MARYLAND LOCAL
OVERDOSE
FATALITY
REVIEW TEAM
PROGRAM
CHRISTINE TRUONG
MHS CANDIDATE, MENTAL HEALTH
OUTLINE
• PHASE Internship Overview
• Opioid Addiction and Overdose
• Research Project Description
• Public Health Significance
PHASE INTERNSHIP
EXPERIENCE
Legislative Research & Policy
• Conducted literature searches
• Drafted policy regarding legislator visits to
BHA-funded mental health facilities
Behavioral Health Research
• Poisoning Characterization Project
• Maryland Local Overdose Fatality Review
(OFR) Team Program
• Continue work with project towards publication
OPIOID ADDICTION
AND OVERDOSE
• Opioid related addiction and overdose affects between 26.4
million and 36 million people worldwide1
• In the United States, between 2000 to 20142:
• Drug overdose death rate has increased 137%
• Rate of opioid related overdose deaths has increased 200%
• In 2014, 47,055 drug overdose deaths occurred in the United
States2
• 6.5% increase from the previous year
• Same upward trend continues into 2015
• In Maryland, between 2010 and 20143:
• Number of heroin-related deaths has more than doubled
• Number of opioid-related deaths has increased by 76%
1.
2.
3.
UNODC (2012). World Drug Report 2012
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in drug and opioid overdose deaths-United States, 2000-2014.MMWR:
Morbidity and mortality weekly report,64(50-51), 1378-1382
Maryland Department of Health and Mental Hygiene (2014). Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2014
THE COSTS OF OPIOID
ADDICTION
Financial:
• Approximately $53 billion annually
Biological:
• Higher association and rates of HIV/AIDS, hepatitis B and C,
and tuberculosis
• Higher risks of premature death, STDs, liver disease from
alcohol abuse, and other physical and mental health
problems
Social:
• Increased crime, increased disease transmission, increased
health care costs, and destabilized communities
OVERDOSE FATALITY
REVIEW TEAMS
What is overdose fatality review?
• Modeled after other fatality review teams such
as CFR, FIMR, or DVFR teams
• Representatives from multiple agencies
assemble to confidentially review cases of
overdose death
• Teams compile individual level data from
multiple stakeholders who are involved in the
community
OVERDOSE FATALITY
REVIEW TEAMS
What is the goal?
• Prevent future deaths by:
• Identifying missed prevention opportunities
and system gaps
• Increasing collaboration between local
stakeholders on overdose prevention
• Recommending policies, programs, laws to
prevent overdose deaths
• Informing local overdose prevention strategy
RESEARCH PROJECT
PURPOSE

Build upon findings from DHMH publication
Development of Maryland Local Overdose Fatality
Review Teams: A Localized, Interdisciplinary
Approach to Combat the Growing Problem of Drug
Overdose Deaths
• Process of establishing three pilot LOFRTs in
Maryland
• Potential as an effective tool to combat overdose
Currently, project has grown and consists of
18 teams
METHODS AND
APPROACH
Mixed methods
• Examine quantitative and qualitative data collected
from 2014 and 2015
In order to:
• Identify risk factor trends and outcomes across
various demographic characteristics and counties.
• Explore and compare categorizations of program
and systemic recommendations
• Developed by OFR teams to inform strategy for
overdose prevention at the state and local levels
METHODS & APPROACH
1.
Completed data entry to OFR database
• Collected information Includes:
• Circumstances surrounding death, drugs identified in case, entities
that collaborated for investigation, risk factors, program changes,
and systemic recommendations
2.
Identified potential database modifications and expansions
3.
Qualitative analysis of team observations
• Codes include:
• Physician engagement, medical care coordination, behavioral health
services integration, systems coordination, judicial system capacity
building, and public assistance programs interventions
4.
Quantitative analysis
•
To determine:
•
Ranking of trends and reach points by demographic characteristics
and county
OFR PUBLIC HEALTH
SIGNIFICANCE
Identify systemic and policy changes that will prevent similar
deaths in the future
Recommendations will have long-term impacts
Strengthen communication and coordination between participating
agencies
This project is essential because:
• Help those suffering with substance use disorder but also their
families, the communities they live in, and service providers.
• By examining risk factor, outcome, and recommendation trends
across demographic characteristics and counties:
• Potential to identify and inform overdose prevention needs and
priorities for increased effectiveness.
ACKNOWLEDGEMENTS
Department of Health and Mental Hygiene (DHMH)
Gayle Jordan-Randolph
Erin Haas
Lisa Hadley
Rianna Matthews-Brown
PHASE Internship Program
Paulani Mui
Beth Resnick
REFERENCES
Drug Enforcement Administration. 2014 national drug threat assessment summary. Washington, DC: United
States Department of Justice; November 2014 - See more at:
http://www.ajmc.com/journals/supplement/2015/ace0029_aug15_painrems/ace0029_aug15_painrems_fudin/P3#sthash.SxWAbPEZ.dpuf
Haas, E. (2016). Development of Maryland Local Overdose Fatality Review Teams: A Localized, Interdisciplinary
Approach to Combat the Growing Problem of Drug Overdose Deaths. Health Promotion Practice. Accepted.
Kampman, K., & Jarvis, M. (2015). American Society of Addiction Medicine (ASAM) National Practice Guideline
for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Journal of addiction
medicine, 9(5), 358.
Leavitt, S.B. (2004). A Community-Centered Solution for Opioid Addiction Methadone Maintenance Treatment
(MMT). Addiction Treatment Forum.
Maryland Department of Health and Mental Hygiene (2014). Drug- and Alcohol-Related Intoxication Deaths in
Maryland, 2014.
Maryland Department of Health and Mental Hygiene. Drug Overdose Fatality Review Program Guidance
Document.
Maryland Department of Health and Mental Hygiene. Overdose Fatality Review Justice Clearing House Webinar.
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in drug and opioid overdose deathsUnited States, 2000-2014.MMWR: Morbidity and mortality weekly report,64(50-51), 1378-1382.
Schwartz, R. P., Gryczynski, J., O’Grady, K. E., Sharfstein, J. M., Warren, G., Olsen, Y., ... & Jaffe, J. H. (2013).
Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995–2009.American journal of
public health, 103(5), 917-922.
UNODC (2012). World Drug Report 2012.