Cuyahoga County Board of Health Cuyahoga County Overdose Data to Action Initiative (OD2A) Yearly Evaluation Report September 1, 2019 – August 31, 2020 Funded by: Centers for Disease Control and Prevention Grant Number: CDC-RFA-CE19-1904 Evaluated by: The Begun Center for Violence Prevention Research and Education Jack, Joseph and Morton Mandel School of Applied Social Sciences Case Western Reserve University 11402 Bellflower Road Cleveland, Ohio 44106 1 | P a g e Acknowledgements The Begun Center for Violence Prevention Research and Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University promotes social justice and community development by conducting applied, community-based and interdisciplinary research on the causes and prevention of violence, and by educating and training social workers, teachers, law enforcement and other professionals in the principles of effective violence prevention. The Center also develops and evaluates the impact of evidence- based best practices in violence prevention and intervention, and seeks to understand the influence of mental health, substance use, youth development and related issues on violent behavior and public health. This publication was supported by grant, 5-NU17CE925005-02-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. We wish to acknowledge the following individuals’ contribution to this report: The Begun Center Dan Flannery, PhD, Director Michelle Riske-Morris, PhD, JD Senior Research Associate Karen Flynn, PhD, Senior Research Associate Rodney Thomas, MA, Senior Research Associate Junghyae Lee, PhD, Research Associate Sarah Fulton, M.A., Research Associate Angela Kavadas, MPH, Research Associate Edward Dabkowski, MA, Research Associate Ryan McMaster, BA, Research Data Manager David Rinderle, BA, Research Assistant Emily Szymanski, MLIS, Research Assistant Ivette Noriega, PhD, Postdoctoral Scholar Cuyahoga County Board of Health Vincent Caraffi, MPH, RS, Supervisor Rebecca Karns, MPH, Program Manager April Vince, MSSA, LSW, Program Manager Samantha Smith, MA, MS, Supervisor Lauren Bottoms, MPH, Data Analyst Kyle Idahosa, MPH, Data Analyst 2 | P a g e Table of Contents I. Executive Summary ............................................................................................................................. 11 II. Overview ............................................................................................................................................. 21 III. Strategy 3 ........................................................................................................................................ 22 Table 1 ..................................................................................................................................................... 23 Short-Term and Intermediate Outcomes for Overdose Review and Identification of High Burden Areas ................................................................................................................................................................ 23 Table 2 ..................................................................................................................................................... 26 Overdose Responses and Related Deaths in Select Cuyahoga County Cities: 2017-2019....................... 26 Table 3 ..................................................................................................................................................... 26 Ratio of total overdose responses from public safety entities data (both fatal and nonfatal) to drug- related overdose deaths for Cleveland, Parma and Lakewood per CCMEO “place of death” records: 2017-2019 ............................................................................................................................................... 26 Table 4 ..................................................................................................................................................... 28 Cleveland EMS “Overdose/Poisoning” Incident Responses (Top Locations) May 2019 to April 2020 .... 28 Figure 1 ................................................................................................................................................... 29 Merging Zip Code-Level Data to Identify High Burden Areas of Drug Overdose .................................... 29 Figure 2 ................................................................................................................................................... 30 Mapping EMS Agencies Naloxone Administration by Doses for the Year 2019 ..................................... 30 Table 5 ..................................................................................................................................................... 31 Short-Term and Intermediate Outcomes for Identification of Additional Risk Factors from OFR .......... 31 Table 6 ..................................................................................................................................................... 32 Short-Term and Intermediate Outcomes on Identification of Prevention and Intervention Opportunities ................................................................................................................................................................ 32 Table 7 ..................................................................................................................................................... 33 Short-Term and Intermediate Outcomes on Identification of QRT Outreach ......................................... 33 Table 8 ..................................................................................................................................................... 35 Short-Term and Intermediate Outcomes on Identification of Education and Training Needs for Medical Providers ................................................................................................................................................. 35 Table 9 ..................................................................................................................................................... 36 Short-Term and Intermediate Outcomes for the Development of Communication Network ................. 36 Figure 3 ................................................................................................................................................... 38 CCMEO Data - Visualized for Dashboard (Example) ............................................................................... 38 3 | P a g e Figure 4 ................................................................................................................................................... 39 EpiCenter and Naloxone Administration Data - Visualized for Dashboard (Example)............................ 39 Figure 5 ................................................................................................................................................... 40 Data Bulletin / Infographic (Example)..................................................................................................... 40 IV. Strategy 4 ........................................................................................................................................ 41 Table 10 ................................................................................................................................................... 41 Short-Term and Intermediate Outcomes for Enhancing PDMP Review and Reporting of High-Volume Prescribers ............................................................................................................................................... 41 Figure 6 ................................................................................................................................................... 43 Summary of MetroHealth Provider OARRS Checks When Issuing Opioid Prescriptions: September 1, 2019 to August 31, 2020 ......................................................................................................................... 43 Figure 7 ................................................................................................................................................... 44 Number of MetroHealth Providers who Checked OARRS at least once When Issuing Opioid Prescriptions: September 1, 2019 to August 31, 2020 ............................................................................ 44 Table 11 ................................................................................................................................................... 45 Short-Term and Intermediate Outcomes for Developing Toolkit ............................................................ 45 Table 12 ................................................................................................................................................... 47 Short-Term and Intermediate Outcomes for Expansion Peer Review Model to Additional Hospitals and Implementation of PDMP review in Non-Traditional Healthcare Settings ............................................. 47 V. Strategy 5 ............................................................................................................................................ 48 Table