Page 24 - Driving Public Health in the Fast Lane

Case Studies

Challenges of Today’s Public Health Surveillance System

Opioid Overdose

The nation is in the midst of a devastating opioid use epidemic. The most recent national data available
from CDC based on state vital records shows approximately 68 percent of the 70,200 overdose deaths
9
reported in 2017 involved an opioid. In past years, the epidemic was driven by prescription opioid-related
overdose deaths, but starting in 2013, illicitly manufactured and synthetic opioids such as fentanyl and
carfentanil began to rise. Today, the opioid epidemic is fast moving and fueled by these highly potent
synthetic substances. The consequences of the opioid epidemic are devastating to communities and
families and create a complex public health problem. Staying ahead of the epidemic requires identifying
emerging synthetic drugs, usage trends, creating early warnings to alert communities of overdose spikes,
and evaluating the effectiveness of control strategies, programs and policy. This requires accurate and
timely overdose data to inform responses at the local, state, and national level. 10

CDC has made significant investments within 32 states through the Enhanced State Opioid Overdose
Surveillance Program and the National Syndromic Surveillance Program to increase timeliness
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of reporting fatal and non-fatal opioid overdoses. This investment has allowed these states to start
providing more comprehensive data to CDC by enhancing their surveillance systems, and begin linking
data sources from medical examiners and coroners, emergency rooms, hospitals, and toxicology
reports. Developing early warning systems for drug overdoses, diagnostics tests, and quantifying the
number of deaths from fentanyl analogs have been early successes of the effort. CDC has also funded the
implementation of EDRS to enhance reporting of fatal opioid overdoses—and all causes of death—from
funeral homes to the vital records registrar and ultimately to NCHS. As of December 2018, 49 of the 57 vital
statistic jurisdictions have implemented EDRS. 12

However, there continue to be many significant barriers within states to provide timely opioid surveillance
data to both their health departments for local and state responses and to CDC for national responses. A
comprehensive public health surveillance system requires uninterrupted data exchange from the health
care system to the public health department and CDC.

Follow the Data

Currently, in the event of an opioid overdose death, the decedent’s EHR and past medical history collected
at the point of care are not linked to the EDRS. To access this information, there are significant and time-
consuming administrative burdens. Medical examiners and coroners must manually access the health
care provider’s health information exchange (if available) or EHR and prescription drug monitoring

9 Understanding the Epidemic. cdc.gov. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated December 19, 2018. Accessed April 11, 2019.
10 Landen M. Nonfatal Opioid Overdose Standardized Surveillance Case Definition. cste.org. https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/2019ps/Nonfatal_Opioid_Overdose_011.pdf.
Updated 2018.
11 Connecting Data Helps Combat the Opioid Crisis. cdc.gov. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated August 23, 2018. Accessed April 11, 2019.
12 Information Systems for Vital Records Stewardship. naphsis.org. https://www.naphsis.org/systems. Published 2014. Accessed May 11, 2019.

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