Drug Overdose Surveillance & Epidemiology

A state of emergency for the opioid epidemic was declared in the Spring of 2017. As a result, the OD2A-S program collaborated with the U.S. Centers for Disease Control and Prevention (CDC), Florida Department of Children and Families, Agency for Health Care Administration, and Florida Perinatal Quality Collaborative to assess and compile opioid-related data across many surveillance systems leading to the development of a substance use dashboard.

The long-term and visionary outcomes of the OD2A-S program include: partners design, target, implement, and evaluate opioid prevention programs informed by OD2A-S data, more effective overdose prevention efforts in target areas, and reduce morbidity and mortality rates due to overdose prevention. 

The OD2A-S is currently collaborating with the following partners:

• Florida Perinatal Quality Collaborative to reduce neonatal abstinence syndrome (NAS)
• Early Steps serves infants and toddlers with NAS
• Florida’s Poison Control Center provides services through call centers
• Syringe Exchange Programs
• Department of Children and Families
• Agency for Health Care Administration
• University of South Florida, College of Public Health
• Florida Hospital Association
• Florida Medical Association
• Florida Medical Examiners
• U.S. Centers for Disease Control and Prevention

Strategy 2: Overdose Morbidity Surveillance

Strategy 2 of the Overdose Data to Action in States (OD2A-S) program is the strategy focused on non-fatal overdose surveillance. The overall goal of this strategy is to increase the timeliness and accessibility of aggregate non-fatal drug overdose data through enhanced surveillance of suspected opioid, heroin, methamphetamine, benzodiazepine, cocaine, fentanyl, all drug, and stimulant overdoses.

Non-fatal overdose data are collected from Florida’s Agency for Health Care Administration, Florida Electronic Surveillance System for the Early Notification of Community-based Epidemics, and Florida’s Emergency Medical Services Tracking and Reporting System.

Strategy 4: Overdose Biosurveillance

Strategy 4 of OD2A-S is dedicated to building a laboratory-confirmed database to identified substances involved in suspected non-fatal overdoses in the emergency department. Florida’s OD2A-S lab in Jacksonville receives specimens of suspected non-fatal overdoses submitted by our hospital partner.

Each specimen is tested in depth for over 90 analytes, and the testing panel is regularly reviewed and updated by our chemists. The biosurveillance team is actively seeking additional hospital partners to better represent the Florida population. OD2A-S surveillance team can be reached by contacting OverdoseResponse@FLHealth.gov.

Strategy 3: Overdose Mortality Surveillance

Strategy 3 of OD2A-S is focused on fatal overdose surveillance. The overall goal of the strategy is to better understand the circumstances surrounding fatal overdoses and increase the timeliness and accessibility of aggregate fatal drug overdose data reporting.

Fatal overdose data are collected by using the Florida Department of Health’s Bureau of Vital Statistics death certificate data, and establishing data partnerships with the medical examiner community to access risk factor and toxicology data.

Available reports (e.g. toxicology, autopsy, investigator) are then requested monthly from the medical examiner districts based on a list of decedents meeting the CDC’s case definition according to death certificate data. Staff abstract risk factor, toxicology, and other CDC-requested data elements from the reports into the CDC’s National Violent Death Registry System’s State Unintentional Drug Overdose Reporting System.

In addition, staff assists participating medical examiners with access to grant funding for comprehensive and specialized toxicology testing related to drug overdose fatalities.

The Florida Overdose Data to Action in States prevention strategies use data collected through OD2A-S surveillance efforts to inform and enhance drug overdose prevention programs. By leveraging real-time data, these strategies aim to improve outcomes for individuals affected by substance use disorder (SUD) through targeted, evidence-based interventions.

The OD2A-S prevention initiatives encompass a comprehensive approach, ranging from harm reduction and linkage to care to public safety partnerships and clinician engagement. These strategies are designed to create more effective, sustainable, and long-term solutions for preventing overdoses and supporting individuals on the path to recovery.

There are four key prevention strategies under OD2A-S, each focused on addressing different aspects of the overdose crisis. Detailed information on these strategies is provided below.

OD2A-S Strategy 6 Overview

Strategy 6 of the OD2A-S program is the strategy focused on infrastructure improvements to Florida’s Prescription Drug Monitoring Program, known as E-FORCSE in the state of Florida, and educating clinicians regarding usage of the PDMP and guidelines for prescribing opioids to patients. Strategy 6 is broken down into two components, with each having specific interventions linked to them.

Strategy 6a: Clinical/Health System Engagement

Interventions:

• Developing trainings on the management of pain, focusing on dissemination to all clinicians who may treat acute subacute, and chronic pain in outpatient settings.
• Developing trainings on screening and diagnosis of substance use disorders (SUDs), especially opioid use disorder (OUD) and stimulant use disorder (StUD), intended for clinicians across a range of specialties.
• Supporting emergency department linkages via multidisciplinary teams including navigators, broadening the scope from only post-overdose scenarios to also include strategies like focused connections during care for conditions that may represent sequalae of substance use (e.g., soft/skin tissue infections) and enhanced universal screening for SUD (e.g., opioids and stimulants) among patients presenting for other reasons to identify new opportunities to engage in and link to care.

Strategy 6b: Health IT/PDMP Enhancement

Interventions:

• Implementing and expanding electronic information sharing among states in compliance with the National Prescription Monitoring Information Exchange Architecture.
• Connecting and maintaining bidirectional connection for the exchange of PDMP data with other “state” PDMP systems and ensuring that every request received by the recipient’s PDMP systems and ensuring that every request received by the recipient’s PDMP system sends and appropriate and timely response.
• Implementing universal PDMP registrations and use that includes a streamlined and simplified PDMP registration process.
• Improving PDMP infrastructure or information systems to support proactive reporting and data analysis including enhancing reporting systems to increase frequency and quality of reporting.
• Designing, validating, or refining algorithms for identifying high-risk prescribing activity and other risk factors associated with overdose to use as a trigger for proactive reports (e.g., receiving prescriptions from multiple clinicians, and concurrent substance use or dangerous combinations that put patients at higher risk for opioid use disorder and overdose).
• Integrating PDMP data into electronic health records.

Strategies 7-9 of the OD2A-S program are the bulk of interventions focused on harm reduction and linkage to care. These strategies, and their related interventions, run the spectrum of harm reduction activities in state/local jails/prisons, to media campaigns to raise awareness of substance use disorder (SUD) to the placement of Linkage-to-Care Navigators in local hospitals/ED’s. These strategies are implemented at the local level by county health department’s with supervision and support by the State Health Office. Strategies 7-9, and their related interventions, are broken down as follows:

Strategy 7: Public Safety Partnerships / Interventions

Interventions:

• Implementing strategies that may take place in criminal justice settings (e.g., courts, jail, parole), upon reentry, and in the community.

Strategy 8: Harm Reduction

Interventions:

• Developing and expanding overdose education and naloxone distribution programs that prioritize education and distribution among those who are at the greatest risk of experiencing or witnessing an overdose.
• Initiating, expanding, and supporting programs and outreach by navigators (e.g., people with lived experience, case mangers) to promote access to harm reduction services (such as syringe services programs) and to link people to care from harm reduction services as appropriate.

Strategy 9: Community-Based Linkage to Care

Interventions:

• Using navigators to facilitate linking people to care and other services.
• Using navigators to facilitate implementing monitoring programs following discharge from acute care to prevent treatment interruption.