Using medical examiner case narratives to improve opioid overdose surveillance

Hurstak, Emily; Rowe, Christopher; Turner, Caitlin; Behar, Emily; Cabugao, Rachel; Lemos, Nikolas P.; Burke, Catherine; Coffin, Phillip O.

doi:10.1016/j.drugpo.2017.12.017

Cited by 18 publications

(17 citation statements)

References 53 publications

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“…Specifically, among these 11 states, there is improved understanding of prescription and illicit opioid involvement, polysubstance use, and potential missed opportunities to intervene to prevent opioid overdose deaths. Previous efforts to differentiate illicit and prescription opioid deaths were limited by grouping within the same drug categories (e.g., synthetic opioids, excluding methadone) and by the difficulty in determining whether detection of morphine or fentanyl by forensic toxicology testing indicates the presence of prescription or illicit opioids ( 2 , 3 ). ¶¶ Findings from this analysis indicate that illicit opioids were a major driver of opioid deaths, especially among younger persons, and were detected in approximately three of four deaths overall.…”

Section: Discussionmentioning

confidence: 99%

Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016–June 2017

Mattson¹,

O’Donnell²,

Kariisa³

et al. 2018

MMWR Morb. Mortal. Wkly. Rep.

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In 2016, 63,632 drug overdose deaths occurred in the United States, 42,249 (66.4%) of which involved opioids (1). The development of prevention programs are hampered by a lack of timely data on specific substances contributing to and circumstances associated with fatal overdoses. This report describes opioid overdose deaths (referred to as opioid deaths) for decedents testing positive for prescription opioids (e.g., oxycodone and hydrocodone), illicit opioids (e.g., heroin, illicitly manufactured fentanyl, and fentanyl analogs), or both prescription and illicit opioids, and describes circumstances surrounding the overdoses, in 11 states participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program.* During July 2016–June 2017, among 11,884 opioid overdose deaths, 17.4% of decedents tested positive for prescription opioids only, 58.7% for illicit opioids only, and 18.5% for both prescription and illicit opioids (type of opioid could not be classified in 649 [5.5%] deaths). Approximately one in 10 decedents had been released from an institutional setting in the month preceding the fatal overdose. Bystanders were reportedly present in approximately 40% of deaths; however, naloxone was rarely administered by a layperson. Enhanced surveillance data from 11 states provided more complete information on the substances involved in and circumstances surrounding opioid overdose deaths. Consistent with other emerging evidence and recommendations,† these data suggest prevention efforts should prioritize naloxone distribution to persons misusing opioids or using high dosage prescription opioids and to their family members and friends. In addition, these data suggest a need to expand treatment and support for persons who have experienced a nonfatal overdose and to expand treatment in detention facilities and upon release.

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Section: Discussionmentioning

confidence: 99%

Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016–June 2017

Mattson¹,

O’Donnell²,

Kariisa³

et al. 2018

MMWR Morb. Mortal. Wkly. Rep.

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“…The data collection tools and processes used in mortality registries (e.g. identification of causes and mechanisms of deaths, issuance and reporting of death certificates, reporting and coding practices) have been investigated in a number of studies [1,4,9–21] in terms of their effect on the recorded number of drug‐induced deaths. In this regard, it is important to note that the issues related to data collection usually result in underreporting of drug‐induced deaths, which has been identified in different countries [9,16–18].…”

Section: Introductionmentioning

confidence: 99%

The identification of artefacts in reporting of drug‐induced deaths using structural breaks analysis of time series statistics

Petruželka

Mravčík

Barták

et al. 2021

Drug and Alcohol Review

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Introduction Drug‐related mortality is a key epidemiological indicator that is collected nationally and internationally. Significant efforts were made in 2006–2007 to improve the quality of data concerning drug‐related mortality in the Czech Republic. The aim of this article is to identify the effect of a quality improvement project on the drug‐induced mortality data reported in the General Mortality Registry (GMR), and to demonstrate how to identify, quantify and interpret changes in drug‐induced mortality based on the example of the Czech Republic. Methods We extracted data on illicit drug‐induced deaths from the Czech Republic GMR and Special Mortality registry (SMR) for the years between 2004 and 2012, and aggregated monthly and quarterly time series. We applied a new procedure to identify structural breakpoints in time series based on dating structural changes in standard linear regression models. Results In the GMR, breakpoints were identified in three time series: (i) opioid‐related deaths; (ii) other stimulant‐related deaths; and (iii) total drug‐induced deaths. In the SMR, the structural breaks were identified for opioids, volatile substances and selection D time series. In each of these time series, the analysis identified a decrease in the intercepts in the different segments. Discussion and Conclusions The structural breaks identified and quantified in the GMR time series were plausibly caused by the quality improvement efforts that started in 2006. These results demonstrate that it is critical for the analysis and use of drug mortality data collected in the registries to identify practice changes in the relevant registries, to quantify their influence and to adjust mortality estimates accordingly.

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“…[10][11][12][13] San Francisco County has high rates of opioid overdose, with deaths clustering in areas of the city with a concentration of low-income housing. 14,15 In response to the local opioid overdose epidemic and to clinician frustration with limited treatment options for chronic pain management, a group of patients, stakeholders, clinicians, researchers, and public health leaders collaborated to design and implement the Integrative Pain Management Program (IPMP) at Tom Waddell Urban Health Center (TWUHC).…”

Section: Introductionmentioning

confidence: 99%

Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic

Hurstak

Chao

Leonoudakis-Watts

et al. 2019

The Journal of Alternative and Complementary Medicine

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Objective: To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. Design: We used a quality improvement ''Plan Do Study Act'' (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. Setting: An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose. Subjects: Eligible participants included individuals with pain for greater than 3 months who were prescribed opioid therapy. Outcome measures: We designed IPMP using a PDSA framework that promotes continuous evaluation and adaptation of the program to meet the needs of the clinical system. We assessed feasibility and acceptability with program referrals and attendance and evaluated program satisfaction. Results: The IPMP delivered a 12-week group-based intervention that involved group support, education on pain etiology and treatments, movement-based interventions, mindfulness-based therapies, acupuncture, and massage therapy. One hundred forty-six patients were referred to IPMP; 58 individuals participated in one of the first three cohorts of the program. Sixty-two percent of participants attended at least half of the sessions. Staff and participants reported high levels of satisfaction with IPMP and demand for longitudinal services. Conclusions: An IPMP delivered within a safety-net primary care clinic could be implemented in a way feasible and acceptable to staff and participants with the support of the local health care system. The application of a PDSA cycle allowed for rigorous implementation and evaluation of a multimodal pain program. Quality improvement frameworks are a strategy to improve and expand the delivery of high-quality patient-centered integrative pain treatments.

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Using medical examiner case narratives to improve opioid overdose surveillance

Cited by 18 publications

References 53 publications

Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016–June 2017

Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016–June 2017

The identification of artefacts in reporting of drug‐induced deaths using structural breaks analysis of time series statistics

Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic

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