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
0
25
50
75
100
125
150
175
200
225
250
275
Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17
Nu
mb
er o
f d
eat
hs
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!