Biosurveillance of Drug Overdoses and Substance Misuse Treated in Selected Emergency Departments in Minnesota, 2017-2020

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 87S-95S
Author(s):  
Terra Wiens ◽  
Elisabeth Bilden ◽  
Stefan Saravia ◽  
Jason Peterson ◽  
Matthew Wogen ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Substance Misuse ◽  
Situational Awareness ◽  
Synthetic Cannabinoids ◽  
Prescription Medications ◽  
Time Data ◽  
Clinical Encounters ◽  
Department Of Health ◽  
Atypical Clinical Presentation ◽  
Drug Overdoses

Objectives Increasing knowledge about the toxicology of drug overdose and substance misuse (DOSM) is important in improving our understanding of the epidemic. We describe the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity, which started collecting data on emergency department (ED) visits attributable to DOSM in 2017, with a focus on the toxicology results of a subset of clinical encounters. Methods From November 1, 2017, through January 30, 2020, we collected near–real-time data on DOSM-related ED encounters. The Minnesota Department of Health Public Health Laboratory tested leftover clinical specimens (blood and/or urine) for the presence of various substances for patients who died, were hospitalized, had an atypical clinical presentation, or were part of a local drug overdose cluster. Testing looked for >250 drugs or their metabolites, including those commonly misused (eg, methamphetamine, cocaine), prescription medications, synthetic cannabinoids and cathinones, and opioids. We describe characteristics of the overall group and a subgroup of clinical encounters with toxicology results. Results Specimens submitted from 6 EDs during the study period represented 239 clinical encounters. Methamphetamine was the most frequently detected substance (67.4%) but was suspected in only 45.6% of encounters. At least 1 opioid was detected in 42.5% of encounters but suspected in only 29.7%. Testing also detected potential adulterants and additives (eg, fentanyl, fentanyl analogues, levamisole) and showed frequent patient exposure to substances not reported by patients or suspected by clinicians. Nearly half (44.4%) of clinical encounters had >1 substance detected. Conclusions ED surveillance for DOSM encounters, enhanced by toxicology testing, can provide local situational awareness on overdoses, prevent potential mischaracterization of the true drug overdose epidemic, and inform harm reduction and drug overdose prevention efforts.

Accuracy of Medical Examiner’s Assessment for Near–Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017–February 2018

2021 ◽  
pp. 003335492110084
Author(s):  
Kirsten Vannice ◽  
Julia Hood ◽  
Nicole Yarid ◽  
Meagan Kay ◽  
Richard Harruff ◽  
...  
Keyword(s):  
Public Health ◽  
Positive Predictive Value ◽  
Real Time ◽  
Negative Predictive Value ◽  
Drug Overdose ◽  
Predictive Value ◽  
Death Certificate ◽  
King County ◽  
Public Health Response ◽  
Drug Overdoses

Objectives Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near–real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring. Methods We analyzed data on deaths in the King County (Washington) Medical Examiner’s Office (KCMEO) jurisdiction that occurred during March 1, 2017–February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs’ classification by using the final death certificate as the gold standard. Results KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event. Conclusions King County MEs’ probable overdose classification provides a near–real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.

scholarly journals The INUS Platform: A Modular Solution for Object Detection and Tracking from UAVs and Terrestrial Surveillance Assets

Computation ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 12
Author(s):  
Evangelos Maltezos ◽  
Athanasios Douklias ◽  
Aris Dadoukis ◽  
Fay Misichroni ◽  
Lazaros Karagiannidis ◽  
...  
Keyword(s):  
Decision Making ◽  
Object Detection ◽  
Situational Awareness ◽  
Machine Learning Techniques ◽  
Measurement Instruments ◽  
Time Data ◽  
Modular Architecture ◽  
Seamless Integration ◽  
Object Detection And Tracking ◽  
Detection And Tracking

Situational awareness is a critical aspect of the decision-making process in emergency response and civil protection and requires the availability of up-to-date information on the current situation. In this context, the related research should not only encompass developing innovative single solutions for (real-time) data collection, but also on the aspect of transforming data into information so that the latter can be considered as a basis for action and decision making. Unmanned systems (UxV) as data acquisition platforms and autonomous or semi-autonomous measurement instruments have become attractive for many applications in emergency operations. This paper proposes a multipurpose situational awareness platform by exploiting advanced on-board processing capabilities and efficient computer vision, image processing, and machine learning techniques. The main pillars of the proposed platform are: (1) a modular architecture that exploits unmanned aerial vehicle (UAV) and terrestrial assets; (2) deployment of on-board data capturing and processing; (3) provision of geolocalized object detection and tracking events; and (4) a user-friendly operational interface for standalone deployment and seamless integration with external systems. Experimental results are provided using RGB and thermal video datasets and applying novel object detection and tracking algorithms. The results show the utility and the potential of the proposed platform, and future directions for extension and optimization are presented.

scholarly journals Mobile health messaging service and helpdesk for South African mothers (MomConnect): history, successes and challenges

2018 ◽  
Vol 3 (Suppl 2) ◽  
pp. e000559 ◽  
Author(s):  
Peter Barron ◽  
Joanne Peter ◽  
Amnesty E LeFevre ◽  
Jane Sebidi ◽  
Marcha Bekker ◽  
...  
Keyword(s):  
Pregnant Women ◽  
South African ◽  
Mobile Health ◽  
Health Workers ◽  
Digital Health ◽  
Universal Coverage ◽  
Text Messages ◽  
Time Data ◽  
Department Of Health ◽  
Early Decision

MomConnect is a flagship programme of the South African National Department of Health that has reached over 1.5 million pregnant women. Using mobile technology, MomConnect provides pregnant and postpartum women with twice-weekly health information text messages as well as access to a helpdesk for patient queries and feedback. In just 3 years, MomConnect has been taken to scale to reach over 95% of public health facilities and has reached 63% of all pregnant women attending their first antenatal appointment. The helpdesk has received over 300 000 queries at an average of 250 per day from 6% of MomConnect users. The service is entirely free to its users. The rapid deployment of MomConnect has been facilitated by strong government leadership, and an ecosystem of mobile health implementers who had experience of much of the content and technology required. An early decision to design MomConnect for universal coverage has required the use of text-based technologies (short messaging service and Unstructured Supplementary Service Data) that are accessible via even the most basic mobile phones, but cumbersome to use and costly at scale. Unlike previous mobile messaging services in South Africa, MomConnect collects the user’s identification number and facility code during registration, enabling future linkages with other health and population databases and geolocated feedback. MomConnect has catalysed additional efforts to strengthen South Africa’s digital health architecture. The rapid growth in smartphone penetration presents new opportunities to reduce costs, increase real-time data collection and expand the reach and scope of MomConnect to serve health workers and other patient groups.

scholarly journals Understanding Fatal and Non-Fatal Drug Overdose Risk Factors: Overdose Risk Questionnaire Pilot Study—Validation

2021 ◽  
Vol 12 ◽  
Author(s):  
Radhouene Doggui ◽  
Keyrellous Adib ◽  
Alex Baldacchino
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Drug Use ◽  
Drug Overdose ◽  
Latent Variables ◽  
Life Stress ◽  
Treatment Seeking ◽  
Latent Factors ◽  
Chronic Drug Use ◽  
Drug Overdoses

Background: Drug overdoses (fatal and non-fatal) are among the leading causes of death in population with substance use disorders. The aim of the current study was to identify risk factors for fatal and non-fatal drug overdose for predominantly opioid-dependent treatment–seeking population.Methods: Data were collected from 640 adult patients using a self-reported 25-item Overdose Risk (OdRi) questionnaire pertaining to drug use and identified related domains. The exploratory factor analysis (EFA) was primarily used to improve the interpretability of this questionnaire. Two sets of EFA were conducted; in the first set of analysis, all items were included, while in the second set, items related to the experience of overdose were removed. Logistic regression was used for the assessment of latent factors’ association with both fatal and non-fatal overdoses.Results: EFA suggested a three-factor solution accounting for 75 and 97% of the variance for items treated in the first and second sets of analysis, respectively. Factor 1 was common for both sets of EFA analysis, containing six items (Cronbach’s α = 0.70) focusing around “illicit drug use and lack of treatment.” In the first set of analysis, Factors 2 (Cronbach’s α = 0.60) and 3 (Cronbach’s α = 0.34) were focusing around “mental health and emotional trauma” and “chronic drug use and frequent overdose” domains, respectively. The increase of Factor 2 was found to be a risk factor for fatal drug overdose (adjusted coefficient = 1.94, p = 0.038). In the second set of analysis, Factors 2 (Cronbach’s α = 0.65) and 3 (Cronbach’s α = 0.59) as well as Factor 1 were found to be risk factors for non-fatal drug overdose ever occurring. Only Factors 1 and 3 were positively associated with non-fatal overdose (one in a past year).Conclusion: The OdRi tool developed here could be helpful for clinical studies for the overdose risk assessment. However, integrating validated tools for mental health can probably help refining the accuracy of latent variables and the questionnaire’s consistency. Mental health and life stress appear as important predictors of both fatal and non-fatal overdoses.

scholarly journals Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns

2019 ◽  
Vol 8 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Gopal K Singh ◽  
Isaac E. Kim, Jr. ◽  
Mehrete Girmay ◽  
Chrisp Perry ◽  
Gem P. Daus ◽  
...  
Keyword(s):  
Pain Management ◽  
Social Determinants ◽  
Drug Overdose ◽  
The United States ◽  
Opioid Epidemic ◽  
The Us ◽  
Drug Overdoses ◽  
Race Ethnicity ◽  
Overdose Mortality ◽  
Racial Ethnic

Objectives: Dramatic increases in opioid and drug overdose mortality have occurred in the United States (US) over the past two decades. To address this national public health crisis and identify gaps in the literature, we analyzed recent empirical trends in US drug overdose mortality by key social determinants and conducted a selective review of the recent literature on the magnitude of the opioid crisis facing different racial/ethnic, socioeconomic, and rural-urban segments of the US population. Methods: We used the 1999-2017 mortality data from the US National Vital Statistics System to analyze trends in drug overdose mortality by race/ethnicity, age, and geographic area. Log-linear regression was used to model mortality trends. Using various key words and their combinations, we searched PubMed and Google Scholar for select peerreviewed journal articles and government reports published on the opioid epidemic between 2010 and 2018. Results: Our original analysis and review indicate marked increases in drug overdose mortality overall and by race/ethnicity and geographic regions, with adolescents and young adults experiencing steep increases in mortality between 1999 and 2017. Our selective search yielded 405 articles, of which 39 publications were selected for detailed review. Suicide mortality from drug overdose among teens aged 12-19 increased consistently between 2009 and 2017, particularly among teen girls. The rise of efficient global supply chains has increased opioid prescription use and undoubtedly contributed to the opioid epidemic. Many other important contributing factors to the epidemic include lack of education and economic opportunities, poor working conditions, and low social capital in disadvantaged communities. Conclusions and Global Health Implications: Our analysis and review indicate substantial disparities in drug overdoses and related mortality, pain management, and treatment outcomes according to social determinants. Increases in drug overdoses and resultant mortality are not only unique to the US, but have also been observed in other industrialized countries. Healthcare systems, community leaders, and policymakers addressing the opioidepidemic should focus on upstream structural factors including education, economic opportunity, social cohesion, racial/ethnic disadvantage, geographic isolation, and life satisfaction. Key words: • Opioids • Drug overdose • Mortality • Pain management • Treatment • Race/Ethnicity • Social determinants • Health disparities Copyright © 2019 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Drug overdose deaths at work, 2011–2016

2019 ◽  
Vol 25 (6) ◽  
pp. 577-580 ◽  
Author(s):  
Hope M Tiesman ◽  
Srinivas Konda ◽  
Lauren Cimineri ◽  
Dawn N Castillo
Keyword(s):  
Drug Overdose ◽  
Negative Binomial ◽  
Occupational Injuries ◽  
Negative Binomial Regression ◽  
Opioid Overdose ◽  
Full Time ◽  
Demographic Groups ◽  
Drug Overdoses ◽  
The Impact ◽  
Overdose Deaths

Drug overdose fatalities have risen sharply and the impact on US workplaces has not been described. This paper describes US workplace overdose deaths between 2011 and 2016. Drug overdose deaths were identified from the Census of Fatal Occupational Injuries and fatality rates calculated using denominators from the Current Population Survey. Fatality rates were compared among demographic groups and industries. Negative binomial regression was used to analyse trends. Between 2011 and 2016, 760 workplace drug overdoses occurred for a fatality rate of 0.9 per 1 000 000 full-time equivalents (FTEs). Workplace overdose fatality rates significantly increased 24% annually. Workplace overdose fatality rates were highest in transportation and mining industries (3.0 and 2.6 per 1 000 000 FTEs, respectively). One-third of workplace overdose fatalities occurred in workplaces with fewer than 10 employees. Heroin was the single most frequent drug documented in workplace overdose deaths (17%). Workplace overdose deaths were low, but increased considerably over the six-year period. Workplaces are impacted by the national opioid overdose epidemic.

Maximising value by using good data to drive good decisions

2016 ◽  
Vol 56 (1) ◽  
pp. 265 ◽  
Author(s):  
Aidan Shields ◽  
Marivic Mirhan ◽  
Emma Stratford
Keyword(s):  
Decision Making ◽  
Data Management ◽  
Situational Awareness ◽  
Operating Cost ◽  
Petroleum Industry ◽  
Problem Analysis ◽  
Time Data ◽  
Data Accessibility ◽  
Good Data ◽  
Management Standards

The industry-wide move towards big data and the digital oilfield is underpinned by good data. This paper outlines a suite of data management standards, systems and processes, and provides examples of how these have led to improved decision making. The approach involved the development of standards and streamlined business processes followed by the implementation of systems focusing on production data accessibility, quality and integration. Accessibility was addressed by making real-time data readily available from multiple devices so users spend more time using data instead of locating it. Quality was improved through the implementation of processes such as operational data validation (ODV) and production allocation (PA). Integration was facilitated so that users could view data from various systems in a single location. The implementation of data management standards, systems and processes led to improved decision making in the areas of external reporting, operating cost, safety, environment, commercial, reservoir management, well surveillance, and situational awareness. In particular, implementation of the ODV process ensured the completeness, accuracy and timeliness of data from reservoir to sales. Furthermore, improved accessibility and integration increased situational awareness, reduced troubleshooting time, and improved problem analysis. While the concept of data management and quality control is not new, the novelty is in the approach of developing robust standards, implementation of systems based on these standards, and creating the supporting business process and culture aligned to what drives value in the organisation. This is easily transferable and adaptable across all facets of the petroleum industry.

scholarly journals Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015

2017 ◽  
Vol 4 ◽  
pp. 233339281772742 ◽  
Author(s):  
Gregory Eigner ◽  
Brian Henriksen ◽  
Philip Huynh ◽  
David Murphy ◽  
Christopher Brubaker ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Drug Overdose ◽  
Monitoring Program ◽  
Place Of Residence ◽  
Department Of Health ◽  
Common Drug ◽  
Drug Classes ◽  
Allen County ◽  
Overdose Deaths

Purpose: To determine the role of opioids in drug overdose deaths in Allen County, Indiana between January 1, 2008, and December 31, 2015. Methods: File review of 418 overdose deaths was performed using Indiana State Department of Health death certificates available through the Allen County Coroner’s Office. Data from autopsy and toxicology reports and coroner-requested prescribing data from Indiana’s Prescription Monitoring Program were reviewed. Cause of death and available data were analyzed to identify patterns and trends related to overdose deaths. Results: Four hundred eighteen drug overdose deaths were identified (336 accidental, 66 intentional, and 16 undetermined). Mean age was 42.5 years, 88.5% were Caucasian, and 68.7% were employed. The majority of deaths occurred at a place of residence (71.4%) and with other people present (57.5% of the time). Depression was the most common comorbidity identified. The most common drug classes identified by toxicology were opioids, followed by benzodiazepines. Significant increases in both heroin (35% of deaths in 2015 versus 8.2% in 2013) and fentanyl (30% of deaths in 2015 versus 2.2% in 2011) were observed. Conclusions: Drug overdose continues to be a significant cause of death in Allen County. The majority of deaths were accidental and in relatively young, employed individuals. Prevention and awareness strategies should be encouraged, given that the majority of overdose deaths occurred at a place of residence with other people frequently present. Additional concerns about patterns of drug use were confirmed with marked increases in both heroin and fentanyl contributing to overdose deaths in the latter part of the study.

Substance misuse disorders on the psychiatric ward

2019 ◽  
pp. 115-122
Author(s):  
Gail Critchlow ◽  
Theodoros Bargiotas
Keyword(s):  
Psychiatric Disorder ◽  
Sexual Activity ◽  
Internet Use ◽  
Substance Misuse ◽  
British Association ◽  
Psychiatric Ward ◽  
Addictive Behaviour ◽  
Department Of Health ◽  
Orange Book ◽  
Primary Focus

The focus of this chapter is the management of substance misuse and addiction on the psychiatric ward in patients who have presented with a psychiatric disorder. Some patients will display other forms of addictive behaviour such as gambling, sexual activity, or Internet use. Where this is not the primary focus, the same principles of broad-based biopsychosocial management apply. There are a number of guidelines available, such as those from the Department of Health (the ‘Orange Book’) and the National Institute for Health and Care Excellence, and prescribing advice, such as the British Association for Psychopharmacology guidelines and The Maudsley Prescribing Guidelines in Psychiatry, that are useful references for the treatment of patients with substance misuse disorders and addiction. This chapter does not seek to replicate this advice, but does include useful and common scenarios that will be encountered on the general psychiatric ward.

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