Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality

Overdose deaths involving opioids in the US have quadrupled since 1999, with 28,647 fatalities in 2014. Research indicates two distinct but interrelated trends: a fifteen-year increase in overdose deaths involving prescription opioid pain relievers (OPR), and a recent surge in heroin overdose deaths. The recent surge in heroin deaths is linked to OPR misuse: four out of five people initiating heroin report prior misuse of OPRs. Sharp increases of 26% and 9% in heroin and natural/semi-synthetic opioid (i.e., commonly prescribed OPRs) overdose death from 2013 to 2014, respectively, highlight the need for timely data. Also, timely data is needed to monitor rapid changes in the types of opioids contributing to overdose deaths. For instance, supply of and deaths related to illicitly manufactured fentanyl surged across multiple states from 2013 to 2014. Time lags from current surveillance systems often exceed a year, limiting public health’s ability to respond. Also, local data on overdose rates and risk factors are needed to effectively respond to opioid-involved drug overdoses because overdose rates vary across counties, heroin and fentanyl-involved deaths concentrate in specific regions and states, and risk factors vary across communities. The goal of the FOA is to assist states with high drug overdose death rates in 2014 or rapidly increasing drug overdose death rates from 2012 to 2014 to improve the timeliness of surveillance of opioid-involved morbidity and mortality. Also, improvements in reporting of risk factors for fatal opioid overdose is funded. Awardees are expected to share surveillance data with CDC to support enhanced multi-state surveillance of opioid-involved overdoses. Specifically, applicants are asked to: 1) Increase the timeliness of nonfatal opioid overdose reporting. Produce quarterly reports on the rate of emergency department (ED) visits and/or emergency medical services (EMS) responses to suspected overdoses involving any-drug, any-opioid (e.g., prescription opioid or heroin/illicitly manufactured fentanyl), and/or heroin within 3 months of the overdose. State/jurisdiction should leverage existing rapid ED and EMS data collection systems to calculate selected indicators. Recognizing that state/jurisdictions may be unable to rapidly collect data on all ED or EMS visits, applicants are required to calculate selected indicators on a minimum of 50% of ED visits or EMS transports; 2) Increase the timeliness of fatal opioid overdose and associated risk factor reporting. Abstract data within 8 months of death using the NVDRS web system from death certificate (DC) and Medical examiner/coroner (ME/C) reports. Data should be extracted on either: a) all opioid-involved deaths in the state/jurisdiction OR b) all opioid-involved deaths in a subset of counties in the applicant’s state/jurisdiction whose residents accounted for a minimum of 75% of the unintentional or undetermined drug overdose deaths that occurred in 2014. Awardees will be required to abstract a standardized set of variables defined by CDC using the National Violent Death Reporting System (NVDRS) web data entry system (See http://www.cdc.gov/violenceprevention/pdf/nvdrs_web_codingmanual.pdf). States need not currently be participating in NVDRS to complete this requirement. 3) Disseminate surveillance findings to key stakeholders working to prevent opioid-involved overdoses. Awardees will create and implement a dissemination plan that outlines multiple strategies for sharing surveillance findings with key stakeholders. Enhanced surveillance will assist key stakeholders in improving prevention and response efforts by providing more timely data on fatal and nonfatal opioid overdose and in-depth information on risk factors that can be targeted for intervention.