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Overdose Spike Response Toolkit

Introduction

Drug overdose deaths continue to increase both in the United States and within the state of Indiana. Over the last two decades, Indiana has seen a drastic increase in the number of drug overdose deaths. From 2016 to 2017 there was a 22.3% increase in overdose deaths within Indiana, the third-highest drug overdose rate increase across the nation. With the onset of the COIVD-19 pandemic in early 2020, Indiana saw an unprecedented increase in overdose deaths. Within the months of April, May, and June of 2020, Indiana saw a 33% increase in drug overdose deaths compared to January, February, and March. The Overdose Spike Response Toolkit is designed to provide local health departments across the state of Indiana with the tools and resources they need to effectively respond to an increase in overdoses in their city, region, or local hospital facilities.

Purpose

The purpose of this toolkit, and the resources provided, can be used to gather quantitative and qualitative information surrounding the increase in overdoses to aid in a timely public health response, identify risk factors for overdose to target local prevention efforts, and support linkage to care for individuals with high risk of overdose.

Planning for an Overdose Spike Response is often categorized into 5 steps:

  1. Identify
  2. Evaluate
  3. Prepare
  4. Investigate
  5. Respond

Identifying an Overdose Spike

Syndromic Surveillance

Syndromic surveillance is the real time collection and analysis of health-related data, such as age, sex, zip code, and reported symptoms, which usually precedes diagnosis and lab results.

Technical Tips and Training: Syndromic Surveillance 101

ESSENCE Overview

ESSENCE, or The Electronic Surveillance System for the Early Notification of Community-Based Epidemics, is used by IDOH to monitor disease clusters and sentinel cases. While ESSENCE has traditionally been used to monitor disease outbreaks such as measles, mumps, and zika, it can also be used to monitor outbreaks and trends in overdoses. ESSENCE collects and analyzes data from participating hospital emergency departments across the state. If you are a member of a local health department or a participating hospital facility you can sign up for an ESSENCE account by filling out the form below and sending it to snierman@isdh.in.gov.

When the case definition for an overdose outbreak or cluster has been met within ESSENCE, IDOH alerts the corresponding local health department of potential increased drug overdose activity in their area.

Read more: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE): Overview, Components, and Public Health Applications

What is an Overdose Spike?

An overdose spike is when a suspected number of overdoses within a certain timeframe exceeds the threshold of normal activity. These overdose spikes may appear gradually over time as a result of changes in drug use trends, rapidly within a narrow geographic area or timeframe as a result of a contaminated source, or over a widespread geographic area as a result of overall changes in the illicit drug supply.

Identify an Overdose Spike

  1. Increases in 911 calls for a suspected overdose
  2. Increase in drug overdose deaths reported by coroners
  3. Increase in EMS treating suspected overdoses and reversing suspected overdoses with naloxone
  4. Increase in emergency department visits by individuals presenting overdose symptoms
  5. Increase in Indiana poison center calls
  6. Increase in police reports of illicit drug arrests or new type of synthetic drug
  7. Toxicology testing capturing threats and changing substance use patterns

Prepare

Develop a Response Plan

Preparing for an overdose spike first begins with developing a response plan. Identify those internally who will be responsible for detecting and initiating an overdose spike response within the community. Consider the systems, partners, and stakeholders that will play leading roles in response measures outside of your organization such as law enforcement, healthcare providers, treatment facilities, and non-profits.

Examples: Overdose Spike Response Framework for Communities and Local Health Departments, Community Response Plan Template, North Carolina Essential Actions to Address the Opioid Epidemic: A Local Health Department’s Guide

Investigate

Activation and Deactivation of the Response

Though ESSENCE may indicate that there is an increase in suspected overdoses within a local region or hospital facility, and these alerts may be beneficial for general knowledge and awareness, it is important to know when an alert warrants public health response within your specific community.

To further evaluate whether an alert warrants activation of the response plan, investigate:

  • How closely in time and location the overdoses occurred
  • The level of substance use within your community or region
  • Similarities in overdose events
  • Recurrence of alerts issued over the last several days
  • Current events that could influence increase in substance use
  • Communication from local partners or stakeholders of increase

Investigate the cause of the outbreak. There are many sources that might be relevant to collecting information including:

  1. Emergency Department data
  2. EMS records
  3. Poison center calls
  4. Police reports

If you determine that it’s time to activate your response plan, consider your current program response capacity and the agencies throughout the community that could provide additional resources.

What is the community’s current access to:

  1. Health care
  2. Behavioral and mental health
  3. Syringe service programs
  4. Treatment for substance use disorder
  5. Overdose prevention programs
  6. Housing
  7. Family services
  8. Local public transportation
  9. Local community-based organizations

Read more: Marshall County Alert Success Story

Respond

Community Collaboration

Internal stakeholders include anyone in your own organization with a responsibility to the overdose spike response. External stakeholders, however, will depend on the existing partnerships you have, as well as the capacity you may have to maintain these partnerships and engage new partnerships within your community. When an overdose spike response is issued, utilizing appropriate measures for information and data sharing, you may report to those relevant partnerships within your community, such as law enforcement, emergency medical services, healthcare providers, substance use disorder treatment facilities, naloxone distributors, and syringe exchange programs, that the overdose spike response has been activated.

Resources: 2020 National Directory of Drug and Alcohol Abuse Treatment Facilities, 2021 National Directory of Mental Health Facilities, Addiction Treatment Locator, Assessment, and Standards Platform (ATLAS), eLearning for Healthcare Professionals on Safe Opioid Prescribing, Virtual Recovery Resources, Deflection and Pre-Arrest Diversion to Prevent Opioid Overdose, Opioid Crisis Response eLearning Series

Control and Prevention Measures

After an overdose spike is issued, it is critical to quickly respond and institute control measures within your local community. These control measures may include further surveillance of the spike, communicating with local partners and stakeholders about the spike, and mobilizing harm reduction strategies such as:

  • Naloxone distribution
  • Syringe exchange programs
  • Community messaging on overdose prevention, Good Samaritan Laws, signs and symptoms of an overdose, and how to use Naloxone
  • Community messaging on where to find support or treatment for behavioral health and substance use disorder
  • Drug disposal or safe drug storage programming
  • Programs to promote linkage to care for substance use disorder
  • Partnering with other relevant community stakeholders, faith-based organizations, and non-profits

Resources: Opioid Overdose Prevention Toolkit, Public Health and Safety Team (PHAST) Toolkit, LHD Opioid Prevention and Response: A How-To Guide, Opioid Epidemic Toolkit 2021, Opioid and Substance Use Disorder Toolkit, Drug Overdose Prevention Tacklebox, CDC Stop Overdose Campaign, Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United StatesOverdose Response and Linkage to Care: A How-To Guide

These resources provided by the Indiana Department of Health may be beneficial in gathering information about the current vulnerability of your specific region.

Tools and Data: Indiana Drug Overdose Dashboard, Naloxone Administration Heat Map, NextLevel Recovery Data Dashboard, Stats Explorer

Evaluation

Evaluation Framework

Evaluation allows public health professionals to assess and enhance the work they are doing. The CDC has created an evaluation framework for public health professionals to help guide in this process. The program is composed of six steps that are aimed as a starting point for tailoring evaluation to a particular effort.

Steps in Program Evaluation:
  1. Engage Stakeholders
  2. Describe the program
  3. Ensure use and share lessons learned
  4. Focus the evaluation design
  5. Gather credible evidence
  6. Justify conclusions

There are several types of evaluation including formative, process, outcome, and impact. When evaluating a program, a logic model, or a visual presentation of shared relationships among resources, activities, outputs, and outcomes or impacts, may focus the evaluation and present the impact that a program or effort has had on the community.

Example: Overdose Response Logic Model

Due to the quick and ever-changing nature of overdose events across communities, it is critical that communities evaluate and reassess their overdose spike response plan. When an overdose spike occurs, communities may need to update and adapt their response plan as new information is received. Ultimately, evaluating your overdose response should help answer how well you achieved your intended goals and outcomes as well as what future improvements can be made. Continued improvement of the overdose response plan not only ensures that a community is prepared for an overdose spike, but that they are able to quickly identify and respond when one occurs. The resources below may be helpful in supporting the evaluation of your overdose spike response.

References

ASTHO. (2020). Responding to an Overdose Spike: A Guide for State Health Departments. ASTHO. https://astho.org/Responding-to-an-Overdose-Spike-Guide/

CDC – NSSP – What is Syndromic Surveillance? https://www.cdc.gov/nssp/overview.html

NACCHO. (2021). Overdose Spike Response Framework for Communities and Local Health Departments. NACCHO. https://www.naccho.org/uploads/downloadable-resources/OVERDOSE-SPIKE-RESPONSE-FRAMEWORK-FOR-COMMUNITIES-LHDS.pdf