Tracking the Opioid Outbreak

By Khadar Abdi

Opioids and derivatives are commonly prescribed in a hospital setting for chronic pain. The liberal prescription of these drugs is a contributing factor in the rapid increase in overdoses in the last 10 years, and this trend can be seen locally. Vermont is a state with high opioid-related overdoses per capita for drugs like fentanyl and heroin. Combating our opioid problem has been difficult without a way to track the outbreak. An article from Moore et al. tackles this issue by retrospective analysis, looking at data from the Chicago, Illinois fentanyl and heroin epidemic from September to October 2015. This research looks at three surveillance systems: Emergency Medical Service (EMS) responses, Medical Examiner (ME) document reports, and Poison Center calls.

The goal of the study was to find which system most accurately reflected the outbreak. Each system had its own requirements for documenting an opioid overdose. EMS requirement for opioid overdose is whether there was a use of Naloxone, an opioid antagonist drug that can prevent opioid overdoses and overdose symptoms. Symptoms include constricted pupils, unconsciousness, and lack of breathing. ME’s data was selected based on known deaths in Cook County, IL caused by fentanyl and/or heroin overdose. And Illinois Poison Center data looked at all calls related heroin and fentanyl poisoning.

Out of these three surveillance systems, Moore et al. demonstrate that EMS responses is the best way to reflect opioid activity. In general, it was found EMTs had the most exposure to the opioid epidemic field and more rapid response to the crisis. However, the ME’s reports were also important for providing information about the severity of specific cases within the outbreak, as well as confirming the level of opioid activity. On the other hand, Poison Center showed no increase of activity.

Overall, the study established the importance of data collection for understanding and responding to the outbreak. It should be noted that creating metrics for opioid abuse and overdose are retroactive approaches to ameliorating an addiction crisis as an ideal system would introduce addiction prevention resources concurrent with outbreak data. However, research by Moore et al. provides necessary information for taking more effective steps to reduce opioid addiction in the US.

Though the test was limited to Chicago, IL, a similar study could be done in Vermont. Organization such as the University of Vermont Medical Center can track the opioid outbreak by recording response rates from opioid overdose. These studies can lead to improvement of developing programs for rapid response to drug overdoses in Vermont.

References

Moore, P. Q., Weber, J., Cina, S., & Aks, S. (2017). Syndrome surveillance of fentanyl

laced heroin outbreaks: utilization of EMS, Medical Examiner and Poison Center databases. The American Journal of Emergency Medicine.