $7.5 million in additional funding supported a program expansion—the CDC funded an additional 20 states and the District of Columbia (see footnote 2). Also in FY 2017, ESOOS states were awarded $4.7 million in supplemental funding to enhance state-level surveillance and directly support medical examiners and coroners with funds for comprehensive toxicology testing.
This is an important and timely effort and directly supports the President’s declaration of a Nationwide Public Health Emergency to address the opioids crisis.

FL-ESOOS Program Approach 

With the grant funding, the Department built an enhanced surveillance system and supporting infrastructure that allow a collaborative and targeted response to the growing opioid challenge, through the timely dissemination of surveillance data to key stakeholders working to address opioid overdoses. The core grant supports resources necessary to: 1) Leverage Florida’s existing incident-level emergency medical services data collection system to calculate any-drug and any-opioid indicators; 2) Collect, abstract, and input fatal opioid-involved overdose data from Florida's Vital Statistics Death Certificates and Medical Examiners' reports for target counties into the CDC’s National Violent Death Registry System’s State Unintentional Drug Overdose Reporting System module; and 3) Communicate surveillance results to key stakeholders at state and local levels.

The grant supplement supports participating Medical Examiner districts that need supplemental funds to: 1) Perform comprehensive toxicology testing for all suspected opioid-involved overdose deaths; and 2) Increase performance of specialized toxicology testing to identify specific fentanyl analogs and other synthetic opioids in suspected opioid overdose deaths.
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1 Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, West Virginia, and Wisconsin.
2 Alaska, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Nevada, New Jersey, North Carolina, Tennessee, Utah, Vermont, Virginia, and Washington.