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Michigan system for opioid overdose surveillance
  1. Jason Goldstick1,2,
  2. Amanda Ballesteros1,2,
  3. Carol Flannagan2,3,
  4. Jessica Roche1,2,
  5. Carl Schmidt4,
  6. Rebecca M Cunningham1,2
  1. 1 Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
  3. 3 Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
  4. 4 Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jason Goldstick, Emergency Medicine - Injury Prevention Center, University of Michigan, Ann Arbor, MI 48109, USA; jasoneg{at}umich.edu

Abstract

Community rapid response may reduce opioid overdose harms, but is hindered by the lack of timely data. To address this need, we created and evaluated the Michigan system for opioid overdose surveillance (SOS). SOS integrates suspected fatal overdose data from Medical Examiners (MEs), and suspected non-fatal overdoses (proxied by naloxone administration) from the Michigan Emergency Medical Services (EMS) into a web-based dashboard that was developed with stakeholder feedback. Authorised stakeholders can view approximate incident locations and automated spatiotemporal data summaries, while the general public can view county-level summaries. Following Centers for Disease Control and Prevention (CDC) surveillance system evaluation guidelines, we assessed simplicity, flexibility, data quality, acceptability, sensitivity, positive value positive (PVP), representativeness, timeliness and stability of SOS. Data are usually integrated into SOS 1-day postincident, and the interface is updated weekly for debugging and new feature addition, suggesting high timeliness, stability and flexibility. Regarding representativeness, SOS data cover 100% of EMS-based naloxone adminstrations in Michigan, and receives suspected fatal overdoses from MEs covering 79.1% of Michigan’s population, but misses those receiving naloxone from non-EMS. PVP of the suspected fatal overdose indicator is nearly 80% across MEs. Because SOS uses pre-existing data, added burden on MEs/EMS is minimal, leading to high acceptability; there are over 300 authorised SOS stakeholders (~6 new registrations/week) as of this writing, suggesting high user acceptability. Using a collaborative, cross-sector approach we created a timely opioid overdose surveillance system that is flexible, acceptable, and is reasonably accurate and complete. Lessons learnt can aid other jurisdictions in creating analogous systems.

  • surveillance
  • epidemiology
  • descriptive epidemiology
  • drugs
  • poisoning

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Footnotes

  • Contributors JG was responsible for the overall direction of the SOS project as Co-PI, led the evaluation of the surveillance system, and led the drafting of the manuscript. AB runs the SOS project as the project manager, conducted the data analyses required for the evaluation, directs the data abstraction conducted by SOS staff for the system, and critically reviewed and revised the manuscript. CF directs the computational team that oversaw the creation of the SOS data system and web-based dashboard, and critically reviewed and revised the manuscript. JR collaborated on all aspects of the SOS project as Managing Director of the U-M Injury Prevention Center—most notably creation and analysis of materials for the stakeholder engagement projects in Washtenaw, Wayne, and Genesee County—and critically reviewed and revised the manuscript. CS aided with the development of the ME data abstraction protocol, and has provided help throughout in ascertainment of suspected overdoses, and also critically reviewed and revised the manuscript. RMC was responsible for the overall direction of the SOS project as Co-PI from its inception and contributed to all aspects of the project; she also critically reviewed and revised the manuscript.

  • Funding Research reported herein was supported by a grant to the University of Michigan Injury Prevention Center by the Centers for Disease Control and Prevention Award Numbers R49-CE-002099 and R49CE003085, by a grant to the Michigan Department of Health and Human Services from the Centers for Disease Control and Prevention, Number NU90TP921987, and by a grant to the Washtenaw County Health Department from the National Association of County and City Health Officials, Number 6NU38OT000306-01.

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  • Competing interests None declared.

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