Interview individuals who:

• Have survived a nonfatal overdose
• Regularly use substances
• Have witnessed an overdose

Ask about:

• Changes in drug appearance or potency
• Where and how substances were obtained
• Polysubstance use
• Naloxone use and response
• Recent changes in drug supplier

Tip: Use trauma-informed interviewing practices and ensure participant confidentiality. Community-based organizations that serve people who use drugs may be helpful in facilitating trust and access.

Laboratory testing helps detect emerging drug threats and inform outbreak response. Two complementary approaches – biological specimen testing and drug product testing – provide critical intelligence about substances circulating in your jurisdiction. 

Testing of Nonfatal Overdoses (Bio surveillance) 

• • Want to know more about participating in your jurisdictional OD2A biosurveillance 
  • Check with your state health laboratory on jurisdictional regulation for overdose as a reportable disease

Note: Focus testing at the public health level, not clinical level, as results often don’t inform immediate treatment 

Want to know more about Biosurveillance? 

Email: od_lab_surveillance@cdc.gov 

Testing of Drug Products and Paraphernalia 

Drug product testing helps capture supply changes through analyzing substances submitted by people who use drugs within specific communities. 

• Leverage existing OD2A toxicology testing of drug product and paraphernalia programs or explore participation opportunities 
• Partner with community organizations and laboratories conducting drug checking 
• Coordinate for safe collection and interpretation of drug product and paraphernalia samples 
• Examples: JAMA xylazine detection | Philadelphia HAN | Chicago alert

Want to know more about OD2A drug product and paraphernalia testing? 

Email: od2altest@cdc.gov  

Postmortem Testing 

• Work with ME/C offices to ensure comprehensive testing for all suspected overdose deaths 
• Connect with ME/C offices with professional organizations like SOFT to align testing with current standards 

Note: Postmortem testing should not be the primary method for initially detecting emerging threats. 

Analyzing and Monitoring Data 

• Integrate toxicology data from multiple sources (biological specimens, drug products, postmortem) 
• Track changes over time in population-level toxicology results and drug product/paraphernalia testing to establish baseline patterns 
• Analyze postmortem results to identify populations at increased risk from emerging and re-emerging drug threats 
• Use historical patterns to inform alert thresholds and public health messaging

Legal Considerations 

Be aware of consent requirements, privacy protections, chain of custody protocols, and state/local regulations. Consult your health department’s legal counsel for specific guidance. 

Want to know more about OD2A drug product and paraphernalia testing? 

Email: ODSurveillance@cdc.gov  

Partners offer frontline insights into emerging trends. Interview:

• Persons who use drugs and people in recovery
• Syringe services and harm reduction program staff
• Law enforcement and first responders
• Emergency department clinicians and EMS providers
• Medical Examiners or Coroners
• Drug treatment providers

Walkthroughs of areas experiencing high overdose rates can help clarify structural and environmental risks. During visits, assess:

• Access to syringe service programs
• Availability of treatment and behavioral health services
• Housing availability
• Public transportation options
• Presence and engagement of community-based organizations
• Location of naloxone and test strip distribution

Use this information to inform response design and identify gaps in services.

Based on your findings, develop a list of potential causes and risk factors, such as:

• A change in the local drug supply (e.g., fentanyl contamination, counterfeit pills)
• Increase in polysubstance use (e.g., stimulants and opioids)
• Changes in prescribing practices or sudden treatment disruptions
• Untreated mental health or substance use disorders
• Structural or environmental changes (e.g., displacement, seasonal shifts)

Resource Highlight: The Association of Public Health Laboratories’ Model Opioids Biosurveillance Strategy offers guidance for developing a sustainable drug biosurveillance program.

Use laboratory testing and forensic data to confirm drug composition and detect novel substances.

• Collaborate with public health, clinical, or forensic labs for comprehensive drug testing
• Leverage federal resources:
  • DEA Emerging Trends Program
  • CDC Traceable Opioid Material® Kits (TOM Kits®) for standard comparisons
  • National Drug Early Warning System (NDEWS) for emerging trends and signals

These resources help confirm what’s circulating locally and how it compares to broader trends.