Following Epidemiological Data to Their Logical (if unexpected) Conclusions

The Commonwealth of Massachusetts was awarded a five-year Strategic Prevention Framework State Incentive Grant (SPF-SIG) in October 2006 from the Substance Abuse and Mental Health Service Administration’s Center for Substance Abuse Prevention (SAMHSA/CSAP).  The grant, called the Massachusetts Collaborative for Action, Leadership, and Learning (MassCALL2), was administered by the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services (BSAS) with guidance from a state-level advisory group.  The overarching goal of this initiative was to reduce substance abuse-related problems in communities.   

As part of the first step of the Strategic Prevention Framework process, the state formed the Massachusetts Epidemiological Workgroup (MEW).  The MEW, which was comprised of senior epidemiologists and representatives from a wide cross-section of state agencies (e.g., public health, public safety, education, social services), undertook a year-long assessment of national and state-level epidemiological data sources to inform the selection of a priority substance abuse related problem on which to intervene.  Eighteen different data sources (9 national and 9 state) were examined as part of the epidemiological assessment.

Based on the results of the MEW’s assessment, the state identified unintentional (i.e., non-suicidal) fatal and non-fatal opioid overdoses as the priority issue for its SPF-SIG grant. This determination was based on data showing that poisonings, which include drug overdoses, were the leading cause of injury death in Massachusetts at the time of the assessment – even surpassing the number of deaths from motor vehicle injuries.  The proportion of poisoning deaths associated with an opioid-related poisoning increased from 28% in 1990 to 68% in 2005. Additional data on non-fatal overdoses collected from acute care hospitals revealed a 19% increase from 2002 to 2005 in the rate of emergency department visits for non-fatal opioid overdoses, and a 63% increase from 1999 to 2005 in the rate of inpatient hospitalizations for non-fatal opioid overdoses.

This portion of the panel symposium will describe the process and criteria the MEW used to identify the MassCALL2 priority issue, demonstrate how following epidemiological data can lead to unexpected conclusions, examine the implications of this decision on the state prevention system, and identify the actions (interventions) that were delivered as a result.  Specific attention will be paid to discussing how the state was able to use epidemiological data to defend its decision to adopt downstream interventions (i.e., harm reduction approaches) rather than more traditional primary prevention strategies.