For preventionists, understanding the epidemiology of synthetic opioid overdoses can be understood by examining the data and focusing on more novel upstream factors for prevention.

A study was conducted using the Centers for Disease Control and Prevention (CDC) WONDER database with a special focus on the ICD-10 (International Classification of Disease and Death) code T40.4 or other synthetic narcotics (Centers for Disease Control and Prevention, 2022a). A data export through WONDER yielded crude rates per 100,000 of opioid overdose deaths at the national, state, and county levels. These rates were converted into 1^st, 2^nd, 3^rd, and 4^th quartiles. Quartiles 1 and 2 have the lowest rates of synthetic opioid overdoses per 100,000. Quartiles 3 and 4 have the highest rates of opioid overdoses per 100,000 population.  Two major findings from this analysis include:

1. The states with the highest number of Quartile 4 counties are: Ohio, West Virginia, Kentucky, Maryland, North Carolina, Pennsylvania, Indiana, New Jersey, Tennessee, and Virginia.
2. Micropolitan (counties of 10,000 to 49,999 residents) and Noncore counties (counties of less than 10,000 residents) have more Quartile 3 and 4 values than large central metro, large fringe metro, medium metro, and small metro counties.

For preventionists, it is important to know an epidemic and know the response needed. To solve a community problem at this level, all actors must collaborate and people who experience the epidemic must be involved in the solutions (Centers for Disease Control and Prevention, 2022b). Strategies that are shown effective against an opioid overdose can be classified as downstream and upstream. Downstream strategies are harm reduction, alternatives to jail, post-overdose education, medication assisted therapy, and naloxone distribution (Minnesota Department of Health, 2020; National Association of City & County Health Officials, 2021). Upstream factors are treatment facilities, stigma reduction, media messaging about addiction, and improving prescribing practices. However, preventionists are encouraged to work more upstream with strategies that prevent opioid addiction (Cannon, 2019). These upstream strategies are:

• Working with community partners to measure stigma related to seeking treatment in the community and strategies that reduce it.
• Measuring and addressing structural racism and prejudice as a risk factor for addiction.  
• Educate partners on the effects of trauma and the benefit of screening for trauma in children, employees, patients, and other community residents. 

References

Cannon, Y. (2019). The kids are not alright: Leveraging existing health law to attack the opioid crisis. Florida Law Review, 71, 765. http://scholarship.law.ufI.edu/fIr/voI71/iss3/3https://scholarship.law.ufI.edu/cgi/viewcontent.cgi?articl e=1434&context=flr

Centers for Disease Control and Prevention. (2022a). WONDER system. www.cdc.gov/wonderpain relievers 

Centers for Disease Control and Prevention. (2022b, June 28). CDC's work is guided by six principles and five strategic priorities to address the overdose crisis. https://www.cdc.gov/drugoverdose/prevention/index.html

Minnesota Department of Health. (2020, October 30). Opioids: Social determinants of substance use & overdose prevention.  https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html

National Association of City & County Health Officials. (2021, August). Identifying the root causes of drug overdose health inequities and related social determinants of health: A literature review. https://www.naccho.org/uploads/downloadable-resources/IdentifyingtheRootCauses- ofDrugOverdoseHealthInequities.pdf