The Rhode Island Department of Health (RIDOH) uses emergency department data to monitor nonfatal opioid overdoses in Rhode Island. In April 2019, RIDOH detected an increase in nonfatal opioid overdoses in Woonsocket, Rhode Island, and sent an alert to state and local partners (eg, fire departments, emergency departments, faith leaders) with guidance on how to respond. To guide community-level, strategic response efforts, RIDOH analyzed surveillance data to identify overdose patterns, populations, and geographic areas most affected. During April–June 2019, nonfatal opioid overdoses in Woonsocket increased 463% (from 13 to 73) when compared with the previous 3 months. Because of the sustained increase in nonfatal opioid overdoses, RIDOH brought together community partners at a meeting in June 2019 to discuss RIDOH opioid overdose data and coordinate next steps. Data analyses were essential to framing the discussion and allowed community partners at the event to identify an unexpected increase in cocaine-involved nonfatal opioid overdoses in Woonsocket. Many patients with cocaine-involved nonfatal overdoses also had fentanyl in their system, and input from community partners suggested that many patients were unaware of using fentanyl. Community response actions included targeting harm reduction services (eg, distribution of naloxone, mobile needle exchange); deploying peer recovery support specialists to overdose hotspots to connect people to treatment and recovery resources; placing harm reduction messaging in high-traffic areas; and targeted social media messaging. After the meeting, nonfatal opioid overdoses returned to pre-outbreak levels. This case study provides an example of how timely opioid overdose data can be effectively used to detect a spike in nonfatal opioid overdoses and inform a strategic, community-level response.

1. Prevent Overdose RI . Overdose death data. 2020. . https://preventoverdoseri.org/overdose-deaths/
Google Scholar2. Centers for Disease Control and Prevention . 2016 drug overdose death rates. . https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2016.html
Google Scholar3. Hedegaard, H., Warner, M., Miniño, AM. Drug overdose deaths in the United States, 1999-2016. NCHS Data Brief. 2017;294:1-8.29319475
Google Scholar | Medline4. McDonald, JV . Using the Rhode Island prescription drug monitoring program (PMP). R I Med J. 2014;97(6):64-65.
Google Scholar5. Bowman, S., Engelman, A., Koziol, J., Mahoney, L., Maxwell, C., McKenzie, M. The Rhode Island community responds to opioid overdose deaths. R I Med J. 2014;97(10):34-37.25271658
Google Scholar | Medline6. McCormick, M., Koziol, J., Sanchez, K. Development and use of a new opioid overdose surveillance system, 2016. R I Med J. 2013;100(4):37-39.
Google Scholar7. Jiang, Y., McDonald, JV., Koziol, J., McCormick, M., Viner-Brown, S., Alexander-Scott, N. Can emergency department, hospital discharge, and death data be used to monitor burden of drug overdose in Rhode Island? J Public Health Manag Pract. 2017;23(5):499-506.doi:10.1097/PHH.0000000000000514 28009694
Google Scholar | Crossref | Medline8. Marshall, BDL., Yedinak, JL., Goyer, J., Green, TC., Koziol, JA., Alexander-Scott, N. Development of a statewide, publicly accessible drug overdose surveillance and information system. Am J Public Health. 2017;107(11):1760-1763.doi:10.2105/AJPH.2017.304007 28933938
Google Scholar | Crossref | Medline9. Waye, KM., Yedinak, JL., Koziol, J., Marshall, BDL. Action-focused, plain language communication for overdose prevention: a qualitative analysis of Rhode Island’s overdose surveillance and information dashboard. Int J Drug Policy. 2018;62:86-93.doi:10.1016/j.drugpo.2018.08.010 30384027
Google Scholar | Crossref | Medline10. Samuels, EA., McDonald, JV., McCormick, M., Koziol, J., Friedman, C., Alexander-Scott, N. Emergency department and hospital care for opioid use disorder: implementation of statewide standards in Rhode Island, 2017-2018. Am J Public Health. 2019;109(2):263-266.doi:10.2105/AJPH.2018.304847 30571304
Google Scholar | Crossref | Medline11. 216-RICR-20-20-5 (2014).
Google Scholar12. Lasher, L., Jason Rhodes, J., Viner-Brown, S. Identification and description of non-fatal opioid overdoses using Rhode Island EMS data, 2016-2018. R I Med J. 2019;102(2):41-45.
Google Scholar13. Rhode Island Department of Health . Rhode Island Enhanced State Opioid Overdose Surveillance (ESOOS): case definition for emergency medical services (EMS). 2019. . https://health.ri.gov/publications/guidelines/ESOOSCaseDefinitionForEMS.pdf
Google Scholar14. Kariisa, M., Scholl, L., Wilson, N., Seth, P., Hoots, B. Drug overdose deaths involving cocaine and psychostimulants with abuse potential—United States, 2003-2017. MMWR Morb Mortal Wkly Rep. 2019;68(17):388-395.doi:10.15585/mmwr.mm6817a3 31048676
Google Scholar | Crossref | Medline15. Hoots, B., Vivolo-Kantor, A., Seth, P. The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States. Addiction. 2020;115(5):946-958.doi:10.1111/add.14878 31912625
Google Scholar | Crossref | Medline