Task Force Uses Contact Tracing to Address Overdose Crisis

Early in the COVID-19 pandemic, contact tracing became a well-known strategy for stopping the spread of the illness. Today, the same tactics are being applied to curb the spread of another threat to public health: drug overdose deaths.

The San Diego CReDO (Community Response to Drug Overdose) Task Force connects public health, public safety, and prevention forces to provide a coordinated response to drug overdoses. Primarily focused on fentanyl, the task force also looks for solutions to address the rise of methamphetamines, as well as safe prescribing solutions and cannabis. Monthly data and case sharing have led to rapid collaboration between the San Diego district attorney’s office and the city’s emergency medical services (EMS) community.

Earlier this year, representatives from the task force discussed their work at the Rx and Illicit Drug Summit in Atlanta, Georgia. Roneet Lev, MD, the first chief medical officer of the White House Office of National Drug Control Policy (ONDCP) and the current chief medical officer for the Center of Community Research in Poway, California, serves as the chair for CReDO. Recently, she spoke with Addiction Professional by email to discuss the task force’s structure, fentanyl screening best practices, and keys for collaboration between public health and public safety forces.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: Can you provide a brief synopsis of how the San Diego CReDO Task Force was created, how it is structured, and what the goals of the task force are?

Roneet Lev: The concept of CReDO (Community Response to Drug Overdose) is borrowed from the National Voluntary Standards Project called CReDO. In 2019, ONDCP, the National Security Council (NSC), and the Department of Homeland Security (DHS) developed the concept of CReDO as a national response to overdose clusters. Voluntary standards were applied to active shooter events with success, and CReDO hoped to accomplish the same for drug overdoses. With the pandemic and changes in administration, the project ended without a national standard. San Diego took the CReDO name and goals to create a local best practice for overdose clusters.

AP: Is the task force focused exclusively on the threat of fentanyl, or are you looking at other illicit substances as well?

RL: CReDO is focused on fentanyl. However, members of the CReDO task force also meet about solutions to methamphetamines, safe prescribing, and cannabis. We learned through our death diary research years ago that people rarely die of a single drug.  We also know that in terms of primary prevention, people rarely start with fentanyl; they start with marijuana.

AP: From your experiences, what are some best practices that you recommend for implementing universal fentanyl testing in hospital drug screens?

RL: Fentanyl testing is available today at any hospital in America, even rural ones. There are 3 FDA-cleared fentanyl reagents that can work in a chemical analyzer machine that is owned by every hospital.  Through our CReDO project we reached out to all 24 hospitals in San Diego County and surveyed current rapid fentanyl testing capacity. After an educational campaign, we increased testing capability by nearly 70% making fentanyl inclusion in drug tests a standard of care.  The project success was the driving force for SB 864, a California bill that would require all hospitals to include fentanyl in their drug panel. The bill passed Senate Health with unanimous bipartisan support.

There is currently no FDS-approved, multiple-drug rapid urine drug test for clinics, so rapid FDA-approved testing is only available at hospitals. Our Hospital Fentanyl Tool Kit is available to any community that would like to get its hospitals to include fentanyl in its rapid urine drug panel.

AP: What are some of the biggest keys for successful collaboration between public health and public safety?

RL: Public health and public safety have the common goal of saving lives. Each silo has their own expertise and data set. Together they are more effective. Public safety provides the medical community intelligence that makes use better doctors. They can teach us about drug trends, neighborhoods that need intervention, and more.

When a man came in after an overdose as a John Doe and on a ventilator, the emergency physician reached out to Team 10 (the overdose team), and they were able to find his family, identify other users who were having chest pain and other symptoms, and remove the fake oxycodone pills that could have killed someone else.

By sending crisis intervention teams to a law enforcement overdose team, we can create a contact tracing method for overdoses. We hope to apply an infectious disease model to overdose as we do for COVID, Shigella, and other infections. Each overdose is a teachable and preventable moment.

AP: Can you share some examples of positive benefits or data showing the impact the launch of the task force has had in addressing the drug overdose crisis?

RL: Who knew babies as little as 6 months old overdose on fentanyl?  This information came to CReDO through the U.S. attorney’s office. A baby received multiple rounds of CPR, intubation, epinephrine without the consideration of fentanyl. After learning about several such cases, CReDO sent communication to all EMS agencies and emergency departments with a case study and medical guidance in always considering fentanyl in an unresponsive baby.  The next month, CReDO learned about another baby overdose, but this time, the baby was revived with naloxone and did not need CPR.

Reference

Lev R, Byrne E, Campman SC. CReDO: Community response to drug overdoses. Presented at Rx and Illicit Drug Summit; April 18-21; Atlanta, Georgia.