Real-time surveillance of illicit drug overdoses using poison center data

Abstract

Background. In early 2006, government and media sources reported that crime syndicates were mixing fentanyl with heroin. This was followed by an increase in heroin overdoses and opiate-related deaths. The most recent fentanyl outbreak illustrated the need for identifying and establishing effective and responsive real-time surveillance tools to monitor drug overdoses in the United States. Objective. In this study, poison call center data from Illinois were evaluated to determine whether the data could have detected the outbreak that occurred in Illinois in early 2006 and whether it could be used for real-time surveillance. Methods. For this analysis, a two-step approach was used to analyze potential heroin-related calls. First, the data were analyzed retrospectively to identify whether any significant temporal shifts occurred, then a prospective analysis was conducted to simulate real-time surveillance. Results. Between 2002 and 2007, there were a total of 1,565 potential heroin-related calls, and the calls increased by 63.6% in 2006 compared to 2005. In the prospective analysis, the principal model would have identified the outbreak in March 2006. Conclusions. If there had been a real-time surveillance program using poison center data, the outbreak would have been identified 1 month before the initial postmortem reports to the Centers for Disease Control and Prevention at the end of April 2006. Poison center data provide the potential for an earlier warning system than postmortem data sources, because the reports are usually made within hours of the exposure. Poison center data can be effectively used to monitor heroin-related exposures.

Keywords:

• Heroin
• Fentanyl
• Drug overdose
• Surveillance
• Real time
• Poison center

Acknowledgments

Thanks to Dr. Michael Wahl of the IPC and Dr. Daniel Hryhorczuk of the University of Illinois at Chicago School of Public Health for assisting in acquiring the data and funding for this project. Thanks to Dr. Linda Forst for providing her feedback on the final draft of this manuscript.