Overdose Data to Action: Surveillance Strategies

Overdose surveillance infrastructure

These strategies help all jurisdictions to better capture, analyze, and disseminate overdose surveillance data. There are some commonalities in activities to enhance surveillance infrastructure between OD2A in States and OD2A: LOCAL jurisdictions, such as:

• Hiring surveillance staff
• Leading data modernization initiatives that are specific to nonfatal and fatal drug overdose surveillance data
• Modernizing public health laboratories
• Developing and automating monthly or quarterly updates on nonfatal drug overdose trends that are disseminated through a web-based dashboard

However, surveillance infrastructure needs and spheres of influence at the state and local levels differ. Examples of activities specific to improving surveillance infrastructure at the local level include:

• Rapidly identifying overdose hotspots or spikes using emergency department visits involving overdoses and/or data on emergency medical services (EMS) responses to suspected overdoses
• Collaborating with medical examiners and coroners to improve drug overdose death investigations, including the timeliness or quality of data and the inclusion of toxicology testing

Morbidity surveillance

Under this strategy, OD2A in States jurisdictions collect data on nonfatal overdoses from healthcare facilities, specifically from emergency departments (EDs), as part of CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) system.

Mortality surveillance

This strategy requires OD2A in States jurisdictions to collect and enter data on the characteristics and substances detected and involved in unintentional and undetermined intent drug overdose deaths into the State Unintentional Drug Overdose Reporting System (SUDORS). Obtaining data on the characteristics and circumstances surrounding overdose deaths gives us information about the risk factors and social determinants of health associated with overdose deaths.

Toxicologic testing of drug products and/or paraphernalia

This strategy helps a subset of OD2A: LOCAL jurisdictions to test drug products and/or drug paraphernalia to identify and track emerging public health threats in illicit drug markets so they can understand and respond to drug overdose outbreaks. Jurisdictions will use these data to inform harm reduction and linkage to care prevention activities, to investigate how changes in the illicit drug market contribute to drug overdose trends, and to communicate new drug risks to communities.

Surveillance of linkage to and retention in care

This strategy helps a subset of OD2A: LOCAL jurisdictions establish a surveillance system to measure linkage to and retention in care for substance use disorder using standardized indicators. Data collected can be used to improve and enhance linkage to care prevention activities.

Biosurveillance

The primary goal of this surveillance strategy is to gather a standard set of laboratory data from biological specimens from suspected overdoses in the emergency department (ED). A subset of OD2A in States jurisdictions use these data to enhance existing DOSE data by providing more contextual information for ED visits that can be used to identify trends in drugs contributing to overdose.

Data linkage

This surveillance strategy helps a subset of OD2A in States jurisdictions link key data sources at the person-level. For example, linking EMS or ED records of previous nonfatal overdoses with mortality data (i.e., SUDORS, vital records). Linking these data sources together provides a more richly detailed picture of overdoses and allows state health departments and other partners to better understand and respond to key events that occur before, during, or after a drug overdose.