FL-ESOOS ProgramDr. Karen Card - Principal Investigator
Department of Children and Families –Substance Abuse and Mental Health Program
______________________Prevention, Treatment, and Recovery Resources
Non-Fatal Opioid Overdoses
Key Strategy: Utilizing Florida’s Emergency Medical Services (EMS) Tracking and Reporting System (EMSTARS), increase the timeliness of aggregate non-fatal opioid overdose reporting with enhanced surveillance.
The Department’s Bureau of Emergency Medical Oversight (Bureau) is comprised of four sections representing the emergency health care system continuum-of-care, which includes the EMS section and an existing system – EMSTARS – to which incident-level, pre-hospital EMS data is reported. Utilizing data from EMSTARS, the Bureau will track two indicators: 1) suspected drug overdoses, and 2) suspected overdoses involving any opioid, including Opioid Pain Relievers (OPRs), heroin, or illicitly made fentanyl.
The Bureau will facilitate analysis of the non-fatal opioid-involved overdose surveillance data and generate reports on more rapid, reliable, and geographically-specific changes in the rate of non-fatal opioid-involved overdoses. The Bureau will generate state- and county-level reports on a quarterly basis (first report developed by April 15, 2018) on the selected two indicators. The state-level report will provide the number and rate of any-drug and any-opioid overdoses. Required demographic slicers for the state-level report – by sex, by age, and by race/ethnicity – are available, within the EMSTARS data, for the chosen indicators and will be included. The county-level report will provide the number and rate of any-drug and any-opioid overdoses for each county; EMSTARS includes geographic data on every incident, including county and zip code.
Fatal Opioid Overdoses
The Bureau will initially target a subset of ME districts, that accounts for approximately 82% of all 2015 unintentional and undetermined drug overdose (UUDO) deaths, based on death data from the Centers for Disease Control and Prevention’s (CDC’s) WONDER database, with a plan to increase this scope over time.
The Bureau will utilize DC data for identifying – monthly – a list of decedents that meet the CDC’s case definition within the targeted subset of counties. This list will be used to generate specific requests to the participating ME districts to obtain associated, available ME reports (e.g. toxicology reports, autopsy reports, investigator reports, etc.). Bureau staff will abstract risk factor, toxicology, and other CDC-requested data elements from the DC and ME reports into the CDC’s National Violent Death Registry System (NVDRS) - State Unintentional Drug Overdose Reporting System (SUDORS) module.
The Bureau will facilitate analysis of the fatal opioid-involved overdose surveillance data to compare the following characteristics of the decedents with the Florida-specific general population: i) Demographic Information: age, sex, race/ethnicity, area of residence, place of death; ii) Co-Morbidities: drug dependency, chronic pain conditions, mental health disorders; iii) Personal Characteristics: prior rehabilitation treatment, previous overdose, prescription history. The Bureau will also analyze the other substances in the decedents’ system at time of death, and whether the opioid was prescription, non-prescription, and/or illicit. If possible, multivariate models will be created to quantify risk factors and account for interactions, and the Bureau can consider additional characteristics that are available. Semi-annual reports containing this information will be generated (first report developed by December 28, 2018).
In addition, the Bureau seeks to assist its participating MEs, by providing them with access to supplemental grant funds (should they not have an adequate level of local funding), to 1) increase the frequency of comprehensive toxicology testing performed for all suspected opioid-involved overdose deaths, and / or 2) increase the frequency of specialized toxicology testing to identify specific fentanyl analogs and other specific synthetic opioids (when needed) in suspected opioid-involved overdose deaths. This will facilitate an increase in the completeness / fidelity of toxicology findings received from the participating ME districts. Should a given ME district have an adequate level of local funding for conducting comprehensive and specialized toxicology testing, the Department will accept concept proposals from the ME district for an alternative way to use the funding to enhance the timeliness and quality of ME investigations of suspected opioid-involved overdose deaths. All concept proposals will be submitted to the CDC for review and approval/denial.
Key Strategy: Adopt a comprehensive approach to surveillance data dissemination – to key stakeholders working to prevent or respond to opioid-involved overdoses – utilizing multiple tools and communication vehicles.
The Bureau will perform environment and stakeholder analyses to facilitate proper dissemination plan development, as well as develop the plan (inclusive of evaluation indicators) based on what is learned in the analyses. The Bureau will implement/execute the dissemination plan to share actionable insights from surveillance data findings and reports with key stakeholders.