Additional levels of crowdsourced data indicate where to help

EL PASO, Texas – Men lined up outside the corner of Hope, a homeless resource center for free delivery in plastic shelves inside a white van.

Some wanted bags with cosmetics or condoms, but others took kits that helped them safely use drugs or naloxone, an opioid overdose antidepressant.

Gilbert Shepherd, an outreach worker at Punto de Partidar, a nonprofit that serves drug abusers, gently questioned those who took the drug safety kit. A man wearing sunglasses and a black T-shirt explained that a long time ago he ate a pill he bought for 1. 1.50 and within minutes he was gone for hours. A man wearing a plaid shirt and khaki pants described seeing someone overdose after taking blue pills a month ago.

Connecting these two overdose texans will be added to a new Texas database called the Overdose Prevention Effort, which aims to improve drug overdose tracking across the country’s second-largest state.

The University of Texas Project, known as TxCOPE, is an attempt to solve a problem that annoys officials across the country who are trying to reduce the record number of drug deaths: getting an instant, accurate picture of excessive doses of unnecessary and deadly drugs. Community groups are now using TxCOPE’s data dashboard and heat map to see where overdose spikes are occurring and then target those hot spots through prevention efforts such as naloxone training and supplies, says Christopher Bailey, project coordinator at Project Vida, El Paso. .

A photo shows Gilbert Shepherd talking to someone out of sight.
Gilbert Shepherd, an outreach worker at Punto de Partidar, a harm reduction group in El Paso, Texas, helped keep drug users alive by handing out an opioid overdose reversal medicine, Naloxone. He is helping to gather data about overdoses for a new crowded Texas database called Texans Connecting Overdose Prevention Efforts, which aims to improve overdose tracking and prevention efforts across the state.(Renuka Raisam / KHN)

According to Leo Belletsky, a public health law expert at Northeastern University, this is one of the few projects to pool crowdsourced overdose data from loss-reducing groups in a systematic way. Such projects compensate for the lack of an accurate picture of the overdose crisis for decades. “It’s scandalous,” Belletsky said.

According to the Center for Disease Control and Prevention, more than 107,000 Americans died of drug overdose in 2021. But there is no national count of how many people have survived drug overdoses. The CDC also does not have a standard method that states can use to calculate unexpected overdoses. It collects overdose data from emergency room visits based on the clinical and billing codes of participating states, but it excludes people who do not contact the medical system, said Bradley Stein, director of the Rand Opioid Policy Center. It’s a “huge blind spot,” Stein said.

Also, data on severe overdoses are often published weeks or months later, once a government medical examiner’s report or toxicology results show that the cause of death has been caused by any substance. “We’re looking at rearview mirrors with opioids,” Stein said.

Other projects that calculate unforeseen overdoses, such as ODMAP, rely on reports from law enforcement or first responders. But Tracy Green, professor and director of opioid policy, says many drug users do not call emergency services or report overdose for fear of harm to their children or residence due to arrest, deportation, or drug use. Brands is a research associate at the University.

“Simply put, current national data systems are not compatible with overdose epidemic levels,” he wrote. Rahul Gupta, director of the National Drug Control Policy Office, called for action, published in JAMA on June 30. He added that creating a good data system is essential and that his agency is working with other federal agencies to improve unexpected overdose data tracking.

Nationally, Green estimates, about 50% of fatal overdoses have not been reported, with stricter law enforcement and higher low numbers among the caste community. The missing part of the photo is “a very diverse one,” he said.

In Texas, an overdose of up to 70%, mostly unexpected, has not been reported, according to Casey Clubburn, lead researcher on the TxCOPE project and an assistant professor at Dell Medical School in UT and the Steve Hicks School of Social Work.

Officially, in 2021, about 5,000 Texans died due to drug overdoses. Claiborne believes this is also a low count, as only 15 of the state’s 254 counties have offices of medical examiners. Most counties have peace judges who do not always request expensive toxicology tests to determine the cause of death. The state recorded about 4,000 opioid-related calls to the Texas Poison Control Network last year and visited about 8,000 opioid-related emergency rooms in 2020. Clabourne analyzes how TxCOPE compares data with official statistics.

Drug experts are frustrated that the United States is not treating the overdose epidemic with urgency for Kovid-19. Illegal fentanyl, which is said to be 50 to 100 times more potent than morphine, has increased drug mortality during the epidemic, flooded the country’s street drug supply and alienated people from supporting substance abuse. But public health authorities lack real-time data on expert and outreach staff to respond to their interventions, which could save the lives of drug users, based on local epidemiological restrictions on covid caseloads and death numbers.

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

This information can help health workers identify which areas should be blanketed with naloxone or educate their people about batches of drugs containing the deadly fentanyl.

TxCOPE, a state opioid grant and funded by the Federal Drug Abuse and Mental Health Services Administration, began in El Paso in June 2021 and then expanded to Austin, San Antonio and later Williamson County. An official launch is planned for September 1, with rollouts to the rest of the state in phases.

Before the group started, the outreach was more random. Bailey said with Project Vida, “It was like a catch-up catch. Like many harm reduction groups, they will unofficially track overdoses, which often occurred within the traveling population. But they had no way of pooling that information with other groups in the city or creating maps to run outreach. TxCOPE has helped the group find the pockets of people at risk so they can provide their overdose prevention, peer support, or treatment referrals. Now “you can really make a home in those areas with a laser-like focus,” he said.

For example, Punto de Partida outreach activist Paulina Hijra said she regularly meets people who find their friends dangerous and ineffective homemade overdose remedies – either a mixture of milk or water and salt – or drink naloxone and never call the authorities. Since outreach workers have built trust in their community, they say, they can gather information about overdoses, including when and where they occurred, which would normally be excluded from official statistics.

One photo shows Gilbert Shepherd and Paulina Hijra standing next to each other in a car.
Gilbert Shepherd and Paulina Heiser are two outreach workers in Texas who have begun collecting information on drug overdose. Data is used to create heat maps to see where excess levels have risen and then target those hot spots with prevention efforts.(Renuka Raisam / KHN)

Privacy is a key feature of the TxCOPE project – people need to be able to share additional levels of information without fear of consequences, says Klaborn. Texas passed a law in 2021 aimed at protecting people who call emergency services during overdoses from arrest, but it is briefly useful. Individuals who have been convicted of drug offenses, for example, are not eligible. And no one escaped arrest once. TxCOPE has a federal certificate of confidentiality that protects it from court orders and does not share raw data with the state of Claborn.

Claborn wants to use the project, which is being restructured before launch this summer, to bring more federal dollars into the state. “We had a hard time proving there was a real problem in Texas because it was hidden,” he said.

He is working on a feature that will allow anyone in the community to report overdoses, in an effort to improve counts in some parts of the state without damage reduction groups. Finally, Claborn wants to test the crowdsourced data against the toxicology report.

For now, though, the project relies on fictitious evidence from drug users and others in the community who see someone being resuscitated with naloxone or seeing someone lose consciousness or suffer other effects of overdose.

On a recent afternoon, Shepherd and Heather recognized a man in El Paso’s Houston Park. He told them about a woman who died alone in his apartment about a week and a half ago after taking a mixture of drugs. He also mentioned a man he was able to resuscitate with naloxone about two months ago. The details were minimal.

Researchers and damage reduction groups say the nebula data are better than they were in the past. Although the project’s anecdotal data aren’t thoroughly verified, the move toward timeliness is great, Stein said. “We have nothing left now,” he said.

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