1. 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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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: 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

9. Division of Disease Control and Health Protection

10. Division of Disease Control and Health Protection

11. 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

12. 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

13. 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

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

15. Chief complaint: heroin
Division of Disease Control and Health Protection

16. Division of Disease Control and Health Protection

17. Division of Disease Control and Health Protection

18. Division of Disease Control and Health Protection

19. 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

20. Division of Disease Control and Health Protection

21. Division of Disease Control and Health Protection

22. 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

23. 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

24. Division of Disease Control and Health Protection
Contact Information:
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