CDC’s Enhanced State Opioid Overdose Surveillance Program:

Tracking NPS OverdosesJulie O’Donnell, PhD MPH

Centers for Disease Control and PreventionNational Center for Injury Prevention and Control

Division of Unintentional Injury Prevention

November 14, 2018

The opioid overdose epidemic has come in 3 distinct waves

Fentanyl?Tramadol?Carfentanil?Cyclopropylfentanyl?

CDC’s 5 priority areas for response to the opioid overdose epidemic

Conduct surveillance

and research

Empower

consumers to make

safe choices

Build state, local, and

tribal capacity

Support providers,

health systems,

and payers

Partner with

public safety

CDC’s 5 priority areas for response to the opioid overdose epidemic

Conduct surveillance

and research

Empower

consumers to make

safe choices

Build state, local, and

tribal capacity

Support providers,

health systems,

and payers

Partner with

public safety

CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) Program

Strategy One:

Increase timeliness of nonfatal opioid overdose reporting (emergency department and

emergency medical services data)

Strategy Two:Increase timeliness and

comprehensiveness of fatal opioid overdose reporting (death certificates, medical

examiner/coroner data)

Strategy Three:Disseminate data widely to key stakeholders

ESOOS funding for enhanced toxicology testing

• Supplemental funding for all ESOOS-funded states

• 40% of base funding• 60% of supplemental funds must go directly to ME/Cs to

support comprehensive toxicology testing

• If ME/Cs already fully funded for testing, can use funds for other innovative projects to improve timeliness/comprehensiveness of data

Funded ESOOS states

ED and EMS data: nonfatal opioid overdoses

• Strategy One of ESOOS

Non-fatal overdoses

Emergency Department

Near real-time ED collection (i.e.

syndromic, ESSENCE)

Case-level or aggregate, shared via

ESSENCE (BioSense) or directly with CDC

Discharge/Billing Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by sex, age group, and county of

residence. Race/ethnicity

is optional

Emergency department data

• Data submitted to CDC quarterly

• Near real-time syndromic surveillance data (visit information within 24-48 hours)• Uses both discharge codes (i.e., ICD-9-CM, ICD-10-CM,

and SNOMED) and free text fields such as chief complaint or triage notes

• Free text searches use common terms, slang, and misspellings (e.g., herion instead of heroin)

• Lagged hospital billing or claims data (usually within 3-4 weeks)• Uses only discharge codes (i.e., ICD-9-CM, ICD-10-CM,

and SNOMED)

Emergency medical services data

• Capture potential EMS transports to EDs• Excludes instances where individual is pronounced deceased

on the scene, inter-facility transports, and when EMTs provide no “treatment” (e.g., patient refused or required no treatment or transport)

• Different variables used:• Chief Complaint; Secondary complaint• Narrative• Provider Impression• ICD-10-CM codes• Medication administered (i.e., Naloxone)• Response to medication administered (i.e., awake following

Naloxone administration)

State Unintentional Drug Overdose Reporting System (SUDORS)

• Strategy Two of ESOOS

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner/

coroner reports

Toxicology reports

Collected for all unintentional and undetermined intent opioid overdose deaths or a sample

SUDORS data entry timeline

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1. Data entry initiation deadline

2. Data entry completion deadline

1. Data entry initiation deadline

2. Data entry completion deadline

SUDORS case definitions for opioid overdose deaths

• Using death certificate cause of death information• Literal cause of death text fields

• Underlying cause-of-death codes X40–44 (unintentional poisoning) and Y10–14 (undetermined intent)

• Multiple cause-of-death codes• T40.0 (poisoning by opium)

• T40.1 (poisoning by heroin)

• T40.2 (poisoning by natural and semi-synthetic opioids)

• T40.3 (poisoning by methadone)

• T40.4 (poisoning by synthetic opioids other than methadone)

• T40.6 (poisoning by other unspecified narcotics)

SUDORS uses the National Violent Death Reporting System web platform

- Basic descriptors

- Compare across

demographics

- Recent release from

institution

- Overdose location

- Survival time

- Mental health

diagnoses

- Substance abuse

treatment history

- Substances present

- Substances

contributing to death

OD tab screenshot

OD tab screenshot

OD tab screenshot

OD tab screenshot

Toxicology tab screenshot

Fentanyl analogs detected in SUDORS in ≥10 deaths (preliminary data)

Other fentanyl analogs detected in ≥1 death

• Furanylethylfentanyl

• 3-methylthiofentanyl

• Tetrahydrofuranylfentanyl

• Valerylfentanyl

• Beta-hydroxythiofentanyl

• Ocfentanil

• Sufentanil

Other illicit synthetic opioids detected in ≥1 death

• U-series• U-47700 (>500 deaths)• U-48800• U-49900

• AH-7921

• MT-45

• (Kratom)

Other illicit synthetic opioids detected in ≥1 death

• U-series• U-47700 (>500 deaths)• U-48800• U-49900

• AH-7921

• MT-45

• (Kratom – non-opioid with opioid-like properties)

Using SUDORS data to track emerging opioids

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202. DOI: http://dx.doi.org/10.15585/mmwr.mm6643e1

Using SUDORS data to track emerging opioids

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep 2017;66:1197–1202. DOI: http://dx.doi.org/10.15585/mmwr.mm6643e1

Using SUDORS data to track emerging opioids

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Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

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Month and year

Other states-carfentanil Ohio-carfentanil

Other states-any fentanyl analog Ohio-any fentanyl analog

Adapted from: O’Donnell J, Gladden RM, Mattson CL, Kariisa M. Notes from the Field: Overdose Deaths with Carfentanil and Other Fentanyl Analogs Detected — 10 States, July 2016–June 2017. MMWR Morb Mortal Wkly Rep 2018;67:767–768. DOI: http://dx.doi.org/10.15585/mmwr.mm6727a4

Acknowledgments

• States participating in the State Unintentional Drug Overdose Reporting System and participating state agencies

• State health departments

• Medical Examiner and coroner offices

• Vital registrar offices

• CDC ESOOS staff

• Puja Seth, Christine Mattson, Matthew Gladden, Alana Vivolo-Kantor, Rose Rudd, Mbabazi Kariisa, Nana Wilson, Brooke Hoots, Stephen Liu, Emily Olsen, Desiree Mustaquim, Felicita David, Londell McGlone, Reshma Mahendra, Naomi David, Anita Pullani, Terry Davis, Shelby Alexander, Jocelyn Wheaton, Henrietta Kuoh, Lindsay Culp, Megan Early, Sabeen Bhimani, Danielle Arellano, Andrea Harris, Pierre Olivier Cote, Wilma Jackson

Thank you!