Going Beyond Chief Complaints to Identify Opioid-Related Emergency Department Visits: The purpose of this article is to identify heroin- and opioid-related emergency department visits using pre-diagnostic data and demonstrate the value of clinical notes to public health surveillance and situational awareness. 

Development of Text-Based Algorithm for Opioid Overdose Identification in EMS Data: This article describes the development of a text-based algorithm using EMS narrative data to improve timely identification of opioid overdoses, strengthening data readiness and foundational methods needed to support overdose anomaly detection and public health response.

Opioid Surveillance Webinar Series #1: Rapid surveillance of overdose morbidity – Developing case definitions, building queries, and analyzing results: This presentation describes how CDC has partnered with states to develop case definitions for all drug, opioid, and heroin within and outside of the NSSP/ESSENCE system, and lessons learned and things to consider for the rapid surveillance of opioid overdose.

Opioid Surveillance Webinar Series #3: Syndromic Surveillance Case Definition for Monitoring Opioid Related ED visits and Drug Overdose Surveillance Using Death Record, Poison Control, and ED Data: This presentation discusses the development of a standard case definition for opioid abuse/poisoning, applicable in multiple jurisdictions.

Opioid Crisis Trending Topic in the NSSP Knowledge Repository: The Opioid tag page on the Knowledge Repository offers a curated collection of syndromic surveillance case definitions, real-world analyses, and validation studies, focused on emergency department and EMS monitoring of suspected nonfatal and fatal opioid-related overdoses (including fentanyl, heroin, and all-opioid definitions).

Finding Chances to Intervene Before the Fatal Overdose: Linking ED and Mortality Data: This article discusses how the Missouri Department of Health and Senior Services links emergency department (ED) with death certificate mortality data in order to examine the prior medical history of opioid overdose victims leading up to their death.

Opioid Surveillance Webinar Series #2: Challenges and Implications of Postmarketing Surveillance of Prescription Opioids: This presentation addresses the unique challenges of surveillance or prescription opioid abuse and presents data from multiple perspectives on the issues and potential solution. 

Behind the Data, Supporting Sovereignty 

The Great Lakes Inter-Tribal Epidemiology Center (GLITEC) serves thirty-four Tribes and four Urban Indian Organizations across Michigan, Wisconsin, Minnesota, and Chicago.  GLITEC provides critical backend data support while honoring Tribal data sovereignty. GLITEC’s role is to assist and empower Tribes in responding to overdose concerns while respecting each Tribes’ sovereignty and decision-making when it comes to their overdose anomaly response. While GLITEC does not initiate overdose responses, they offer response guidance, prevention, and harm reduction resources, including naloxone and fentanyl test strips, to Tribes. GLITEC further monitors trends using state syndromic surveillance data and are exploring obtaining access to Overdose Detection Mapping Application Program (ODMAP), which is a real-time overdose surveillance tool to facilitate quick response to overdoses. Some Tribes in the region currently utilize ODMAP while others are exploring the option; Tribes may share overdose data with GLITEC if they choose to do so.    

The Oklahoma State Department of Health brings decades of experience and strong partnerships to overdose surveillance, including access to consistent, reliable data from a centralized medical examiner system covering all deaths statewide and the Prescription Drug Monitoring Program (PDMP). They have made significant strides in improving access and timeliness by establishing statewide, electronic Emergency Department (ED) data reported monthly and transitioning inpatient discharge data to quarterly reporting with a cloud-based system. While real-time syndromic surveillance and increased ODMAP uptake across the state remain areas for growth, the state has a strong foundation in place, including collaborations with hospitals, local health departments, and poison control.  The Oklahoma Office of the Chief Medical Examiner is in the process of updating its statewide case management system, making overdose data even more accessible and actionable. By building on these strengths, the department is well-positioned to expand real-time surveillance and support communities across Oklahoma in responding to overdose challenges. 

Connecting the Dots at the Rhode Island Department of Health (RIDOH) 

RIDOH created an Opioid Overdose Integrated Surveillance System (ISS) that pairs Emergency Medical Services (EMS) runs with Emergency Department (ED) visits to track non-fatal overdoses statewide. By merging records using name, date of birth, and de-duplicating to one person per day, the system catches cases that one dataset alone might miss. EMS data arrive within an hour of an overdose and ED data within 48 hours, giving RIDOH a near real-time view of overdose trends. Triangulating data sources helps RIDOH identify hot spots to ensure a more complete picture of opioid overdose, improve early detection of anomalies, and inform tailored response strategies in Rhode Island. 

For more information: https://ridoh-drug-overdose-surveillance-iss-rihealth.hub.arcgis.com/ 

Mapping and Responding to Overdose in Rhode Island 
Rhode Island is divided into 11 overdose regions, each with its own anomaly threshold based on the previous year of data. RIDOH tracks these regions daily and uses a Levels of Response plan to guide the resources deployed and the partners and outreach involved, ranging from alerts for sudden spikes to strategies for sustained high burden. When thresholds are exceeded, RIDOH activates its Overdose Spike Alert Notification System, which alerts local leaders, public safety, healthcare providers, and community partners via email list serv about a sudden increase in non–fatal overdoses. Responses may include expanded outreach, harm reduction efforts, and emergency community meetings. Higher rates of overdose burden in a region warrant a greater response level. For instance, a region with a ‘Sustained High Rate of Overdose Burden’ may involve community partners for increased outreach and convene an emergency community meeting.  This response plan drives timely action and helps integrate overdose anomaly data into real-time public health action. 

RIDOH established a 7-day threshold system to send alerts when an overdose region’s nonfatal overdoses exceeded a level set at three standard deviations above the annual average count for that region. RIDOH developed a more prospective metric that examines overdose rates over the past six months. This approach compares each region’s overdose rate per 100,000 residents to the statewide rate, highlighting areas with sustained burden. By shifting focus from short-term spikes to longer-term trends, RIDOH can better target resources and prevention strategies where they’re most needed. 

For more information: https://ridoh-drug-overdose-surveillance-iss-rihealth.hub.arcgis.com/ 

Partnering for Data-Driven Response and Outreach 

RIDOH works closely with its diverse partners to ensure overdose data are translated into meaningful action. RIDOH’s evaluator monitors how peer-support and outreach workers use the data provided to adapt their community response, while system or response changes are shaped by input from those on the ground. To strengthen collaboration, RIDOH convenes three weekly meetings: one with treatment providers to share data updates, one with internal partners (including epidemiologists, Emergency Medical Services (EMS), laboratory and medical directors, and High Intensity Drug Trafficking Area (HIDTA) officials), and one with peer support and community partners. These structured touchpoints foster consistent communication across agencies and communities. In addition, RIDOH is developing data-sharing agreements with the Department of Corrections and contributes to Prevent Overdose RI, a statewide hub for naloxone access and other resources. Together, this collaborative ecosystem integrates diverse datasets with community outreach, making overdose response more informed, coordinated, and responsive. 

As a centralized state agency, the Wyoming Department of Health (WDH) leverages strong partnerships with law enforcement, Emergency Medical Services (EMS), Vital Records, and local prevention partners to monitor and respond to overdose trends across the state. They draw on a wide range of data sources—including mortality data, hospital discharge, outpatient visits, Prescription Drug Monitoring Program (PDMP), EMS, law enforcement, and poison control reports—to guide their work. A partnership between WDH, ODMAP, and the HIDTA program has enabled development and distribution of anomaly alerts and collaboration with prevention partners and law enforcement on local response. The WDH prevention network, through the Community Prevention Unit (CPU), spans all 23 counties in the state, supporting naloxone distribution and targeted overdose prevention. They also work with five independent county health departments. All counties benefit from the agency’s centralized expertise to help fill gaps caused by limited local resources. While county-level response capacity can be constrained and alert deployment must be carefully managed, Wyoming is steadily strengthening infrastructure, expanding prevention efforts, and enhancing coordination with neighboring states.