In Pennsylvania (PA), there were 5,168 unintentional/undetermined drug overdose deaths (UUDO) in 2020, the 2nd highest number in state history and the 4th highest nationwide; local data show higher UUDO in 2021. There is a continued need to better understand the contextual issues around increasing rates of overdoses and implement evidence-based and community-informed prevention programs.
PA will maintain existing staff to conduct overdose morbidity and mortality surveillance (Strategy 1) and to maintain, enhance, and implement prevention programs and policies, with a special focus on populations disproportionately affected by the overdose epidemic. PA intends to improve access to timely, high-quality, actionable morbidity and mortality data to inform overdose prevention efforts by key stakeholders; increase clinical and health system capacity to treat pain, screen, diagnose, and link patients to care for opioid and substance use disorder (OUD/SUD), and access Prescription Drug Monitoring Data (PDMP); increase the use of harm reduction practices, naloxone use, trauma-informed care, and recovery-oriented approaches among first responders (FRs); increase access to overdose prevention and reversal tools, treatment options, and drug checking equipment programs; and increase the utilization of navigators to facilitate linkage to care and other services.
PA will work towards these goals through 9 strategy-based initiatives. PA’s surveillance strategies will concentrate on conducting, improving, and analyzing overdose surveillance data. Efforts will focus on sustaining established partnerships with 100% of emergency departments (ED) via syndromic surveillance and inpatient discharge data (Strategy 2) and 55 coroners/medical examiners from counties accounting for >90% of UUDO in 2021 (Strategy 3, Option 2). To gain further insight into the rapidly changing illicit drug supply, PA is applying for Strategy 4 to conduct comprehensive toxicology testing on leftover biologic specimens from overdose-related ED visits. PA is also applying to Strategy 5; leveraging existing, and establishing new partnerships, PA will conduct statewide linkages with many unique data sources: SUDORS, nonfatal overdoses, PDMP, state prison release data, social determinants of health, Hepatitis C, and neonatal abstinence syndrome. The resulting linked datasets allow for more in-depth and robust analyses, which are critical to investigating the underlying reasons for overdose-related health disparities prevalent in PA. Experienced surveillance staff will aid in collection and analysis of surveillance data and share data products on a regular, timely basis.
Prevention strategies focus on implementing programs aimed at preventing overdose mortality and minimizing morbidity risk. Strategy 6 activities include updated and expanded training for healthcare providers, including, but not limited to, prescribing and tapering best practices, evidence-based interventions to link people to care, and stigma reduction; an expanded scope of PA’s ED navigation program to increase ED capacity for linking patients to OUD/SUD care, initiating medications for OUD, and distributing harm reduction resources; and expanded data-sharing efforts with additional states to increase the utility of the PDMP. PA will continue the Patient Advocacy program, facilitating coordination between public health, public safety, and clinicians during medication access disruption events (e.g., clinic closure) and the First Responder Addiction and Connection to Treatment Program, which aims to reduce stigma and improve response and communication skills in FRs and public safety professionals (Strategy 7). Finally, PA will seek partnerships with harm reduction and community-based organizations to initiate, expand, and support programs that ensure that people who use drugs can access overdose prevention and reversal tools, and access treatment and harm reduction services through navigators (Strategies 8 & 9).