Abstract
On August 15, 2016, the Mayor's Office of Drug Control Policy in Huntington, West Virginia, notified the Cabell-Huntington Health Department (CHHD) of multiple calls regarding opioid overdose received by the emergency medical system (EMS) during 3 p.m.-8 p.m. that day. A public health investigation and response conducted by the West Virginia Bureau for Public Health (BPH) and CHHD identified 20 opioid overdose cases within a 53-hour period in Cabell County; all cases included emergency department (ED) encounters. EMS personnel, other first responders, and ED providers administered the opioid antidote naloxone to 16 (80%) patients, six of whom were administered multiple doses, suggesting exposure to a highly potent opioid. No patients received referral for recovery support services. In addition to the public health investigation, a public safety investigation was conducted; comprehensive opioid toxicology testing of clinical specimens identified the synthetic opioid fentanyl* and novel fentanyl analogs, including carfentanil,† which had been used by patients who overdosed in Huntington. Results of these two investigations highlight the importance of collaboration between public health and public safety agencies to provide in-depth surveillance data from opioid overdose outbreaks that involve high-potency fentanyl analogs. These data facilitated a public health response through increased awareness of powerful opioid substances requiring multiple naloxone doses for reversal, and improved patient linkage to recovery support services and a harm reduction program from the ED after opioid overdose.
Highlights
Patient administration of the opioid antidote naloxone during an opioid overdose outbreak can save lives; little is known about follow-up care after resuscitation of patients who experience overdose during an outbreak
Development of public health and public safety partnerships for substance identification, and of strategies to link overdose patients to recovery support services at the point of resuscitation, might reduce missed opportunities to engage persons who use illicit opioids
Summary
Contained key terms in these sections: Medication administration: Naloxone, narcotic antagonist Dispatch complaint: Ingestion, poisoning Chief complaint: Overdose, heroin Procedure: Airway, bagged Drug use indicator: Drug Diagnostic impression: Poisoning/Drug ingestion. Public safety officials conducted a separate investigation of this opioid overdose outbreak in conjunction with legal proceedings; this investigation included comprehensive opioid toxicology testing of clinical specimens obtained from the treating EDs. In October 2016, the BPH Office of the Chief Medical Examiner (OCME) and the Drug Enforcement Administration confirmed the first carfentanil-related death in Cabell County, which occurred within days of the August 15, 2016 outbreak [2]. ** Mortality and drug testing data from Cabell County during the study period was not immediately available to public health investigators because of legal constraints These data were reported to public health investigators separately in March 2017. After receiving public health investigation findings that no opioid overdose patients who met the case definition had been referred for substance use disorder treatment, CHHD and local ED staff members improved referral protocols for overdose care and recovery support services. Local EDs coordinated with substance use–disorder treatment facilities to pilot multidisciplinary response teams that follow up with patients who experience opioid overdose and ensure linkage to care availability after ED encounters (e.g., direct connection to CHHD harm reduction program staff members)
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