Big Data and the Opioid Epidemic

As the opioid crisis continues to devastate communities across the nation, public health and policy experts recently gathered to discuss how data can help inform national and local responses to mitigate the epidemic. The briefing, “Big Data and the Opioid Epidemic,” was organized by amfAR’s Public Policy Office and held at the Kaiser Family Foundation on December 4 in Washington, D.C.

Representatives from the Centers for Disease Control and Prevention (CDC), academia, and think tanks including the American Enterprise Institute, Center for Budget Policy and Priorities, FasterCURES, and the Kaiser Family Foundation engaged in a lively discussion. Topics included the current landscape of the opioid crisis, the challenge of averting opioid-related health crises such as the 2014 HIV and hepatitis C outbreak in Scott County, Indiana, and the importance of data collection, analysis, and sharing in helping researchers and policymakers establish new, public health-oriented approaches.

The demand doesn’t meet what’s available  

Even with President Trump’s declaration of the epidemic as a public health emergency in November, and the subsequent release of recommendations from the White House opioid commission, there was general consensus among the experts that much more needs to be done.  ‘‘The demand doesn’t meet what’s available,” said amfAR Vice President and Director of Public Policy Greg Millett, comparing the rising rates of opioid-related deaths and increased populations at risk of HIV with the limited available funding and effective interventions, such as syringe services programs, to stem the crisis.

Millett also moderated a series of presentations from featured speakers including John Brooks, M.D., a medical epidemiologist from the CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Dr. Brooks provided an in-depth look at how the CDC identified 220 U.S. counties at risk of an HIV and hepatitis C outbreak due to injection drug use. The CDC estimate was based on factors including drug overdose deaths, prescriptions opioid sales, and poverty rates.

Christopher Ruhm, Ph.D., Professor of Public Policy and Economics at the University of Virginia, highlighted how faulty data collection can lead the American public to underestimate the severity of the nation’s opioid epidemic, often caused by incomplete reporting of fatal drug overdoses. According to Ruhm, drug overdoses that kill people often involve more than one type of drug. However, when information is entered on a person’s death certificate, the specific types of drugs are not always recorded and in many cases “unspecified drugs” are listed as the cause of death. Ruhm raised the point that when we build responses to the epidemic on poor quality data, we run the risk of misdiagnosing the interventions that are required or useful.

And Jeffrey Crowley, MPH, Distinguished Scholar, Georgetown Law School, and Former White House Director of National AIDS Policy under President Obama, underscored the importance of having a clear focused set of prioritized strategies that can be implemented. He raised the concern that while the White House opioid commission’s recommendations are solid and appropriate, there are so many areas on which to focus that the response risks becoming stagnant as state and local officials work through the important first steps and try to determine which recommendations can actually be achieved. He also emphasized that the Commission’s recommendations left out one of the core prevention and harm mitigation strategies that state and local governments should be focused on in relation to the opioid epidemic and its intersection with HIV and hepatitis C – syringe exchange programs.

A critical source of data

The briefing also featured a demonstration of new updates to amfAR’s Opioid & Health Indicators database – a free online resource that graphically displays data across three interrelated public health crises: opioids, hepatitis C and HIV. Features include new Indicator pages that allow users to view national opioid, HIV, and hepatitis C data as well as services that are available at the state and county level including substance abuse treatment facilities and syringe exchange programs. Users can also map local impact, monitor local trends and create side-by-side state or congressional district maps of opioid use and prescription rates. And improved download functionality enables researchers and advocates to use the data to further their analyses and advocate for improved policies.