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Knox County, Tennessee, established its overdose fatality review (OFR) team in 2021, and as of October 2022, the team had reviewed 105 cases. In its first annual report, the OFR team identified hospital emergency departments (EDs) as a high-priority setting for substance misuse interventions and overdose prevention. Of the first 105 cases the team reviewed, 22 were excluded because of lack of medical data. Among the remaining 83 individuals with sufficient data, there were 711 lifetime ED visits. Of these 83 individuals, 69 visited the hospital within 1 year of death, totaling 335 hospital visits. Chart notes showed a pattern across individuals of leaving the hospital against medical advice, and OFR team members inferred from their experience that withdrawal symptoms played a role in many of these cases. Each hospital visit represents an opportunity to intervene and prevent a death by overdose. University of Tennessee Medical Center (UTMC), a local hospital system that is represented on the OFR team, has begun a pilot program to bridge the gap between hospitals and drug treatment programs by initiating medication for opioid use disorder in the ED and then a warm handoff to a grant-funded intensive outpatient program (also represented on the OFR team). The OFR team has convened a work group to evaluate the success of UTMC’s program and discuss expanding it to other area hospitals, especially those with existing peer navigator programs. The work group includes the founder of a national ED/medical staffing company and representatives from local behavioral health providers.
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With a population of 2.5 million residents and 55 overdose deaths per month, Riverside County became the first county in California to establish an overdose fatality review (OFR) team. The Riverside County Overdose Data to Action (RODA) Program’s OFR multidisciplinary team meets monthly to review selected overdose cases within a pre-identified focus area (e.g., individuals experiencing homelessness, the Native American population, youth aged 15 to 24, etc.) to fill gaps in knowledge of local overdose trends and increase coordination and collaboration among partner agencies. The RODA Program utilizes Jamboard to facilitate each decedent’s review and engage the 10-plus team members to discuss the circumstances leading up to the decedent’s death. During these discussions, the OFR team develops recommendations to prevent substance use, overdose, and death. The recommendations are added to an action plan to track progress. The RODA Program monitors the action plan and brings in the appropriate partners to carry out the activities. OFR recommendations have been integrated into prevention activities, including a harm reduction mass media campaign, quick response (QR) codes on substance use resources for first responders, and harm reduction and naloxone training. The OFR team has proved to be a valuable tool for informing programmatic activities and strengthening partnerships among entities that share the common goal of reducing overdoses.
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Beginning in 2015, the Wisconsin Department of Corrections (DOC) began a coordinated response to the opioid epidemic that continues to have a devastating national impact. Through the implementation of many initiatives that focused on medication-assisted treatment service delivery to those under the Wisconsin DOC’s care and control, harm reduction, and evidence-based practices, the overdose fatality review (OFR) committee continued to see fatalities from this disease. In 2020, leaders across the Wisconsin DOC embraced a concept to review the fatalities at a state level to better understand the processes and policies that the OFR team could improve upon to lessen overdose fatalities in its correctional population. The Wisconsin DOC’s OFR team is modeled after other national teams, but its uniqueness stems from statewide membership and coordination that reflects the diversity of Wisconsin. Wisconsin is home to 72 counties, which vary greatly from urban to rural and in race, age, income, and service level for responding to the opioid epidemic. The Wisconsin DOC supervises clients in all 72 counties (and a Native American territory), and as a result, its fatality review team reviews cases from all 72 counties. The team reviews two fatalities per month, with overall leadership offered by the Medical College of Wisconsin. Cases are selected with consideration for age, race, gender, geographic location, toxicology reports, and other factors suspected to contribute to the fatality. The Wisconsin DOC is eager to share its experience, project data, policy improvements, and lessons learned for other states to replicate.
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The Allen County, Indiana, overdose fatality review (OFR) team has found a recurring theme in its recommendations: a need for familial support. In the 3 years since Allen County started its OFR, it has become increasingly evident that mothers and families are struggling with substance use. Many of the deaths occurring are happening within 12 months of giving birth, with children present at the place of death or with children placed in relation or foster care. In light of these findings, Allen County has refined its OFR processes to include ad-hoc members of the OFR team in all meetings; those representatives being those from the Department of Child Services, maternal health providers, grief counselors, and pediatricians, as well as a clinical social worker who specializes in family-centered therapy. With these additional members, the team is able to assess the aspects of familial support that could have made a difference in the case, including individual, family, community, and societal factors. This session will review findings and identified interventions related to building support for families, providers, and systems impacting overdose deaths.
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This workshop will feature discussion from tribal representatives on their responses to drug use and overdose in their communities. Topics will include the development of multidisciplinary governance structures to guide the decision making; pulling together multiple streams of information across agencies; using tools such as the Overdose Detection Mapping Application Program (ODMAP) and overdose fatality review (OFR) to better understand the nature of drug use; and creating active partnerships between public health and public safety to intervene with individuals at risk for overdose.
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Back by popular demand and rated one of the 2019 OFR Annual Forum’s favorite sessions, the Open Forum allows participants to share their reflections on the forum experience, hear how overdose fatality review implementation is going for others, and ask questions of the audience and the experts. This session is an open mic session with no presentations.
