Background In response to the growing prescription drug overdose (DO) epidemic in the U.S., an Injury Surveillance Workgroup on Poisoning (ISWP) released Consensus Recommendations for National and State Poisoning Surveillance in April 2012. The ISWP proposed standardised tools to conduct and improve DO surveillance.

Methods The Council of State and Territorial Epidemiologists (CSTE) formed an Overdose Subcommittee (OS) to raise CSTE membership awareness of DO deaths and to test the proposed DO indicators before they were widely adopted as surveil­lance tools.

Results The CSTE OS aims and results have been discussed during monthly calls opened to all CSTE members. Several major projects were completed with voluntary participation from CSTE OS members. Analysis of death certificate (DC) data in 11 jurisdictions revealed variations in completeness and specificity of the drug-related information (e.g., DO death rates not contributed to any drug varied from 0/100,000 in New York City to 7.4/100,000 in Kentucky). A study using toxicology and DC data found that drug-specific sensitivity on DCs in three jurisdictions varied widely (23%–92% benzodiazepines, 61%–92% heroin, 91%–100% opioid analgesics). New epidemiological tools for DC data analysis were developed. Several jurisdictions worked successfully with medical examiners/coroners to improve completeness and specificity of drugs listed on DCs. The CSTE findings were presented at national conferences, published in papers, and informed the development of national guidelines for state special emphasis reports on DO death data.

Conclusions The CSTE OS work is an ongoing learning process that already improved the DO mortality surveillance methodology and standardisation, increased the epidemiological capacity for DO reporting and data quality improvement at state and local levels, and strengthened the collaborations among epidemiologists from different jurisdictions.