States Battle the Devastating Opioid Crisis with Data

The numbers are sobering: In 2016, 48.5 million Americans used illicit drugs or misused prescription drugs, while 197,000 have died from overdoses related to opioids between 1999 and 2016, according to the Centers for Disease Control and Prevention. Here’s another: More than 115 people in the United States are dying every day after overdosing on opioids, according to the National Institute on Drug Abuse.

Like any large-scale epidemic, the nation’s drug problem is a disease and needs comprehensive treatment. To bring such a large epidemic under control, government is using data to stop it from spreading, contain further outbreaks of illicit drug distribution and treat the victims.

One example is the statewide prescription drug monitoring programs, known as PDMPs, that have been active in every state since at least 2017. PDMPs use public and private data and typically take aim at so-called pill mills that churn out prescription opioids, physicians who may not be prescribing legally or accurately and residents who may engage in “doctor shopping” to feed an addiction.

But PDMPs contain private information that is protected by the Health Insurance Portability and Accountability Act and other statutes, and can only be used by certain people for certain purposes, according to Jonathan Caulkins, professor of operations research and public policy at Carnegie Mellon University’s Heinz College. Given the scale of the opioid crisis, a substantial need also exists for informed, accurate and easy-to-follow data at local, county and state levels, said Caulkins, who has studied drug policy for nearly 30 years. The collection of high-impact data has started to happen, with some governments and advisory organizations deploying websites, dashboards, GIS-powered tools and analytics that offer compelling, real-time, easy-to-use information to guide first responders, residents and policymakers alike.

Enhanced State Opioid Overdose Surveillance The Centers for Disease Control and Prevention (CDC) is providing funding to 32 states and the District of Columbia to improve data collection on opioid overdoses. The $11.8 million program will help states to: Establish an early warning system by using data from emergency departments and EMS to detect increases or decreases in non-fatal opioid overdoses. Integrate data from death certificates and unique medical examiner and coroner investigations. Share findings with state and national stakeholders to improve overdose prevention and response efforts. The program, known as Enhanced State Opioid Overdose Surveillance, started in 2016 with 12 states and expanded to include an additional 20 states, plus D.C., and is funded through August 2019. Every four months, participating states report to the CDC overdose data on ER visits and EMS transports; every six months they report critical death-scene investigation information. According to the CDC, the program has scored some early success, such as identifying the dangers of illicitly manufactured fentanyl and developing an effective early warning system about heroin and opioid overdoses that states can refine for their own use.

Caulkins has been part of a study committee advising the Food and Drug Administration on its response to pain management and opioid epidemic problems. “This is a massive problem that we have been cluing in to quite slowly, but have been over the last number of years, so there are efforts at all sorts of levels to do many things in response,” he said. “Naturally, people want to be grounded in evidence and data. And then, people are trying to fill that need.”

Indiana Leverages Its Hub

Indiana is among the states mounting a response to the opioid epidemic, and is using its Management Performance Hub (MPH) to develop dashboards for key statewide opioid-related data sets on topics ranging from emergency medical services (EMS) runs, arrests and deaths to emergency room visits and prescription information.

A popular data visualization is its naloxone heat map, which shows where the overdose treatment drug has been administered in communities and neighborhoods. Representatives of the state and governor’s office said the map highlights the value of local input and motivates them to get residents and officials from all levels more involved. Indiana is also using the OpenBeds platform, which links emergency rooms and treatment facilities and provides public-facing access via 211, a free and confidential call center for human services, to maximize treatment awareness and generate overdose data for MPH. 

The state also has mandatory toxicology testing when an overdose is the likely cause of death, and has expanded this data collection from pilot to test phase with state funding. Both projects have further enabled the flow of information and improved data quality. MPH has also used data to suggest locations for new opioid treatment programs.

Like earlier data work in the areas of education and workforce, MPH’s opioid endeavors benefited from the state strategy of linking information in the background, at the record level, a practice that Tim George, director of policy for Gov. Eric Holcomb, called “the more exciting piece.” He recommended establishing a centralized data hub and cementing top-down buy-in as vital early steps for agencies contemplating the use of technology to counter opioid abuse. 

MPH was also aided in this area by a statute that facilitates data sharing by enabling the hub to act as an agent for the agency whose data it uses. MPH abides by that agency’s data regulations and restrictions while enabling real-time data, said Josie Fasoldt, director of engagement and analytics for Indiana’s Department of Health and Human Services.

“I think one of the really great things that comes out of record linkage is that we can really now start to ask questions about the gaps in our services,” she said. “We can just start asking a lot more detailed questions and we can start visualizing.”

Massachusetts Emphasizes Longitudinal Data

The state of Massachusetts has been hit especially hard by the epidemic, with its opioid death rate surpassing the national average. In response, the Massachusetts Department of Public Health (MDPH) has studied the opioid epidemic closely, following an authorization by Gov. Charlie Baker via Chapter 55 of the Legislative Acts of 2015, and has issued two reports in 2016 and 2017 based on its opioid overdose studies. The work has “expanded the understanding of several root causes of the opioid epidemic,” MDPH Commissioner Monica Bharel said in an email. Based on the studies’ findings, officials and lawmakers gathered in a working group to create an action plan with initiatives in prevention, intervention, treatment and recovery support, and have produced data visualization charts that document the widespread impacts of the problem.

Data has been crucial to the state’s efforts to reduce substance abuse and overdose deaths. Collectively, the information “supports MDPH in studying how individuals interact with various parts of the public service system, which provided new understanding about the lives, experiences and risk factors of these populations and also revealed opportunities (or missed opportunities) for intervention,” Bharel said. A hallmark of the Chapter 55 database was its use of longitudinal data that has given MDPH a long-term view of data and outcomes. The commissioner emphasized the importance of establishing a clear vision for the work, maintaining a solution-focused orientation, and fielding a multidisciplinary team with strong relationships and leadership.

The Massachusetts Health Officers Association (MHOA) added an Opioid Toolkit to its website in June that grew out of an earlier version designed to empower local health departments. Funded by MHOA and block grant funding through MDPH, it assists local government in a state where health departments are significantly decentralized. The toolkit, completed in partnership with LiveStories, a private civic data hub, helps local agencies build their own response to the opioid problem. It offers 10 essential services around opioid-related activity, founded on best practices recommended by local officials, ranging from “diagnose and investigate” to “mobilize community partnerships,” each with links to further data and support.

The project was a priority for MHOA’s immediate past president, Derek Fullerton, who emphasized how the scale of the epidemic in his state — where roughly one in four people knows someone who has died from an overdose — underscored the urgency of the need. “The reality is, with the toolkit, with the opioid epidemic, there’s no one answer. Every community is doing something different, but every community, if they can collectively plan, they can connect the dots with one another,” said Fullerton, who is now the chief health strategist-director of public health for the town of Middleton, Mass. Typical hurdles center on staffing, and identifying personnel who can shepherd data from interpretation through building to display and visualization, he explained.

Pennsylvania Focuses on the Future

Pennsylvania’s online response to the opioid epidemic grew in the spring of 2018 and features several components founded on PDMP prescriber data along with information on ER visits, naloxone use and EMS activity. The state has produced a map of treatment centers, information on naloxone, county-level resources and drug take-backs, as well as a link to the Pennsylvania Opioid Data Dashboard, which features prevention, rescue and treatment as well as county information and statistics down to the number of annual opioid dispensations per 1,000 people.

Gov. Tom Wolf declared a medical emergency for the state’s opioid crisis earlier this year. The move helped counter agency limitations to free up data sharing while bringing on statewide support. For example, the state’s opioid operational command center meets weekly and consists of representatives from 14 state agencies and the governor’s office who share data and strategize. Among the state’s areas of response, its Overdose Information Network (ODIN) and the opioid dashboard both debuted in March.

All aspects of Pennsylvania’s online response are fairly equally utilized and there’s no clear standout in popularity, according to April Hutchison, state communications director. But the initiative has reminded officials that, while the most-visited statistic would likely always be the number of people that have died as a result of the epidemic, the state focuses on the future: on residents battling the disease, getting treatment, being saved and getting sober; and on its message to young people not to start on these medications, she said.

“We’ve seen an 88 percent rate of transport for someone who has been revived [by] naloxone and that’s a good statistic. So, you need to also look at that, that rescue is working. It also helps you drive where your prevention efforts need to go,” Hutchison said, noting that the dashboard has become not just a hub offering a wider perspective but a way for officials to judge the impact of their initiatives and identify where a larger response is needed. Going forward, the state will partner with the University of Pittsburgh’s Graduate School of Public Health to utilize predictive modeling to identify potential areas of outbreak and at-risk populations, Hutchison said.