Division of Disease Control and Health Protection Drug Overdose Surveillance in Florida Using Death Record, Poison Control, and Emergency Department Data David Atrubin, Florida Department of Health International Society for Disease Surveillance Opioid Webinar Series 3 July 27, 2017 Division of Disease Control and Health Protection

Division of Disease Control and Health Protection Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE-FL) Infectious disease surveillance (outbreak detection, situational awareness, case identification, trend analysis, special event surveillance, post-storm surveillance) Over 300 statewide users in 67 counties, hospital infection preventionist (IP) users too Ad hoc requests for injury data (fireworks near July 4th, drug use data when activity increases) Division of Disease Control and Health Protection

ESSENCE-FL Data Sources Emergency Department (ED)/Urgent Care (UC) Data 245/250 EDs, 58/~910 UCs, data: daily or every 2 hrs chief complaint, discharge diagnosis, triage note Florida Poison Information Center Network (FPICN) Data 3 centers covering the state, data: every 20 minutes major and minor substance categories, exposure and information calls Bureau of Vital Statistics Mortality Data All deaths occurring in FL; 202,000 in 2016 Data: once per day, delays can be 6-7 months when toxicology is pending Division of Disease Control and Health Protection

Other ESSENCE-FL Data Sources Reportable disease data Disaster Medical Assistance Team (DMAT) data when operational Weather data Air quality data Division of Disease Control and Health Protection

Drug Use Surveillance ESSENCE-FL Data Sources ED/UC Visits Poison Control Calls Death Records Division of Disease Control and Health Protection

Previous Use of ESSENCE-FL for Drug Use Surveillance Flakka (bath salt derivative) Spice (cannabinoid receptor) Opioids/heroin/cocaine Alcohol Division of Disease Control and Health Protection

Division of Disease Control and Health Protection Florida Fusion Center Collaborative effort of local, state, and federal partners using an all-hazards approach to public safety with an emphasis on crime and terrorism prevention and control Division of Disease Control and Health Protection

Division of Disease Control and Health Protection The Flakka Queries ED/UC Data ^flakka^,or,^flaka^,or,^flacka^,or,^flaca^,or,^flacca^ Poison Control Calls ^flakka^,or,^flaka^,or,^flacka^,or,^flaca^,or,^flacca^; Pois Code: 7917771 Death Record Data ^flakka^,or,^flaka^,or,^flacka^,or,^flaca^,or,^flacca^,or,^alpha- pvp^,or,^alpha-pyrro^ Note: “flocka” spelling in ED data identified late Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection Poison Control (FPICN) Flakka Calls by County, June 2015 – Sept 2015 (n=91) County Frequency Percent Broward 60 65.9% Palm Beach 8 8.8% Miami-Dade 7 7.7% Martin 3 3.3% Collier 2 2.2% Indian River Volusia Bay 1 1.1% Bradford Hernando Highlands Hillsborough Okaloosa St Lucie Total 91 100.0% Division of Disease Control and Health Protection

Presenting Syndromic Drug Use Data Case definition vs. syndrome definition Good labeling of graphs, tables, axes Caveats/disclaimers Multiple data sources showing similar trends/concordance are useful Division of Disease Control and Health Protection

CDC Heroin Overdose ED Query ChiefComplaints  ^,andnot,^denies her[io][oi]n^,andnot,^deny her[io][oi]n^,andnot,^denied her[io][oi]n^   CC and DD (,^narcan^,or,^naloxo^,or,^poison^,or,^[ao]verdose^,or,^over dose^,or,^overose^,or,^sobredosis^,or,^nodding^,or,^ nod ^,or,^snort^,or,^adverse rxn^,or,^adverse reaction^,or,^adv effect drug^,or,^adverse effect drug^,or,^drug reaction^,or,^adverse drug^,or,^in[gj]est^,or,^intoxic^,),and,(,^her[io][oi]n^,or,^ hod ^,or,^speedball^,or,^speed ball^,or,^dope^,or,^spheroin^,),or,^[;/ ]T40.1X1A^,or,^[;/ ]T401X1A^,or,^[;/ ]T40.1X4A^,or,^[;/ ]T401X4A^ Division of Disease Control and Health Protection

Florida’s Heroin ED Data Query ^heroin^,or,^herion^,or,^heriun^,or,^heruin^ Division of Disease Control and Health Protection

Chief complaint: heroin Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection source: Miniño, A. Coding and classification of causes of death in accordance with the Tenth Revision of the International Classification of Diseases. CDC Powerpoint slide downloaded 7/10/17. Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Division of Disease Control and Health Protection

Data Disclaimers/Caveats Do you have complete data? Are the updates complete? Are the data collected/sent in the same way? Were toxicology tests done? Have the data changed over time? How was the query structured? Division of Disease Control and Health Protection

Division of Disease Control and Health Protection Presenting Your Data The disclaimers will be different for your different data sources. Communication of the data needs to address all of this. Is the communication understandable? Division of Disease Control and Health Protection

Division of Disease Control and Health Protection Contact Information: david.atrubin@flhealth.gov Acknowledgments Alan Mai Janet Hamilton Mike Wiese Toni Hudson Ben Klekamp Allison Culpepper Sam Prahlow Scott Bowden Johns Hopkins University Applied Physics Laboratory Division of Disease Control and Health Protection