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With a population of 2.5 million residents and 55 overdose deaths per month, Riverside County became the first county in California to establish an overdose fatality review (OFR) team. The Riverside County Overdose Data to Action (RODA) Program’s OFR multidisciplinary team meets monthly to review selected overdose cases within a pre-identified focus area (e.g., individuals experiencing homelessness, the Native American population, youth aged 15 to 24, etc.) to fill gaps in knowledge of local overdose trends and increase coordination and collaboration among partner agencies. The RODA Program utilizes Jamboard to facilitate each decedent’s review and engage the 10-plus team members to discuss the circumstances leading up to the decedent’s death. During these discussions, the OFR team develops recommendations to prevent substance use, overdose, and death. The recommendations are added to an action plan to track progress. The RODA Program monitors the action plan and brings in the appropriate partners to carry out the activities. OFR recommendations have been integrated into prevention activities, including a harm reduction mass media campaign, quick response (QR) codes on substance use resources for first responders, and harm reduction and naloxone training. The OFR team has proved to be a valuable tool for informing programmatic activities and strengthening partnerships among entities that share the common goal of reducing overdoses.

Beginning in 2015, the Wisconsin Department of Corrections (DOC) began a coordinated response to the opioid epidemic that continues to have a devastating national impact. Through the implementation of many initiatives that focused on medication-assisted treatment service delivery to those under the Wisconsin DOC’s care and control, harm reduction, and evidence-based practices, the overdose fatality review (OFR) committee continued to see fatalities from this disease. In 2020, leaders across the Wisconsin DOC embraced a concept to review the fatalities at a state level to better understand the processes and policies that the OFR team could improve upon to lessen overdose fatalities in its correctional population. The Wisconsin DOC’s OFR team is modeled after other national teams, but its uniqueness stems from statewide membership and coordination that reflects the diversity of Wisconsin. Wisconsin is home to 72 counties, which vary greatly from urban to rural and in race, age, income, and service level for responding to the opioid epidemic. The Wisconsin DOC supervises clients in all 72 counties (and a Native American territory), and as a result, its fatality review team reviews cases from all 72 counties. The team reviews two fatalities per month, with overall leadership offered by the Medical College of Wisconsin. Cases are selected with consideration for age, race, gender, geographic location, toxicology reports, and other factors suspected to contribute to the fatality. The Wisconsin DOC is eager to share its experience, project data, policy improvements, and lessons learned for other states to replicate.

As the practice of overdose fatality review (OFR) evolves, techniques for recommendation development, prioritization, and implementation to help prevent overdoses are emerging. To assist communities with overdose prevention strategies through public health and public safety partnerships, the Centers for Disease Control and Prevention (CDC) and the Office of National Drug Control Policy (ONDCP) support the Overdose Response Strategy (ORS). ORS teams of public health analysts, working with the CDC Foundation, and drug intelligence officers, working with the High Intensity Drug Trafficking Area (HIDTA) programs, participate in and support local reviews. After reviewing approaches from Philadelphia, Pennsylvania, Winnebago County, Wisconsin, and other jurisdictions, the OFR team in Lexington County, South Carolina, created a unique approach for developing recommendations and applying Lean Six Sigma process improvements, facilitated by the ORS public health analyst. This presentation will describe the team’s process for identifying gaps/needs, generating and prioritizing solutions, and creating action plans. The presentation describes results of two prioritization exercises and recommendations that were implemented, including adding members for new sectors; educating members about Handle With Care protocols for referring children experiencing trauma to additional support; and seeking strategic partnerships and resources for community outreach, mobile services, and linkage to care. By describing methods and results of the process in Lexington County, attendees will be able to apply tools like a benefit-effort matrix and voting techniques for focusing partner resources and identify ways this process can achieve system improvements to prevent overdoses.

The Michigan Public Health Institute (MPHI) began establishing overdose fatality review (OFR) teams in Michigan in 2021. Following case reviews, MPHI sought feedback, surveyed teams, and followed up on information gaps. This resulted in several community-based, often team member-led presentations that have provided unexpected learning opportunities. The review of the case of a veteran who died because of an overdose left team members with unanswered questions, especially regarding the services and resources available to this particular population. As a result, a review team member connected MPHI with a representative from the Michigan Veterans Affairs Agency, who presented to the team about these issues and ended up joining the team. Michigan’s Children’s Protective Services representatives presented information to teams regarding what happens when children experience the loss of their parents due to overdose. In addition, the largest harm reduction agency in the region provided training on Narcan access and administration, as well as the services that the agency provides. Finally, MPHI asked emergency medical services (EMS) to share its criteria for naloxone administration, post-overdose substance use disorder treatment resources provided by EMS and any changes MPHI should recommend where those resources do not exist, treatment for non-opioid overdoses, and whether the need for naloxone reversal is increasing from previous years. MPHI has invited additional groups to educate its teams regarding information from their respective disciplines in order to enhance team capacity and efficacy. Increasing teams’ awareness of the various resources available in their communities is crucial to ensuring a robust review process that produces better-informed recommendations to prevent overdoses in Michigan communities.

In partnership with community partners, the Lackawanna County, Pennsylvania, District Attorney’s Office established a local, multiagency overdose fatality review (OFR) team in 2020 to examine the contributing causes of overdose fatalities in Lackawanna County. This plenary session will focus on two separate recommendations involving community education and awareness, harm reduction strategies, and decriminalization of fentanyl test strips.

Through cases reviewed by Lackawanna County’s OFR team, it became clear that the risk of fentanyl overdose did not simply or predominantly lie with heroin use. The review of these cases led to the recommendation for a deeper analysis of fentanyl-related overdose deaths and to increase awareness of this local data and risk of fentanyl overdose. In order to do this, the Lackawanna County District Attorney and the Mayor of Scranton, Pennsylvania, held a press conference, where they presented data and stressed that fentanyl was being seen laced in all street drugs, not just heroin, and that there had been several local overdoses due to pure fentanyl being disguised as other drugs and pills. The press conference was covered by local media and disseminated both in the local newspaper and TV news coverage. A one-page fentanyl educational document was also developed and disseminated to the OFR team, the local recovery coalition, and other relevant community partners. This press conference led to extensive discussions with a wide variety of community partners regarding the decriminalization of fentanyl testing strips. In addition, both the Pennsylvania District Attorneys Association and the City of Scranton publicly advocated for a state bill to decriminalize fentanyl testing strips following these discussions, which passed in October 2022.

Another recommendation that Lackawanna County’s OFR team was able to identify, develop an action plan for, and implement involved ensuring that all Lackawanna County police departments have access to naloxone as well as training on naloxone administration and local resources. Through collaboration between the Lackawanna County District Attorney’s Office and Pennsylvania Ambulance, this recommendation was successfully implemented and then expanded to other sectors throughout the community. Because of a significant number of school nurses requesting naloxone through Lackawanna County’s naloxone-by-mail initiative, as well as increased overdoses due to fentanyl pills being disguised as medications such as Percocet and Vicodin—which are increasingly popular with high school students—the OFR team also generated a similar recommendation to ensure naloxone access and education in all Lackawanna County schools. The Lackawanna-Susquehanna Office of Drug and Alcohol Programs took the lead on this initiative and sent a letter to all the school superintendents, and the Lackawanna County District Attorney’s Office mailed letters to all police chiefs in Lackawanna County, with telephone follow-up completed for anyone who did not respond. All schools and police departments were provided with naloxone, resources, and training as needed and appropriate. One hundred percent of Lackawanna County schools and police departments now have naloxone and resources onsite and were provided training, if needed, as a result of the findings and recommendation from the OFR team.

The York County, Pennsylvania, Overdose Fatality Review (OFR) Team was established by a joint initiative among the City of York Bureau of Health, the York Opioid Collaborative, and the County of York Offices of the Coroner and District Attorney. The purpose of the OFR team is to identify drug overdose fatality trends; improve incidence data to accurately record the number of overdose deaths in a county; define effective strategies for coordinating overdose prevention strategies; recommend statutory, regulatory, and policy changes; promote coordination among agencies that investigate drug fatalities and provide services to families; and develop plans for enhancing efforts of partner organizations. Recommendations to date have focused on communication, information/resource sharing, training, referring to services, naloxone distribution, and education opportunities. The recommendations generated are presented to the OFR team’s governing committee, the Public Health and Safety Team (PHAST), that supports and provides resources for implementation. The “We Care, York” initiative was developed based on a recommendation identified during the OFR team’s first case review in June 2021. The recommendation was to create a referral-to-help card that partner agencies could share with at-risk individuals and their loved ones, based off Winnebago County, Wisconsin’s “We Heart You” initiative. “We Care, York” links individuals experiencing a mental health and/or substance use crisis to services and ensures that individuals are aware of resources in the community when they find themselves in need to minimize the stigma associated with seeking help.