On average, 115 people die from a drug overdose in the United States every day. It’s the leading cause of death for individuals under the age of 50. In the past, drug addiction was historically associated with poor, urban communities driven in many respects by a lack of treatment and mental health services. But the face of addiction has changed, and drug abuse has expanded into what many view as a proliferation in distribution practices for prescription opioids – fentanyl being among the most notorious examples.
Are we drowning in drug abuse? Statistically, it appears so: According to data from the Substance Abuse and Mental Health Services Administration, there are more than 2.1 million Americans with opioid use disorder. Three out of four individuals who used heroin in the past year report misusing prescription opioids first, making an argument that the prescription pad has become the modern day gateway drug.
But nationally, we are implementing some positive policies to push back against this crisis. Step by step, we are coming to a better understanding of the depth and breadth of opioid abuse. First, this understanding requires context:
The emergence of synthetic opioids like fentanyl, which is up to 100 times more lethal than heroin, is bringing this epidemic to a crisis point. Fentanyl and its derivatives are being manufactured in illicit labs overseas and distributed throughout the U.S. in increasing quantities. Sixty-six percent of the fatal overdoses reported in 2016 were attributed to fentanyl – and in Maryland alone, we have seen a 5,403 percent increase in fentanyl related deaths from 2012 to 2017. Our state reported more than 1,500 fentanyl-related deaths last year.
The increase in the number of individuals suffering from opioid use disorder and the availability of deadly synthetics, including this extremely dangerous drug, necessitate new, innovative and collaborative strategies to protect our families, friends, and neighbors.
One bright spot – and it’s an important one – is that there has been a significant reduction in opioid prescriptions. While this will have a positive impact in the long term, for the time being it has led to the unintended consequence of driving those who suffer from opioid use disorder to break the law in order to access opioids.
Additionally, state and local governments have worked to make naloxone and other overdose reversal drugs available in our communities. They have paved the way to increase naloxone dispensing from pharmacies, and in many communities they are requiring and training first responders to administer the drug in the field during a suspected overdose. Presumably, we will see a reduction in fatal overdoses, but perhaps not overdoses in general. In other words, this kind of progress may create a false sense of accomplishment when it comes to this crisis.
A better strategy
Currently, many jurisdictions lack real-time overdose data. Often, they only track fatalities after confirmation of an overdose by toxicology, which may take weeks or even months. Records related to overdose data collected by fire and EMS are not routinely shared with law enforcement or public health. Efforts are under way to connect real-time data about overdose cases with relevant public-health and -safety agencies. We simply must develop a better strategy, so that we can save more lives.
The Washington/Baltimore High Intensity Drug Trafficking Areas (W/B HIDTA) program, housed within the Center for Drug Policy and Enforcement at the University of Baltimore, developed the Overdose Detection Mapping Application Program (ODMAP). ODMAP provides real-time overdose surveillance data across jurisdictions to support public safety and health efforts, which in turn mobilizes an immediate response to a spike in overdoses. This is a mobile tool, used in the field by first responders on any mobile device or data terminal connected to an agency’s computer system, or through an application/programming interface linking a native data system to ODMAP. Updates on overdose counts, including locations, can take place within seconds.
The system, designed with analytical tools to assist local agencies in spotting trends and patterns within their jurisdictions, also shows data linkages across county jurisdictions. This can serve as an early warning system for officials in areas that are impacted by the same supply of drugs.
The data also can support active police investigations, while giving public and behavioral health experts the information they need to target treatment and prevention efforts. To support the implementation and use of ODMAP, the program developed the Overdose Spike Response Framework, which serves as a guide for establishing a local spike response team and a plan.
ODMAP is now in use in more than 700 agencies in 38 states, including Maryland. During the 2018 legislation session, the Maryland General Assembly passed a bill introduced by Gov. Larry Hogan: HB 359 — “Reporting of Overdose Information.” This legislation requires statewide overdose data reported through EMS to be shared with ODMAP. Soon, Maryland will be the first state in the nation to have a complete data set available in real time – while overdoses are occurring – so that our public health and safety officials may better respond to the opioid epidemic.
We expect ODMAP to become the national platform for accurate, up-to-the-minute overdose surveillance.
Will tracking data end the opioid crisis? No. No single effort by law enforcement, public health officials or the pharmaceutical industry itself will get us through this dangerous time. But step by step, state by state, case by case, we are recovering from this tragedy. As we progress, we are discovering that the scope of an epidemic like this demands new, innovative ways of responding. Understanding is where it starts. Sharing what we’ve learned – that’s where it leads.
Jeff Beeson is deputy director of the Center for Drug Policy and Enforcement in the University of Baltimore’s College of Public Affairs. His email is email@example.com.