Module 2

Review Aggregate and Case-Level Data

Both aggregate and case-level data can be used to answer key questions about the local overdose crisis. Aggregate or population-level data typically are used to answer key investigation questions.

Case-level data are used for conducting overdose fatality reviews (OFR), post-overdose outreach, or establishing linkages to care. Case-level data may also be used to link or combine datasets to investigate population-level overdose risks and trends.

Open discussions about what data are needed for what purposes can help PHAST partners address knowledge gaps and mutually agreed upon solutions to move their work forward.

For example, non-fatal overdose data from first responders may be used as aggregate-level data or case-level data to answer different key questions about the local overdose crisis (See Table 5 in the PHAST Toolkit for more examples):

Assess Shared Understanding

Assessing partners’ shared understanding of substance use disorders (SUDs) and the overdose crisis can help a PHAST determine what knowledge gaps may need to be addressed to facilitate effective multi-sector collaboration. Partners may review the questions below and then determine where additional discussion or resources may be beneficial.

What is our current shared understanding about:

• The science of drug use and SUDs. (Do all partners agree that a SUD is a treatable, chronic disease and that overdose is a preventable injury?)
• Stigma of SUDs and its impact. (Do we use stigma-reducing language in our discussions?)
• Harm reduction (Do we have a clear vision of what harm reduction strategies include?)
• Compassion fatigue and the need for responder wellness. (Do we know which local frontline workers are at risk of compassion fatigue and what the impact may be?)
• Social determinants of the local overdose crisis. (Can we identify social factors that contribute to the current overdose crisis?)
• Effective substance use treatment, including Medication for Opioid Use Disorder (MOUD)/ Medication Assisted Treatment (MAT)? (What are our shared perceptions about various treatment and recovery strategies?)

For a list of resources on each of these topics, please see the Resources Table on SUDs and the Overdose Crisis.

Assess Data Availability and Data Gaps

Partners may work together to determine which key investigation questions can be answered with available data. Through this process, PHAST partners can increase their collective understanding of the local crisis and establish an inventory of available data and identify data gaps.

For each question, PHAST members are encouraged to identify which partner (and agency) can answer the question with the data they collect or manage.

Key Investigation Questions to discuss among all PHAST partners:

• What is the overdose death rate, by substance/poly-substances, in our jurisdiction?
• What is the non-fatal overdose rate in our jurisdiction?
• Where are overdoses happening in our jurisdiction?
• Are we seeing a spike in overdoses or overdoses involving a specific type of drug or combination of drugs?
• Who is overdosing and in need of treatment and support services?
• What are the local opioid prescribing practices and trends?
• What is in the local drug supply? (What types of illicit drugs are commonly used? What, if any, adulterants are present in these illicit drugs that have the potential to cause serious health issues?)

If questions cannot be answered, partners may brainstorm and prioritize potential data sources that may be used to answer these questions.

Use the Data Inventory Table, to track your jurisdiction’s data availability and record next steps for obtaining, sharing, and using local data.

Improve Data Access and Data Use

After working through the key investigation questions, a PHAST may discover critical data gaps. If this is the case, PHASTs may decide to invite additional partners that are stewards of key data sets to join their PHAST and provide access to new data sources.

If your PHAST has identified a critical data gap, you may consider using or discussing the benefits of using the following approaches:

• Data Mapping
• New data analysis methodologies or approaches
• New data collection
• Sequential Intercept Mapping

More information about these approaches can be found on pages 40-46 in the PHAST Toolkit.

Establish Simple Data Sharing Practices

Simple data sharing is the most basic and fundamental way data can be used at the local level to develop a shared understanding of the overdose crisis. It typically involves each agency or set of agencies that collect data in disparate ways, sharing aggregate data.

With the help of your PHAST data analyst(s), partners can attend data presentations and learn:

• what types of data related to the overdose crisis are collected by different partner agencies,
• what the data reveal about the local crisis, local resources, or potential needs, and
• what data gaps may need to be filled to improve the quality of the data for a specific purpose.

Organize Topical Presentations By Partners or Expert Guest Speakers

PHASTs may bring in guest speakers who can describe existing programs or interventions already underway in the jurisdiction or elsewhere. Part of the collaborative learning process may also involve developing shared terminology, addressing stigma, and learning about local contextual factors as well as existing prevention programs and resources. Potential topics include:

• Stigma and myths of substance abuse disorders (SUDs)
• Local programs or interventions serving people with an SUD
• Data mapping of non-fatal and fatal overdoses, 911 overdose calls, first responder naloxone administration, or available prevention, treatment, and recovery services
• Frequency and location of people experiencing fatal and non-fatal overdoses
• Emerging drug threats and drugs associated with overdoses
• Risk factors associated with overdoses
• Available resources and barriers in the community
• Characteristics of people experiencing overdoses in the community
• Overdose spikes

Facilitate Data-Driven Discussions and Collective Interpretation

Data analysis results and presentations are intended to serve not only as a method of “reporting out” updates to partners but also a catalyst for data-driven discussions. Follow the guidance below to build capacity of the PHAST to interpret data together.

• After sharing data tables or charts, provide explanation and opportunity for discussion.
• Examine data as a group to gather input and perspectives from multiple sectors and help shape the interpretation and contribute to a more holistic understanding of the overdose crisis.
• Leverage partners’ collective experience and expertise can be used to make sense of discrete data elements and the overall opioid overdose crisis.

With a comprehensive understanding, discussions can then move to systems-level problem-solving.

Identify Gaps and Needs

As partners share data with one another about the local overdose crisis, one key question to keep in mind is, “What does this mean?”

Often, data may reveal gaps, needs, or barriers in the community. Following each data presentation or data sharing activity, PHASTs are encouraged to collectively identify:

• underlying problems, issues, gaps, and needs revealed by the data, and
• implications and actionable insights.

Suggested discussion questions include:

• What insights can be drawn?
• What are the implications?
• What is the big picture?
• What does this mean for people at risk for overdose in our community?
• Do we have enough information or is more analysis necessary?
• What factors may be contributing to this?
• What additional questions does this raise?

At the end of each discussion, partners should have a shared understanding of local needs, gaps, and barriers relevant to the data that were shared.

By connecting data to its broader implications, data sharing will become more purposeful, partners will be better prepared to make sense of the evidence, and the PHAST will be primed to connect insights to action.