This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Drug overdose death rates have reached a record high. Effective responses to the overdose epidemic require accurate and timely drug overdose surveillance data. Death certificates are the foundation of overdose mortality surveillance; however, long turnaround times for issuing finalized death certificates in suspected drug-related deaths hinders surveillance activities and prevents rapid responses by public health programs. Coroners and medical examiners (C/MEs) play a critical role in generating data for the medical certification section of death certificates. These data are routinely collected immediately after the overdose fatality occurs and provide an opportunity to rapidly examine the circumstances of death and inform time-sensitive activities in response to fatal overdoses. The New York City (NYC) Office of Chief Medical Examiner (OCME) developed a tool that uses data generated during death investigations to identify drug overdose deaths in near real-time. This tool, named the Suspected Potential Overdose Tracker (SPOT), uses a small number of variables routinely collected by death investigators in a rigorous and reproducible algorithm to rapidly predict whether a death was an unintentional drug overdose. While preliminary findings show that SPOT is highly promising for identifying fatal overdoses in near real-time, there is a need to further enhance the tool, examine its performance across different subpopulations, and assess its performance and usability outside of NYC. Thus, this study aims to (1) Optimize SPOT through additional data from the NYC OCME to improve performance of the tool and develop advanced features using natural language processing; (2) Assess barriers and facilitators of adopting SPOT in preparation for its deployment through semi-structured interviews with primary and secondary users of SPOT data; and (3) Evaluate the usability and performance of SPOT in C/ME offices across New York State, including counties involved in the NIDA-funded HEALing Communities Study. The public health implications of adopting this tool are significant: 1) it allows for near real-time monitoring of overdose fatality levels and detection of atypical patterns; 2) it provides a mechanism for expedited outreach to family and friends of overdose decedents who may be at high risk for overdose; 3) it allows for identification of gaps in overdose response preparedness and data-driven decision making of public health and public safety agencies; and 4) it affords opportunities for evaluation and consistent information exchange of overdose prevention interventions, programs and policies. If found successful, the SPOT methodology can be readily disseminated to other states to enhance surveillance of drug overdose mortality. This project is highly responsive to a top NIDA research priority, and directly addresses one of the nation’s most challenging public health crises.

PROJECT NARRATIVE This study will comprehensively evaluate and refine a tool, named the Suspected Potential Overdose Tracker (SPOT), that uses data routinely collected during death investigations to identify accidental drug overdose as the cause and manner of death in near real-time. Near real-time data on overdose deaths will allow for data- driven decision making, the identification of gaps in public health and public safety overdose response preparedness, and opportunities to evaluate overdose prevention interventions, programs, and policies.