Learning from Tragedy: Overdose Fatality Review Teams

Overdose Fatality Review Teams do important work to improve overdose prevention in the community, but continued technical assistance may best support consistently rigorous implementation of best practices. 

Overdoses continue to kill in the United States. Accidental death by poisoning continues to be the leading cause of death for individuals 15-44, and the rate of overdose deaths continues to rise. Overdose fatality review (OFR) teams bring stakeholders together at the community level to learn from these tragedies and come up with ways to prevent future overdoses. They generally include a blend of professionals from public health, health services, social services, first responder, and legal/justice system backgrounds.

We were interested in whether these OFR teams, which operate locally, shared common characteristics – and whether those characteristics were consistent with national OFR team implementation guidelines. To examine this, we invited participants at a virtual national meeting on OFR to answer survey questions we developed to represent these guidelines. 58 individuals representing 30 teams from Indiana, New Jersey, Wisconsin, Maryland, and Ohio completed the survey.

We found that the 30 teams represented in the survey results crossed systems successfully, with an average of over 7 different agencies represented in a team. Teams reported high adherence to practice guidelines, with almost two thirds reporting use of at least 11 of the 14 recommended practices. Still, there were several areas we found that could use some improvement:

  • Without funding, some recommended team roles remain unfilled. Specifically, teams were likely to lack data managers, which we concluded was likely because most OFR teams operate on a volunteer basis. Funding to formally support measurement of team success through data manager positions will be essential for functional evaluation of the suggested next directions listed below.
  • Teams need more support around guideline use. A standardized, national approach to training and measuring fidelity could increase teams’ recognition of and adherence to the guidelines. A program of mentored support of new OFR teams by prior teams could further push teams toward optimal guideline use.
  • Harm reduction needs more of a voice at the table. One third of these team members dedicated to improvement in overdose fatalities still lacked some faith in overdose death preventability. Inclusion of harm reduction team members on these teams could increase the presence of notions of preventability among both team members and trickle into the communities and agencies they represent. Efforts to decrease stigma and feelings of hopelessness around overdose work are needed at the team and public health messaging levels. Non-stigmatizing harm reduction messaging can both invigorate team members and support the families and communities most affected by the individual tragedy each overdose death represents.

What’s next?

  • We need to know which OFR practices are the most effective. This exploratory work was focused on adherence, but future work should include analysis of which practices lead to the highest decreases in overdose deaths.
  • We need to know why some teams don’t use some of the recommended practices. Figuring out some of their barriers to practice implementation can help refine the implementation guide or the way it is taught.

To learn more about what we found and its public health implications, check out the whole paper at Comparing Practices Used in Overdose Fatality Review Teams to Recommended Implementation Guidelines published in the Journal of Public Health Management and Practice

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