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By PIERRE THOMAS, ASHLEY LOUSZKO, DURRELL DAWSON, ERIN BRADY, GENEVA SANDS, ASHAN SINGH and LAUREN EFFRON
A 22-year-old mother in Kentucky who had a little girl. A fifth grader in Miami who had just left a swimming pool. A police officer in Ohio who nearly died during an arrest.
These are just a handful of victims who have suffered fatal or near-fatal opioid overdoses this summer out of the tens of thousands of Americans who grapple with opioid addiction every day.
Opioids are a class of drugs that include the illegal drug heroin and powerful pain relievers available legally with a prescription, such as oxycodone, codeine and morphine, according to the National Institute on Drug Abuse.
The Centers for Disease Control say overdose deaths involving prescription opioids have quadrupled since 1999 and drug overdoses now kill more people every year than gun violence or car accidents.
"One American now dies of a drug overdose every 11 minutes and more than two million Americans are addicted to prescription painkillers," U.S. Attorney General Jeff Sessions said on July 20.
To take an in-depth look at the scope of the opioid epidemic, "Nightline" monitored fatal and near-fatal overdose cases for just one week in July.
Communities across the nation are trying to figure out new ways to pull the country out of this epidemic, from a program in Albuquerque, New Mexico, called "Addict to Athlete" to a family treatment drug court in Erie County, New York, that offers mental health counseling and access to a relapse center.
But health care officials point out that the most recent national report on the total number of opioid overdose deaths, put out by the CDC, is already two years old. There is such a lag in information gathering that many in the public health community have been calling for a national database of real-time tracking known as "syndromic surveillance."
The complicated task of tracking opioid overdoses
The most up-to-date national total of opioid overdose deaths comes from 2015, and complete data from 2016 isn't expected to be available until the end of this year. It takes a significant amount of time for data on the local level to bubble up and be analyzed nationally by the CDC.
By the time the CDC corrects for regional differences in how reports are confirmed, collected and defined, more than a year can pass.
In 2015, more than 33,000 Americans died from opioid overdoses, according to the CDC, which says preliminary data from 2016 suggests the total number of overdose deaths will increase.
Daniel Ciccarone, an associate editor for the International Journal of Drug Policy and professor at the University of California San Francisco School of Medicine, said the lag time of a year is an improvement from how data was collected a few years ago, but it’s still a problem for understanding the scope of the current epidemic.
"The numbers are extraordinary and it's easy to get kind of numbed when you're in that kind of event when you say, 'well, this has had more deaths than the Vietnam War, this has had more deaths in a given year than HIV-AIDS,'" Ciccarone said. "We're reached epidemic levels because this is of crisis proportions. It's going to require a crisis response: resources, time, effort, humanity, compassion of a historic proportion."
"Nightline" reached out to officials in all 50 states and the District of Columbia to determine how each track both fatal and non-fatal overdoses. Each state uses its own criteria to collect data and even the way one state defines an opioid overdose can differ from another. Most states are reluctant to label a death as an opioid overdose until it is confirmed by toxicology reports and the time each local district takes to finalize an individual death certificate can range anywhere from days to months.
There is also variation in terms of non-fatal opioid overdoses. The most current analysis of national hospital data by the Agency for Healthcare Research and Quality shows 1.27 million emergency room visits or inpatient stays were for non-fatal overdoses in 2014 – the most recent year the data is available. Often, victims that don't end up in hospitals or morgues return to their lives without the overdose being documented. Few states conduct real-time monitoring of non-fatal overdoses from sources like hospital emergency departments and EMS reports.
Twenty states, Washington, D.C., and various hospital associations agreed to share with "Nightline" preliminary overdose data from the seven days covering July 17 through July 23. The results provide a patchwork of data that highlights the difficulty of rapidly tracking the victims of the opioid crisis. Each state that shared their info cautioned that their numbers would not represent the full scope of those who overdosed during our seven-day report.
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"Nightline's" findings in tracking opioid overdoses across the country
"Nightline" found that public health departments and hospital associations in all 50 states collect opioid overdose data in vastly different ways. Some health care systems have to wait months after a person has died for toxicology reports to confirm an opioid contributed to the death. Other systems don't even track overdose visits to emergency rooms or calls to first responders.
After Arizona's Gov. Doug Ducey declared a state of emergency in June, state and local agencies there began working together to more quickly track suspected opioid overdoses. The state posts its opioid overdose data on a weekly basis. For the seven-day period "Nightline" tracked, there were 174 suspected opioid overdoses recorded. Of that number, 22 were fatal.
In Illinois, the state's Department of Public Health was able to provide hospital emergency department data that showed 273 opioid overdose visits during "Nightline's" seven-day timeline. This figure accounted for only 0.26 percent of total visits to Illinois hospitals, according to the state.
In New Jersey, the state's Department of Health was able to collect data from both hospital emergency department data (97 visits) and EMS reports (172 reports) over the seven days for "Nightline." But New Jersey State Police track overdose reports separately.
There is increasing recognition that real-time data can help communities respond to overdose outbreaks by stocking up on the opioid-reversing drug naloxone, commonly referred to by the brand name Narcan, and tracking the people selling illicit drugs. On day one of "Nightline's" seven-day report, the CDC announced $12 million in funding to 23 states and Washington, D.C., to better track opioid-related overdoses.
The National Institute on Drug Abuse's HIDTA (High Intensity Drug Trafficking Areas) program launched an overdose reporting application this January that is currently in use across 11 states and 38 counties. Called ODMap, the app allows first responders to quickly submit details about an overdose so it can be analyzed to detect trends.
"Even if it's only one person, one person can save one life, by entering data and maybe foreseeing something that might happen down the road. That makes it all worthwhile," Captain Richard Flynn of the Arlington, Massachusetts, police department told ABC affiliate WCVB.
The app was developed by the Washington/Baltimore HIDTA over the past year and continues to be rolled out in counties across the country. Since ODMap's pilot phase, over 3,000 overdoses have been reported by first responders using the app. It is this type of reporting on the local level that will ultimately provide the most accurate national picture.
Snohomish Health District in Washington state, which covers public health services in Snohomish County, worked with its local fire, police, EMS, hospitals and clinics to gather data for "Nightline" and shows 37 suspected opioid overdoses occurred during our seven-day period. Three of those overdoses resulted in death.
Some cities like Cincinnati have started posting real-time data that allows the public to pinpoint instances of heroin overdoses to specific hours and neighborhoods.
"I think it's really about building a community of how we can address this epidemic," Cincinnati Chief Data Officer Brandon Crowley told ABC affiliate WCPO. "Because it's not just Cincinnati, it's not just affecting Ohio. It's affecting the country."
American life under the opioid crisis
"Nightline" partnered with ABC affiliate stations across the country for this report, covering the opioid crisis in their communities and nationally from July 17 to July 23, and the following stories are just some snapshots from the lives of Americans affected by this epidemic.
This map illustrates our ABC affiliates' coverage of the opioid epidemic during the week of July 17 to 23:
These stories highlight those who overdosed, the families members left behind to pick up the pieces, the health care personnel trying to save lives, the law enforcement officers chasing down drug dealers, and city and state officials pushing legislation and funding to help combat the deadliest drug crisis in American history.
Lawrence, Massachusetts – Monday, July 17
It was just after sunrise in this manufacturing town when a man called 911.
"He was ingesting what he thought was cocaine," said Lawrence Police Chief James Fitzpatrick.
But testing later showed it had been laced with fentanyl, a powerful synthetic drug 50 times more potent than heroin. Just a tiny amount, as shown in this DEA photo below, can be lethal.
When emergency personnel arrived on the scene, they found two men already dead and another in need of immediate medical attention.
"He said he felt like his body was shutting down," Fitzpatrick said.
As police consoled the living man's grieving family members, fire marshals entered the home in hazmat suits to protect themselves from the drug's toxicity, which the DEA cautions can be inhaled or absorbed through the skin.
"Unfortunately we have to go through these extremes now because these drugs are so dangerous to make sure it's safe for first responders," Fitzpatrick said.
In Massachusetts, fentanyl was linked to 1,302 deaths last year, accounting for more than half -- 69 percent -- of all opioid-related deaths in the state.
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Source : http://abcnews.go.com/Nightline/deepdive/american-life-under-opioid-crisis-49355808