Using data to drive overdose prevention and surveillance efforts in Puerto Rico - Background: The estimated population for Puerto Rico (PR) in 2021 was 3.3 million with a median age of 44.2 years and characterized by a significant old-age structure with 26.1% of population in the group of 40-59 years and 27.9% over 60 years of age (Census, 2021). Particularly, older people have a higher prevalence of chronic diseases such as arthritis (20.9%), diabetes (16.8%), and depression (21.7%), among others (Behavioral Risk Factor Surveillance System [BRFSS], 2021). Such diseases can affect the quality of life and increase pain levels. Analgesics such as opioids, stimulants, and polysubstance are used to help manage chronic pain. Also, data published in the PR Opioid Dashboard (PROD) show higher rates of use of major opioids in age groups 45 years and older. Deaths poisoning and by accidental poisoning by drugs, medicaments, and biological substances (ICD-10 X40-X44) and undetermined intent (ICD-10 Y10-Y14) have been responsible for 633 confirmed deaths in PR in 2021 (PR Demographic Registry Office, 2022) For that same year, were identified 535 nonfatal overdose events reported through the PR Overdose Surveillance System (PROSS). In addition, there has been an increase in fentanyl deaths from 2017 with 74 to 2021 with 544 (Forensic Science Institute [ICF], 2022). Since 2017, a series of events have hit the island, including hurricanes Irma and Maria. Recent studies present that before Maria 10.6% of the surveyed population had an overdose, with an increase to 24.2% in the post-Maria interview (Abadie, et al., 2022). Purpose: Seeks to reduce fatal and non-fatal drug overdoses in those populations that are proportionally underserved considering the health inequalities, social determinants of health and other structural factors that impact access to services. For this reason, we proposed the implementation of two components. Component A: Will focus on addressing issues related to the opioid, stimulant, and polysubstance crisis in the community, public safety, and health care settings through seven major initiatives: (a) Improving linkage and retention in care efforts through the implementation of the Navigator Program for Case Management and Treatment Referrals; (b) Distribution of naloxone and fentanyl strips; (c) Delivery of training on overdose identification, prevention, harm reduction, use of naloxone kits and use of fentanyl strips; (d) addressing health disparities with persons who use drugs use, (e) developing a stigma-free certification and media education campaign on stigma, opioid use and abuse, and how to seek help, among others. As part of the outcomes of this project, it is expected that the number of collaborators, integration of navigators, and access to services aimed at harm reduction, stigma reduction, and increased educational services will increase. Also, is expected to achieve fidelity processes, increase the efficiency and effectiveness of the programs, and in the long term reduce fatal drug overdoses, among others. Component C: Will design and implement a data integration module within the PROSS for data entry, monitoring, and measurement related to Linkage to Care (LTC). The outcomes of this project, it is expected to increase sharing and use of data related to linkage and retention in care that will inform prevention and response efforts. Also, will increase capacity of programs to respond to overdose trends for groups disproportionately affected by the overdose epidemic, increased use of standardized indicators on LTC indicators to support local and national surveillance, and expanded and enhanced use of surveillance, program evaluation, and community data to drive prevention actions that are appropriate for the population to inform implementation and improvement of prevention and response efforts, especially for groups disproportionately affected by the overdose epidemic.
