University of Texas project gathers data on drug overdoses

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EL PASO — Men lined outside the Corner of Hope, a resource center for the homeless, eyeing free supplies on plastic shelves inside a white van.

Some wanted bags with toiletries or condoms, but others took kits that help them safely use drugs or naloxone, an opioid overdose reversal drug.

Gilbert Shepherd, an outreach worker for Punto de Partida, a nonprofit that serves people who abuse drugs, kindly interviewed those who took the drug safety kits. A man in sunglasses and a black T-shirt explained that not too long ago he took a pill he bought for $1.50 and within minutes he was passed out for hours. A man in a plaid shirt and khaki pants described seeing someone overdose after taking a blue pill a month before.

These two overdoses would be added to a new Texas database called Texans connect overdose prevention effortswhich aims to improve tracking of drug overdoses in the nation’s second-largest state.

The University of Texas project, known as TxCOPE, is an attempt to solve a problem infuriating national officials trying to curb record drug deaths: getting an instant, accurate picture of drug overdoses non-lethal and lethal drugs. Community groups are now using TxCOPE’s data dashboards and heatmaps to see where overdoses are rising, then target those hotspots with prevention efforts like training and naloxone supplies, said Christopher Bailey, coordinator project manager at Project Vida, a health center in El Paso.

According Leo Beletski, a public health law expert at Northeastern University. Such projects make up for the decades-long lack of an accurate picture of the overdose crisis. “It’s outrageous,” Beletsky said.

More than 107,000 Americans died of drug overdoses in 2021, according to the Centers for Disaster Control and Prevention. But there is no national tally of how many people survive drug overdoses. The CDC doesn’t even have a standard method that states can use to count non-fatal overdoses. It aggregates overdose data from emergency department visits based on participating states’ clinical and billing codes, but that excludes people who don’t interact with the medical system, said Bradley Stein, director of the Rand Opioid Policy Center. It’s a “huge blind spot,” Stein said.

Additionally, data on fatal overdoses are often released weeks or months later, once an official medical examiner’s report or toxicology results show which substances caused the deaths. “We’re looking in the rearview mirror with opioids,” Stein said.

Other projects that count non-fatal overdoses, such as ODMAP, rely on reports from law enforcement or first responders. But many addicts do not call emergency services or report overdoses for fear of arrest, deportation or other consequences such as the loss of their children or a home due to drug use. drugs, said Tracy Greenprofessor and director of the Opioid Policy Research Collaborative at Brandeis University.

“Put simply, current national data systems have not kept up with the scale of the overdose epidemic,” Dr. Rahul Gupta, director of the Office of National Drug Control Policy, wrote in a statement. call to action published on June 30 in JAMA. He added that building a better data system is essential and that his agency is meeting with other federal agencies to improve data tracking on non-fatal overdoses.

Nationally, Green estimated that about 50% of nonfatal overdoses go unreported, with higher undercounts in places with stricter law enforcement and among communities of color. The missing part of the picture “is very diverse,” she said.

In Texas, up to 70% of mostly non-fatal overdoses go unreported, estimates show Kasey ClabornPrincipal Investigator of the TxCOPE Project and Adjunct Professor at UT’s Dell Medical School and Steve Hicks School of Social Work.

Officially, about 5,000 Texans died from drug overdoses in 2021. Claborn thinks that’s also an undercount, because the state has medical examiners’ offices in only 15 of its 254 counties. Most counties have justices of the peace who don’t always order expensive toxicology tests to determine cause of death. The state has recorded nearly 4,000 opioid-related calls to Texas Poison Center Network last year and nearly 8,000 opioid-related emergency room visits in 2020. Claborn analyzes how the data collected by TxCOPE compares to these official statistics.

Drug experts are frustrated that the United States is not treating the overdose epidemic with the urgency it does for COVID-19. Drug-related deaths rose during the pandemic as illegal fentanyl, which is 50 to 100 times more potent than morphine, flooded the country’s street drug supply and people were cut off from aid to drug addicts. But while public health authorities were basing pandemic restrictions on local COVID case counts and death tolls, experts and outreach workers lacked real-time data that would allow them to respond with interventions that could save life. the lives of drug addicts.

“How does this help in a public health emergency?” said Daniel Sledge, a paramedic testing TxCOPE in Williamson County, just north of Austin.

This information could help health workers identify areas to cover with naloxone or whether to tell people about a batch of drugs containing deadly fentanyl.

TxCOPE, funded by the State Opioid Grant and the Federal Administration of Substance Abuse and Mental Health Services, began in El Paso in June 2021, then expanded to Austin, San Antonio and later to County of Williamson. An official launch is scheduled for September 1, with a rollout to the rest of the state in stages.

Before the start of the group, sensitization was more random. “It was catch as catch can,” Bailey said, with Project Vida. Like many harm reduction groups, they informally tracked overdoses, which often occurred among a traveling population. But they had no way to share this information with other groups in the city or generate maps to boost awareness. TxCOPE helped the group find pockets of at-risk people to provide them with overdose prevention, peer support, or treatment referrals. Now, “you can really focus on those areas with laser focus,” he said.

For example, Paulina Hijar, outreach worker at Punto de Partida, said she regularly encounters people who inject their friends with dangerous and ineffective home remedies for overdoses – either milk or a mixture of water and salt – or who received naloxone and never called the authorities. Because outreach workers have established trust in their communities, they say, they can gather information about overdoses, including when and where they happened, that would normally be omitted from official statistics.

Confidentiality is a key feature of the TxCOPE project — people must be able to share information about overdoses without fear of consequences, Claborn said. Texas passed a law in 2021 to protect people who call emergency services during an overdose from arrest, but it is closely matched. People who have a conviction for drug trafficking, for example, are not eligible. And someone is only protected from arrest once. TxCOPE has a federal privacy certificate that protects it from court orders, and Claborn does not share raw data with the state.

Claborn wants to use the project, which is being revamped this summer ahead of launch, to bring more federal dollars to the state. “We’ve had a hard time proving there’s a real problem in Texas because it’s been covered up,” she said.

She worked on a feature that would allow anyone in the community to report overdoses, an effort to improve counting in parts of the state without harm reduction groups. Eventually, Claborn wants to verify the crowdsourced data against the toxicology reports.

For now, however, the project relies on anecdotal evidence from drug users and other community members who say they have revived someone with naloxone or seen someone pass out or suffer pain. other effects of taking too much of a drug.

A recent afternoon, Shepherd and Hijar recognized a man in Houston Park in El Paso. He told them about a woman who had died alone in her apartment about a week and a half earlier after taking a mixture of drugs. He also mentioned a guy he was able to revive with naloxone about two months earlier. Details were minimal.

Researchers and harm reduction groups say this nebulous data is better than what they had in the past. Even if the project’s anecdotal data isn’t thoroughly vetted, the leap to speed is big, Stein said.

“We don’t have anything else at the moment,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

Disclosure: The University of Texas at Austin financially supported The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations, and corporate sponsors. Financial supporters play no role in the journalism of the Tribune. Find a suit list here.

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