At a glance
Puerto Rico has strengthened their data systems to more quickly identify and act on overdose event alerts, leading to faster and more personalized links to lifesaving treatment and support services.
The syndromic surveillance situation
The Electronic Surveillance System for the Early Notification of Community-based Epidemics, or ESSENCE, is a syndromic surveillance system that supports collaboration and investigation. Limited data infrastructure in Puerto Rico's medical facilities made it challenging to use ESSENCE. This has hindered the capture and sharing of information needed to take timely action to help people at risk of overdose.
Puerto Rico's team of navigators, who are responsible for connecting people to treatment resources and medical services, didn't have the data they needed to react quickly to overdoses. The delay limited the effectiveness of their interventions and reduced their ability to anticipate the needs of people who use substances.
Policy change strengthens the system
As of September 2025, all emergency departments (EDs) are required to report visits for nonfatal overdoses. This means the response team can now use syndromic surveillance, a system that detects unusual patterns in real time in ED visits or medical reports and generates alerts to track and respond to overdoses.
With the information provided by the alerts, navigators can immediately contact affected individuals or their family members to offer quick access to treatment centers and intervention options. Navigators offer immediate support to individuals who have experienced an overdose, including linkage to substance use disorder treatment, access to urgent medical care, and psychological services. This support can reduce the risk of subsequent overdoses and help individuals engage in long-term treatment and recovery services.
Between January - August 2025, syndromic surveillance produced 652 total alerts related to potential and/or suspected overdoses from 28 EDs. Navigators coordinated 45 services like links to treatment, overdose prevention education, and psychosocial support.
- Navigator
Lessons learned so far
Invest in robust technological infrastructure. ESSENCE requires high-quality, timely data. Upgrading information systems in hospitals, clinics, and laboratories is essential to achieve their full potential.
Standardize and rigorously govern data. Consistent, high-quality data are essential. ESSENCE demonstrates the value of rigorous processes and protocols to ensure reliable information.
Progressive learning. Implementing ESSENCE in Puerto Rico is a gradual journey. As Puerto Rico improves their data infrastructure and builds trust with data providers, there will be greater possibilities for epidemiological surveillance and emergency response.
Thanks to OD2A: LOCAL investments, more complete (mandatory substance reporting in ED visit records) and timely (rapid alerts from syndromic surveillance) data are leading to increased and faster linkages to care.