Resource Library

The city of Chicago, Illinois, is home to more than 2 million people. In 2021, the city lost 1,316 community members because of drug overdose.* The city had previously explored implementing an overdose fatality review (OFR) to support the existing programs offered throughout the city to address drug overdose, but it lacked the staff to work through the initial planning process. In spring 2022, the Chicago Mayor’s Office and the Chicago Department of Public Health partnered with the Overdose Response Strategy (ORS) public health analyst in Illinois to begin the process of developing an OFR for the city. This presentation demonstrates the impact of leveraging existing partnerships to build a robust OFR program and highlights the effective utilization of existing resources such as the Bureau of Justice Assistance’s Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) technical assistance tools and state and national ORS program subject-matter experts in the field. In addition, this presentation will walk through challenges faced by the Chicago OFR planning team, such as refining case selection methodologies and data sharing scenarios in a state without legislation specific to OFR, and draw attention to the innovative solutions and recommendations that resulted from these challenges.

*Source: Illinois Department of Public Health Death Statistics: Drug Overdose Death by County.

The New York City, New York (NYC) RxStat initiative was established in 2012 and has included overdose fatality review (OFR) meetings since 2016. The past 2 years have brought many changes to RxStat. Today, RxStat has three meeting types, each with a clear goal and structure. These meeting types include:

• Drug trends meetings, which focus on high-level overdose trends and policies.
• OFR meetings, designed to unearth missed opportunities for overdose prevention and intervention.
• Action meetings, which create shared accountability and result in concrete recommendations and action items.

NYC has more than 2,000 fatal overdoses each year; the RxStat initiative cannot hope to review every case in its OFR meetings. Instead, it selects cases by theme to help focus the conversation in each OFR. Then, a subsequent action meeting focuses on how to take the gaps identified during the OFR and turn them into specific, achievable recommendations. In this presentation, the RxStat initiative will provide an overview of the goals and structure for all three meeting types and provide one to two case studies that provide an overview of:

• A theme the RxStat initiative chose for an OFR meeting.
• The process for selecting OFR cases that fit that theme.
• Gaps identified during the OFR meeting.
• Recommendations generated by the action meeting, including any workgroups created.
• Final actionable outcomes that resulted from the process.

This presentation showcases how RxStat moves from OFR case review to action and will provide examples of OFR themes that have resulted in fruitful discussion and action in NYC.

Overdose fatality review (OFR) teams represent multisector community stakeholders coming together to address substance use challenges in their communities. The heart of the work that these teams do is the development of recommendations—for the agencies, the community, the region, and the state. What if we conceptualize the work of the OFR as community systems development? What can happen when the team itself becomes the subject of recommendations (e.g., we recommend that this team help move our local system through the stages of the community readiness model)? If we start to track and show the outcomes of that—how individual agencies made process/policy changes or the new connections or collaborations made across team members’ agencies—those can be leveraged to set the foundation for continued, and more complex, efforts. This presentation discusses the case study of the LaPorte, Indiana, OFR team and how its work and collaboration contributed to the county being awarded a “community catalyst” grant to develop and implement a crisis intervention team (CIT). This effort will involve the participation of every law enforcement jurisdiction in the county and training for officers on utilizing the community system to provide appropriate responses and resources in crisis incidents such as overdose, suicide, or domestic violence. Patterns and recommendations identified by the OFR team can inform planning stage processes and training decisions. The OFR team will then have the unique ability to evaluate practical outcomes of CIT responses in future case reviews to provide a direct feedback loop for continuous improvement recommendations.

Established in 2018, the Winnebago County, Wisconsin, overdose fatality review (OFR) team has pursued numerous recommendations that have positively affected the community over the past 4 years. This plenary session will highlight recommendations that came out of Winnebago County’s OFR team meeting and were implemented to connect people to resources, utilize peer-led programs, break stigmas, and begin changing the culture of an entire community.

After the OFR team discovered that few OFR cases had connections to the recovery community, the team recommended to support and expand a substance-free culture that engages many stakeholders in the community and focuses on the support of individuals and families that are on a path to recovery. The initial phase of implementation included adding people in recovery to the OFR table, starting a sounding board to understand the relevance of OFR recommendations, and hosting community conversations with people in recovery to better understand their journeys and how the community could be more supportive. Participants will learn how this recommendation grew to be the “We Heart You” campaign, which included the creation of the We Heart You resource and referral card, the implementation of a public service announcement (PSA) focused on how to use the card, and the hosting of a community event. Ripples in the community were created from this event, and since that time, Winnebago County has created the We Heart You App, a peer-led rapid response team, and a PSA that breaks down the stigma of people who have been impacted by substance use disorder and humanizes recovery. After this session, the PSA video will be made available to any community that needs an inspirational template on the thriving recovery community with inputted local resources. 

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.

According to the Minnesota Department of Health’s (MDH) 2021 Overdose Data Report, Black Minnesotans are three times more likely to die of a drug overdose than white Minnesotans. As home to one of the largest Somali populations in the nation, Minnesota’s Somali community has been underrepresented in overdose data. When collecting data on race and ethnicity, Somalis are often classified solely as Black, with no mention of the relevant ethnic subgroup. In 2017, MDH identified that the state lacked specific data to address the needs of the Somali community. Voices from the community demonstrated anecdote stories of overdoses of Somali youth. To address this issue, MDH launched pilot overdose fatality reviews (OFRs) in 2019, which recommended applying the OFR model using a culturally specific lens in the Somali community. The following year, using funding from the Centers for Disease Control and Prevention Overdose Data to Action grant, MDH partnered with Alliance Wellness Center—a culturally specific provider specializing in treatment and recovery for Somalis. During OFR implementation training, the OFR team lead shared concerns about the deeply rooted stigma surrounding overdoses in the Somali community as a barrier to community participation and facilitation of OFRs. To address the cultural stigma and build organizational capacity, the OFR team conducted prevention interviews before implementing OFRs in the community. Through these deep conversations, the OFR team captured the Somali community’s collective voice and identified barriers preventing community discussion on overdose deaths.