ES 2. Diagnose and Investigate Health Problems and Health Hazards

Core Function: Assessment

Assessment activities for ES 2 include epidemiologic investigations of disease outbreaks and patterns of infection, chronic disease, injuries, environmental hazards and other public health threats and emergencies. The opioid epidemic is both a public health threat and an emergency.

Communities of all sizes and levels of affluence are affected by opioid misuse. Community-level contributors include economic instability, barriers to accessing health care, and low educational attainment. Indicators of these health determinants, along with surveillance data, can enhance understanding of the causes and effects of opioid misuse on the local level and can help direct the development of prevention, intervention, and treatment programming.

In Connecticut, local health departments can partner with the state health department on epidemiologic investigations. Some towns and cities, especially those with grant-funded coalitions, have demonstrated the ability to collect and analyze local data to gain a deeper understanding of the opioid epidemic’s impact. Communities may see an emerging trend in opioid-related activity that triggers investigation; which may result in the identification of specific sub-populations at greater risk for opioid misuse, or neighborhood clusters of overdoses due to particularly lethal strains of drugs.

Sources for Rapid CT Data

• EpiCenter is an electronic syndromic surveillance reporting system maintained by the Connecticut Department of Public Health (CT DPH). Data are regularly collected on several reportable conditions, including opioid overdoses. Access is limited to hospitals, local health departments and CT DPH staff. To request access to data in EpiCenter, contact dph.syndromic@ct.gov. More information may be found on the CT DPH Syndromic Surveillance webpage. https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Syndromic-Surveillance
• The Connecticut Emergency Medical Services Statewide Opioid Reporting Directive (SWORD) is a near real-time reporting mechanism for suspected opioid overdoses in Connecticut from the CT DPH Office of Emergency Medical Services (OEMS), in collaboration with the CT Poison Control Center (CPCC) at University of Connecticut Health.  The SWORD program uses the Washington-Baltimore High Intensity Drug Trafficking Area’s (HIDTA) Overdose Detection Mapping Application Program (ODMAP). Goals of the program are to surveille the opioid epidemic, create an early warning system to overdose spikes and bad batches, as well as to share data with local communities. All EMS providers are mandated to call CPCC when caring for a suspected overdose.  CPCC enters the information into ODMAP, giving us the data to identify areas of need. The program also produces newsletters, which are posted for the public. https://portal.ct.gov/DPH/Emergency-Medical-Services/EMS/OEMS—SWORD . 
• The ODMAP tool is available to governmental agencies serving the interest of public health and safety. To gain access to this service, you must register at https://odmap.hidta.org and request an agency code or sign up by contacting ODMAP’s HelpDesk Support. ODMAP HelpDesk Support may be reached by phone at 301-489-1744 or email at hd@wb.hidta.org . More information may be found on the ODMAP webpage. http://odmap.org/
• Overdose Spike Response Framework is a companion guide for ODMAP stakeholders that brings together recommendations for a coordinated response between public health and public safety agencies to overdose spikes. It includes examples from the field and promising practices. http://odmap.org/Content/docs/ODMap-Overdose-Response-Framework-2018-3.29.18.pdf

Other Resources

• Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs report from Centers for Disease Control and Prevention (CDC) provides information on preparing for, detecting, investigating and responding to an outbreak of HIV or hepatitis C, as well as suggestions for engaging community partners and law enforcement. https://www.naccho.org/uploads/downloadable-resources/HRR-managing-hiv-hcv-pwid-toolkit14.pdf
• CDC Opioid Rapid Response Teams (ORRTs) are composed of public health experts ready to deploy on short notice to support jurisdictions experiencing spikes in opioid-related overdoses or the closure of a clinic where patients are prescribed opioid therapy. ORRTs can help reduce opioid-related morbidity and mortality by identifying risks of harm and linking to appropriate clinical care and social services. https://www.cdc.gov/opioids/opioid-rapid-response-teams.html
• National Drug Early Warning System (NDEWS) monitors emerging drug use trends across the country to allow for a quick response to potential outbreaks of illicit drugs such as heroin and to identify increased use of designer synthetic compounds. https://ndews.umd.edu