Possible Explanations About Likely Causes Using Available Data

Conduct qualitative case interviews with individuals who: have witnessed an overdose, have experienced a nonfatal overdose, and who use substances. These interviews can help interviewers identify changes in the environment and risk factors. It’s important to ask questions about overdose and drug use. 

Consider toxicology testing of people misusing drugs, people overdosing seeking medical care, or drug paraphernalia as allowed by state and local law. 

Conduct key stakeholder interviews with persons who use drugs, persons in recovery, harm reduction programs including syringe services programs, law enforcement, Medical Examiners/Coroners, drug abuse treatment providers and emergency department and EMS providers. 

Conduct visits and walkthroughs of areas with high overdose burden to understand the following:  

• Access to syringe services programs 
• Access to treatment for drug use disorder 
• Availability of housing 
• Local transit options 
• Local community-based organizations  

Develop a list of hypothesized causes and risk factors including shifts in the local drug supply, and counterfeit pills, changes in polysubstance use patterns, changes in drug pain reliever prescribing patterns, untreated mental health disorders, and untreated drug use disorders. The Association of Public Health Laboratories’ Model Opioids Biosurveillance Strategy for Public Health Practice provides guidance for public health agencies interested in developing and implementing an effective and impactful drugs biosurveillance program in their jurisdiction.

Test laboratory samples and consider using government forensic laboratories that support law enforcement and can aid with reference materials or reference data on a case-by-case basis. These include the DEA Reference Materials Program and the DEA Emerging Trends Program. The National Drug Early Warning System (NDEWS) incorporates and leverages novel surveillance methods to ensure the early detection of signals of new and emerging drug trends. Their work is disseminated through a number of interactive tools and publications. CDC is expanding the national capability of US laboratories to detect and identify current and emerging drugs through development of Traceable Opioid Material® Kits (TOM Kits®). TOMS Kits® provide testing laboratories with reference standards for compound comparison and confirmation.