A Novel Surveillance System for Detecting an Increase in Non-Fatal Overdoses in Allegheny County, PA

In 2013, 17,000 Americans died from opioid overdose. Nationwide, heroin overdoses has become a major public health problem. In Allegheny County, PA, overdoses in which heroin was found at autopsy increased from 90 in 2002 to over 300 in 2013. During January of 2014 alone, 15 individuals died from overdoses due to a combination of heroin and fentanyl.  As the problem grows, surveillance is critical to prevent further mortality. However, there are challenges to monitoring overdose activity given the limitations of data sources (hospital emergency department (ED) visits, deaths).

One potential source of surveillance data is Naloxone administration by emergency medical services (EMS). This information is currently reported to the Pennsylvania Department of Public Health (PADOH). Naloxone (or narcan) is administered to counteract the effects of opioid overdose but also used when patients are found obtunded. Since February 2014, the Allegheny County Health Department (ACHD) has been receiving daily surveillance data on Naloxone administration (including zip code of administration) from PADOH.

To assess the specificity and predictive value of monitoring EMS administration of Naloxone, we correlated time-constrained administration of Naloxone with ED chief complaints of overdose from our syndromic surveillance system. Correlation coefficients ranged from R=0.67 (p<0.01) to R=0.52, indicating a positive relationship between administration of Naloxone and ED admissions for overdose. ACHD will continue to monitor these systems and assess the value of temporal and spatial surveillance for overdose in order to proactively alert our community partners about sudden increases in apparent overdoses.