Overdose data to action: Toward addiction prevention using data in Alabama

Even though opioid prescriptions in AL have decreased, overdose deaths continue to rise. It is generally agreed that there is not a single silver bullet to attack the opioid crisis, but rather multiple approaches with multiple stakeholder groups focusing on expanding reach, evaluating, and modifying in multiple iterations over time. The Alabama Dept. of Public Health, as part of a wider initiative, is conducting an evaluation of program activities and better understand their impact on the overdose deaths in AL. This study uses sequential and appended monthly primary data collection across a 11 stakeholders and places emphasis on the role or peer navigation as the primary linkages to care. Data are then aggregated by zip code to identify target areas of need. Findings suggest that barriers such as hiring freezes, awareness, and coroner participation contribute to adequate and accurate data collection. Throughout the two years of this initiative, those barriers have remained, but various community events and faith-based events have increased awareness and participation at the community person level. Community events are the primary mechanism to increase awareness. With an average of 75 individuals at each of the 38 community events with 75% of the individuals provided services and 1589 provided linkages to care through peer navigation. In total, we have reached almost 12,000 individuals through community events. Surveillance activities have been enhanced through data visualization activities to create a shared understanding of surveillance activities. Initially, there were barriers with hospital participation in surveillance activities, but now we have 93/94 participants. Clinician participation in our prescription drug monitoring program (PDMP) has been challenging and thus fosters doctor shopping for prescription drugs. We have increased PDMP participation by over 400 prescribers with 4 hospitals participating in a clinical alert software program. In terms of prevention and harm reduction, we include programs around naloxone distribution and fentanyl test strips. Over 3000 naloxone kits have been distribute over 94 zip codes. Other various harm reduction activities included over 21,000 service encounters across 126 zip codes. We have conducted over 600 trainings on the proper use of fentanyl test strips and have actually noted a reduction in fentanyl seizures due to the new administration and increased border security, although Marijuana, Methamphetamine, and cocaine continue to be the top seizures in AL. Additional programs with our carceral system has broadened the participation on addiction prevention activities. Overall, we continue this initiative and with iterative recommendations from every reporting period. It remains a challenge to ensure that all stakeholders are reporting monthly and to that end, ADPH needs better enforcement to ensure sustained data collection.

Sue Feldman, RN, MEd, PhD, FACMI, is Professor and Director of Graduate Programs-Health Informatics in the School of Health Professions at the University of Alabama at Birmingham. Her research focuses on health information systems for social good and social protections. Her international and domestic research in health, wellness and social-benefit initiatives has been funded by The World Bank, The Asian Development Bank, The Centers for Disease Control and Prevention, and The Centers for Medicaid and Medicare Services. Awards include Changemaker in Health, Mentor of the Year, Faculty Innovator of the Year. She is a graduate of Claremont Graduate University.