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Support Collaboration and Alignment Across Public Health, Public Safety, and Behavioral Health Systems to Support Effective Responses to Substance Use and Misuse and Drug Overdoses.

No single institution or sector can solve illicit substance use and misuse. Improving communication and collaboration among public health, public safety, and behavioral health systems can help coordinate a more timely and effective response to illicit substance use and misuse, overdoses, and deaths. Cross-system partnerships that facilitate information sharing can help stakeholders identify key gaps, as well as opportunities to build collective solutions that maximize limited resources and enhance overall response efforts. One of the earliest public health and public safety projects funded by BJA was the RxStat initiative that was established in New York City. RxStat is housed at the New York City Department of Health and Mental Hygiene (Health Department) and is co-led by the New York/New Jersey High Intensity Drug Trafficking Area (NY/NJ HIDTA) Program. The goal of RxStat is to reduce overdose deaths and to elevate the message that drug overdose deaths are preventable. RxStat involves timely analysis of drug misuse indicators from multiple data sources, including emergency department, fire, and EMS personnel, the medical examiner, state prescription data, the Drug Enforcement Administration, and the Manhattan District Attorney’s Office. These data are used to identify high-risk populations and places and direct the rapid deployment of public health and public safety resources. The Bureau of Justice Assistance (BJA) funded a technical assistance manual for New York City’s RxStat program to provide a road map for communities interested in replicating this model.

BJA also supports the development of local overdose fatality review (OFR) teams which are multiagency, multidisciplinary teams that meet regularly to share, review, and analyze data associated with drug overdose descendants. Similar to RxStat, the focus is on prevention through multistakeholder information sharing at the descendant level. The OFR process uses a problem-solving framework to review the overdose event, as well as the days, weeks, and years preceding the event, to identify missed opportunities for prevention. Stakeholders include public health, law enforcement, prosecution, medical examiner/coroner, EMS, jails, corrections, schools, child welfare, behavioral health, health-care, and substance use treatment providers. Overdose fatality reviews are effective at informing strategic prevention planning, improving quality of services provided to people at risk, and strengthening public safety and community-based responses to illicit substance use and misuse.

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Modeled after similar mortality review teams for deaths associated with children or domestic violence, the goal of overdose fatality reviews is to:

  • Improve timely information sharing
  • Identify missed prevention opportunities and system gaps
  • Increase collaboration among local stakeholders including public health and public safety
  • Identify policies, programs, and legal actions that could prevent future overdose deaths
  • Inform strategies to prevent future fatal and nonfatal overdoses

COSSUP supports activities that:

  • Implement and expand partnership models and information sharing among public health, behavioral health, and public safety.
  • Support the establishment or enhancement of overdose fatality review teams as a means of identifying potential policy improvements that can be made.


Grantee Projects

University of Alabama


The Institute of Business Analytics (IBA) is the research hub for the Culverhouse College of Business at the University of Alabama. IBA will develop the Unified Nexus for Leveraging Opioid Crime Knowledge (UNLOCK) system, which will provide decision makers with the information they need to allocate resources and policies in a timely manner. The UNLOCK system will serve as a data communications pipeline whereby information from the Alabama Department of Forensic Sciences, Medicaid, and other future partners can flow back up the chain to decision makers in a de-identified manner. The data will consist of summarized toxicology information, evidence test results, and coroner death report information and other georeferenced data that will assist decision makers. The UNLOCK system will be deployed to field officers, law enforcement administrators, prosecutors, community affiliates, public health providers, and researchers to provide them with complete analytics capability.
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Rhode Island State Police

Rhode Island

The Rhode Island State Police will implement the Heroin-Opioid Prevention Effort (HOPE) Initiative, the nation’s first statewide law enforcement-led opioid overdose outreach program, modeled after the Police Assisted Addiction and Recovery Initiative (PAARI). The HOPE Initiative engages law enforcement personnel in a proactive outreach strategy to combat the opioid overdose epidemic by bringing together substance-use professionals and members of law enforcement with the mission of reaching out to those who are at risk of overdosing and encouraging them to be assessed and treated. The project will support the HOPE Initiative by enhancing the ongoing efforts of state and local government to address the opioid overdose epidemic, including gathering real-time law enforcement data on opioid overdoses to identify individuals with opioid use disorder. In addition, the project will support a program involving law enforcement and case management to provide outreach to individuals with opioid use disorder. Outreach efforts will include victims and child welfare services. Data gathered through the HOPE Initiative will be shared with the Overdose Detection Mapping Application Program (ODMAP). Kelley Research Associates will serve as the project evaluator.
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Dayton and Montgomery County


Public health – Dayton and Montgomery County will work with county partners and Ascend Innovations to create a more robust multidisciplinary approach to data sharing by incorporating law enforcement data, coroner’s office data, mortality data, crime lab data, criminal justice data, treatment data, hospital emergency department and inpatient encounter data, and naloxone administration data. The data will be used by the county’s Community Overdose Action Team and the Poisoning Death Review Committee to create a comprehensive view of the addicted population in Montgomery County, Ohio, and to assist in developing specific plans for prevention and intervention strategies. Ascend Innovations will also serve as the evaluator on the proposed project.
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