Describe the Event

Last Updated: March 2022

There are several questions to consider when defining and finding cases.  

• Are there certain characteristics or circumstances that increase risk of overdose in this event?
  • The State Unintentional Drug Overdose Reporting System (SUDORS) captures key variables that identify key risk and protective factors of overdose deaths. 

• Which specific drug(s) have been involved in the overdose incident?
  • This may not be reliably available from death certificates because ME/C may list only one contributing drug, all drugs that are noted on toxicology reports, or no specific drug at all (e.g., “multi-drug toxicity”). Post-mortem toxicology testing results provide the most in-depth information about substances involved in an overdose.

• Do prescription drug histories of decedents indicate if prescription drugs were being misused prior to death?
  • Useful resource: Contributions of prescribed and non-prescribed opioids to opioid related deaths: population-based cohort study in Ontario, Canada 

• What level of awareness do persons who use drugs have about this overdose event, and what precautionary actions have they taken in response?
  • Useful resource: Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016 

• What is the level of drug use in the affected community? What drugs are being mixed with opioids and how frequently?
  • Useful resources: Polysubstance combinations involving prescription opioids and rationales for combining among people who use internet drug discussion forums, NDEWS – Atlanta Metro Sentinel Community Site , and Ohio Drug Trend Reports 

• What are the clinical characteristics of affected individuals?
  • Consider: Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016.  Is repeated naloxone dosing required? Is there a difference in the number of naloxone administrations by laypersons versus EMS? 

• What drugs did the person think they were using versus what does toxicology show?
  • Recently, there have been large discrepancies between what people may think they are using and what the illicit drug contains (e.g., a person bought counterfeit prescription pills, cocaine, or heroin adulterated with fentanyl). Useful resources: Expected and actual fentanyl exposure among persons seeking opioid withdrawal management, Multiple Fentanyl Overdoses — New Haven, Connecticut, June 23, 2016 , and CDC – Health Alert Network on synthetic opioids. 

• Is there a potential for cases to occur in other states? Is the jurisdiction near the border with another state?
  • If so, engage neighboring states and communities as needed.