In practice, Overdose Fatality Reviews involve a series of confidential individual death reviews by a multidisciplinary team to effectively identify system gaps and innovative community-specific overdose prevention and intervention strategies.

Overdose Fatality Review (OFR)


The purpose of an OFR is to effectively identify system gaps and innovative community-specific overdose prevention and intervention strategies.

In practice, OFRs involve a series of confidential individual death reviews by a multidisciplinary team. A death review (also referred to as a “case review”) examines a decedent’s life cycle in terms of drug use history, comorbidity, major health events, social-emotional trauma (including adverse childhood experiences), encounters with law enforcement and the criminal justice system, treatment history, and other factors, including local conditions to facilitate a deeper understanding of the missed opportunities for prevention and intervention that may have prevented an overdose death.

By conducting a series of OFRs, jurisdictions begin to see patterns of need and opportunity, not only within specific agencies, but across systems.

Blending input from public health, public safety, providers, and the community, OFR teams develop program and policy recommendations to improve coordination and collaboration between agencies and community conditions to prevent future overdose deaths.

These recommendations are presented to a governing committee that supports and provides resources for implementation and a framework for accountability for action. Examples of successful recommendations include the integration of peer recovery specialists into new settings, targeted naloxone distribution, and improved coordination of public safety and public health.

Guide Design

border Toolkit

This guide is a companion document to the CDC Foundation’s Public Health and Safety Team (PHAST) Toolkit and was created to help communities plan, implement, and evaluate OFRs. It is designed for multiple audiences including public health, public safety, criminal justice, drug treatment, and social services.

The goal of the guide is to provide the reader with the needed information to build a successful OFR process with a strong foundation in coalition, data collection, and prevention. The guide content draws on other fatality reviews and the authors’ practice-based knowledge. It is organized into five modules:

Are Overdose deaths preventable?

Overdose Deaths Are Preventable

Yes. Overdose deaths can be prevented with coordinated prevention strategies, timely implementation of evidence-based interventions, community mobilization, and supportive families and friends.

The shared understanding that overdose deaths are preventable guides the entire overdose fatality review (OFR) process. Federal agencies, such as the Bureau of Justice Assistance (BJA) and the Centers for Disease Control and Prevention (CDC), are strategically coordinating to mobilize local communities to develop and implement OFRs.

OFR Resources


“Change Happens at the Speed of Trust”: OFR Forum Raises Profile of Winning Strategy in Battle Against Substance Abuse

Publication — 4/16/2021

As Overdose Fatality Review (OFR) Circle Widens, Ripple Effects Intersect in Pennsylvania County

Publication — 10/18/2021

Changes Spurred by OFR Team Transform Battle Against Substance Use in Winnebago County

Publication — 12/20/2021

COSSAP Webinar: Next-of-Kin Interviews

Webinar — 3/16/2022

COSSAP Webinar: OFR Evaluation: Resources and Practical Steps for Implementation

Webinar — 8/17/2022

COSSAP Webinar: Understanding and Addressing Substance Use Disorder (SUD) Stigma Among Public Health and Public Safety Professionals

Webinar — 10/24/2022

Data to Action Through Public Health and Public Safety Partnerships: OFR and PHAST

Webinar — 3/3/2023

Embedding Self-Care Throughout the Overdose Fatality Review Process

Publication — 10/20/2022

Evaluation Profile for Overdose Fatality Reviews

Report — 9/1/2021

From the Field: Overdose Fatality Review, Indiana Department of Health

Online Resource — 1/15/2021

From the Field: Violence and Injury Prevention Program, Utah Department of Health

Online Resource — 1/15/2021

From the Field: Winnebago County Overdose Fatality Review Team, Winnebago County, Wisconsin

Online Resource — 1/15/2021

Law Enforcement's and First Responders' Roles in Overdose Prevention—Deflection and Overdose Fatality Review

Webinar — 5/18/2022

Model Overdose Fatality Review Teams Act

Report — 2/17/2021

Multiple Perspectives on Overdose Fatality Reviews

Webinar — 7/27/2021

New to OFR Virtual Training

Video — 1/5/2023

New to OFRs Affinity Group

Webinar — 2/15/2022

Next-of-Kin Interviews: A Practitioner’s Guide to Implementation

Toolkit — 3/22/2022

OFR Annual Report: Empowering Community Action

Webinar — 2/15/2023

One-on-One With Legislative Analysis and Public Policy Association (LAPPA)

Podcast — 3/11/2021

Overdose Fatality Review (OFR): Recruit Your OFR Team

Webinar — 3/15/2022

Overdose Fatality Review Mentor Program Relaunch Overview

Webinar — 9/21/2022

Overdose Fatality Review: A Practitioner's Guide to Implementation

Report — 9/1/2020

Overdose Fatality Review: National Standards

Webinar — 4/20/2022

Overdose Fatality Review: National Standards

Report — 6/30/2022

Partnerships for Prevention: Overdose Fatality Review 101

Webinar — 1/16/2020

Public Health and Safety Team (PHAST) Toolkit, Draft Version 2.0

Report — 3/15/2020

Rural Learning Community: Implementing Data-Driven Approaches to Addressing SUD in Rural Communities

Webinar — 2/14/2023

Rural-focused OFR Webinar

Webinar — 8/24/2020

Success Story: Overdose Fatality Review Use of Overdose Detection Mapping Application Program Data

Webinar — 6/15/2022

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