OMAHA -- When someone dies of a drug overdose, family members, friends and others are left to anguish over what went wrong and what might have been done to prevent the tragedy.
A team formed by the Douglas County Health Department and backed by local partner Coalition Rx aims to help prevent such deaths by digging deeper into those questions.
To that end, the Douglas County Overdose Fatality Review team seeks to conduct confidential case reviews of overdose deaths in the county. The aim is to examine cases systematically, looking at what interventions were in place, said Leah Casanave, the Douglas County Health Department’s division chief for community health, nutrition and clinical services.
"It's the best place for us to find out what is failing folks," she said. Such reviews also can help indicate whether intervention programs are working as intended.
One challenge for the team has been getting the local data they need to complete the reviews, Patty Falcone, the Health Department's supervisor of health promotion, told the Douglas County Board of Health in October.
The state sends data to the federal Centers for Disease Control and Prevention, Casanave said. But because overdose deaths are not a condition health officials are required to report, like measles and polio, the team can get general data, such as numbers, but no details about individuals. State and federal reports also lag by a year or two.
To help remedy the lack of local data, state Sens. Tony Vargas and Megan Hunt, both of Omaha, introduced a bill (LB570) that would create a template for county-level overdose fatality review teams in the state. The teams would be allowed to obtain and review records and other documentation related to overdoses from "relevant agencies, entities and individuals" while remaining in compliance with confidentiality laws.
"It's important for us to bridge that gap," said Carey Pomykata, executive director and co-founder of Coalition Rx, a local nonprofit working to prevent substance abuse. "We need to have some real-time data when it comes to this."
Available data indicates that overdose deaths have been on the rise, both nationally and in Nebraska. Nationally, the rate of overdose deaths increased by 31% from 2019 to 2020. That year, overdoses killed 91,799 Americans, according to the CDC.
Nebraska recorded , according to CDC's State Unintentional Drug Overdose Reporting System. At least one opportunity for intervention was documented in 53% of those deaths. A potential bystander was present in 30% of deaths, indicating that there may have been an opportunity to provide lifesaving actions.
In 2021, the state recorded 174 overdose deaths. The per capita rate of 9.4 deaths per 100,000 residents was the lowest among the 32 reporting jurisdictions, which included Washington, D.C.
According to the bill, LB570, the local team's review could include the person's points of contact with health care systems, social services, schools, law enforcement, the criminal justice system and other organizations.
Anything discussed by the team, Casanave said, would stay within the team. Prosecutors would not be able to access and use such information.
"We're just trying to find the best way to protect people from future overdoses," she said.
The overdose fatality review team would function similarly to the county health department's Fetal Infant Mortality Review team, which gathers information about infant deaths from medical and public health records. Those records may be supplemented by voluntary interviews with the mother by a public health nurse trained in grief counseling, assessment and community resources.
The team then provides information to the Baby Blossoms Collaborative. That local group, comprised of representatives from up to 40 health and social service organizations, reviews the team's findings to determine whether additional actions might help head off problems in the community. One such step, both nationally and locally, has been successful campaigns to promote safe sleeping positions for babies.
Similarly, the overdose death review team's findings would be shared with a collaborative group created by Coalition Rx, which would look at the data and determine prevention strategies.
Casanave said the Douglas County team, which was funded by the state with federal dollars, is piloting the program. She hopes to see other large counties in the state follow suit.
Pomykata said there are close to 400 overdose fatality review teams across the country. She and Falcone were in Washington, D.C., last week attending a national forum on the topic. Pomykata said they hope to learn what others involved in the work have been through and what they've learned.
"We've got to find out what the gaps in communities are so we can put a stop to this," Pomykata said.