This document summarizes a presentation on preventing hepatitis C and HIV outbreaks. It includes learning objectives about informing attendees of risks of infectious disease outbreaks related to injection drug use and describing collaborations between injury and infectious disease programs. The presentation features four speakers from Indiana and North Carolina public health departments and focuses on lessons learned from an HIV outbreak in Indiana linked to injection drug use.

1. Preventing Hepatitis C
and HIV Outbreaks
Presenters:
• Joan Duwve, MD, MPH, Chief Medical Officer, Indiana State Department of Health
• Jerome Adams, MD, MPH, State Health Commissioner, Indiana State Department
of Health
• Scott Proescholdbell, MPH, Epidemiologist, Injury and Violence Prevention
Branch, North Carolina Department of Health and Human Services
• Nidhi Sachdeva, MPH, Injury Prevention Consultant, Division of Public Health,
North Carolina Department of Health and Human Services
Prevention Track
Moderator: Jinhee J. Lee, PharmD, Public Health Advisor, Division of
Pharmacologic Therapies, SAMHSA, and Member, Rx and Heroin Summit
National Advisory Board

2. Disclosures
Jerome Adams, MD, MPH; Joan Duwve, MD,
MPH; Scott Proescholdbell, MPH; Nidhi
Sachdeva, MPH; and Jinhee J. Lee, PharmD, have
disclosed no relevant, real, or apparent personal
or professional financial relationships with
proprietary entities that produce healthcare
goods and services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Inform attendees of the risks of infection disease
outbreaks related to injection drug use.
2. Identify lessons learned by Indiana public health
officials during their investigation and response
to a 2015 outbreak of HIV infections linked to
injection drug use.
3. Describe North Carolina’s collaboration between
injury and infectious disease programs to reduce
injection drug associated harms.
4. Provide accurate and appropriate counsel as
part of the treatment team.

5. Community Outbreak of HIV Infection Linked to
Injection Drug Use of Oxymorphone —
Indiana, 2015
Joan M. Duwve, MD, MPH
Chief Medical Officer, Indiana State Department of Health;
Associate Dean for Public Health Practice,
Indiana University Richard M. Fairbanks School of Public Health
jduwve2@isdh.in.gov

6. Disclaimer
□ Joan Duwve has no conflicts to report
□ Trade names will be used in this presentation to
accurately reflect Rx drug use patterns

7. Indiana HIV Outbreak Overview
□ Dec. 2014: 3 new HIV diagnoses in Austin IN
▫ DIS learned 2 had a common-needle sharing partner
▫ Contact tracing  8 additional infections by January 23
▫ Only 5 HIV infections had been reported 2004-2013
□ As of Feb. 4, 2016: 189 individuals diagnosed with HIV
▫ All linked to Austin, IN
▫ Infections were recent and from a single strain of HIV
▫ 91% co-infected with Hepatitis C
□ Source of infection: injection of the prescription opioid,
oxymorphone (OPANA® ER)

8. Indiana HIV outbreak: geographic distribution
Scott County pop. 24,000; Austin, IN pop. 4,200
Scott County

9. Contact Tracing and HIV Testing Results
2/4/2016
Named Contacts 515
Tested 454 (88.1%)
Refused testing 17 (3.3%)
Unable to locate 28 (5.4%)
Other 16 (3.1%)
Other Tested 26
Total Tested 480
HIV positive 189 (39.4%)
Indiana State Department of Health Division of HIV/STD

10. Demographics of individuals infected with HIV
(N=189)
 58% male
 98% non-Hispanic white
 Median age 33.5 years
 93% reported injecting drugs
 All oxymorphone, some methamphetamine and heroin as well
0
20
40
60
80
Age at HIV Dx
#ofPeopleDxwithHIV
Indiana State Department of Health Division of HIV/STD

11. HIV+
HIV-
Not tested
Number of
Reported
Contacts
Size
Contact tracing network
Contact Type Frequency
Needle-sharing 59.7%
Sex 5.7%
Needle-sharing
AND sex
9.7%
Social contact 25.0%
Credit: Romeo Galang, MD, MPH; Division of HIV/AIDS Prevention;
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention

12. Geomapping of 89 HIV positive individuals identified a hotspot in Austin.
44% live within a ½ mile square area where 27% of Austin’s population resides.
The estimated infection rate within this hotspot is 34 cases/1,000 people.

13. Why Indiana?
Percent Change in Leading Causes of Injury Death*— Indiana,
1999–2009
501.5%
-30.8%
13.9%
22.5%
-11.1%
-100% 0% 100% 200% 300% 400% 500% 600%
Unintentional Poisoning
Unintentional MV Traffic
Suicide Firearm
Unintentional Fall
Homicide Firearm
Source: WISQARS
*Age-adjusted rates
Source: CDC WISQARS

14. Geographic Variation in Opioid Prescribing in the
U.S.

15. Youth and Controlled Substances
Source: Indiana Youth Risk Behavior Survey, 2011

16. Source: Suryaprasad, Clin Infect Dis; 2014, 59(10):1411-1419
2006 2012
Emerging Epidemic of Hepatitis C Virus Infections Among Young Non-
Urban Persons who Inject Drugs in the United States, 2006–2012

17. Gaps in Treatment Capacity, 2012
(2012 rates per 1,000 people ≥12 years of age)
Rate of past year opioid abuse or dependence
RateofOA-MATcapacity
Source: Jones, CM, et. al. National and State Treatment Need and Capacity forOpioid Agonist
Medication-Assisted Treatment. AJPH 2015 2015 Aug;105(8):e55-63 17

18. Why Austin?

21. At least nine people have died so far this year from prescription
drug overdoses in Scott County, Indiana. Most of the fatalities
involved Opana, according to county coroner Kevin Collins.
Reuters

22. Why Opana® ER ?
 2010 - reformulation of Oxycontin®
 Opana® quickly replaced Oxycontin® - snorted, injected
 2012 – Opana® ER reformulated, impossible to crush/snort
 Short half-life 3-4 hours when injected = multiple injections/day
 Cost $160/40 mg tablet = pill sharing
 Higher Morphine Equivalent Dose than heroin
 You know what you’re getting

23. What We Needed to Control the Outbreak
 Expand HIV/HCV testing and capacity for early detection
 Routine HIV testing at venues with high-risk persons (jails, addiction
services, ERs)
 Active outreach testing to at-risk population
 Get all HIV-infected individuals on ARV
 Develop systems to keep at-risk individuals uninfected
 Systematic retesting and education of high-risk persons
 SSP and HIV PrEP (Pre Exposure Prophylaxis)
 Increase addiction treatment services
 Medication-assisted treatment
 Behavioral Health
 Recovery Support

24. Credit: Philip Peters, MD; NCHHSTP/DHAP/Epidemiology Branch; CDC
Cumulative HIV infections associated with injection of
Opana® ER, by date of diagnosis, SE Indiana (N=188)

25. Community Outreach Center with One-Stop Shop
 Insurance enrollment
 Care coordination
 Syringe service program
 HIV and Hep B/C testing
 Immunizations
 Referral to substance abuse treatment

26. Communications

28. Acknowledgements
• Scott County Health Department
• Clark County Health Department
• Disease Intervention Specialists (EMAC states)
• Foundations Family Medicine
• Indiana University, Division of Infectious Diseases
• University of Louisville, Division of Infectious Diseases
• CDC
– Division of STD Prevention
– Division of HIV/AIDS Prevention (DHAP)
– Division of Viral Hepatitis (DVH)
– Epidemic Intelligence Service (EIS) Program Office
• Indiana Department of Mental Health and Addiction (DMHA)
• Indiana State Department of Health (ISDH)

29. Tackling the Prescription Drug
and Opioid Abuse Epidemic
Jerome M. Adams, MD, MPH
Indiana State Health Commissioner

30. Lessons from Indiana
• Be aware… of risk factors and trends in your
community
• Look for touchpoints… and unique
opportunities to intervene
• Partner.. and speak to your audience/ in their
language

31. Be Aware

33. Suryaprasad Clin Infect Dis; 2014, 59(10):1411-1419
Prescribing correlates with IDU,
unsafe injection practices, and
overdoses
2006 2012

34. Scott County HIV Outbreak
• Rural injection of Rx oral opioid = largest
ever HIV outbreak in IN, largest IDU HIV
outbreak in US
• 188 HIV cases in a rural county that never
had more than 3 in one year
• Almost all cases report injection of the
opioid analgesic oxymorphone (Opana® ER
and generic ER)
• All white, significant poverty (19.0%),
unemployment (8.9%), lack of education
(21% no high school), and lack of insurance

35. Adapted from and with permission of Phil Peters, CDC
HIV Infection: Tip of a High-Mortality
Iceberg
HIV
Infection
Overdose,
Bacterial
infections
Hepatitis C virus
Infection
Injection Drug use
Substance Use Disorder
Social Determinants
188 diagnoses
5 deaths during
contact tracing
287 Hep C + total,
92% of HIV+ coinfected
with Hep C
Network of at
least 500 PWID
Got your attention
now?

36. Look for opportunities to intervene

37. Public Health and Policy
Behavior Change
Ignorance, denial
Ambivalence, conflicted
emotions. (Barriers!!!)
Collect info, small pilots,
motivation/ public relations
Must show success, and
gain (vs lose) support
Coping strategies, rewards,
must deal w burn out
Acknowledge and fix
problems, remind of goals

38. Outbreak Control
Interventions
• Little HIV awareness: multiple educational efforts including billboards,
infographics, webinars, TV/radio, newspaper, Jeannie White Ginder
community event at Austin HS. #URNotAlone*
• Very few insured: established “one-stop shop”
• No HIV/HCV care: state provided resources (IU), HRSA, PREP
• Syringe exchange illegal: executive orders followed by new law
• Limited addiction services (methadone moratorium): raise awareness of
MAT, train and accredit providers to prescribe Suboxone®, local mental
health provider designated as a FQHC, SAMHSA collaboration

39. Indiana Syringe Exchange Law
• Local health officer declares to county/municipality:
– There is an epidemic of hepatitis C or HIV;
– The primary mode of transmission is IV drug use;
– Syringe exchange is medically appropriate as part of the
comprehensive public health response.
• The executive/legislative body of county/municipality:
– Conducts a public hearing
– Votes to adopt the declaration of the local health officer
• The county/municipality notifies the ISDH Commissioner and:
– Requests the Commissioner to declare a public health emergency
– Other measures to address the epidemic have not worked
• Commissioner must approve or deny within 10 days from submission
– Can request additional information extending the deadline for an
additional 10 days

40. Bending the transmission curve…
Epidemic Curve 2.18.2016
1 1
2
1 1
8
3
5
9 9
1
9
7
18
14
11
22
17
9
5 5
3 3
5
2
1 11
0 0 000000 0
2
0 0
4
0 0000 0 00000
3
0 00 00 0
1 1 1 1 1
00

41. Continuum of HIV care in Austin, Indiana
May 15, 2015
N=156 N=95 N=87 N=69 N=33 N=0
Mean VL: 431,836
N=113

42. Continuum of HIV care in Austin, Indiana
February 18, 2016
Total diagnosed=189 (189 confirmed). Persons were ineligible if deceased (n=2) or outside of the jurisdiction
(n=4); estimates are based on the number of eligible persons (n=183); ** Patients engaged in care if have at least
one VL or CD4 *** Percent on ARVs increases to 66% and virally suppressed increases to 51% when denominator
changed to number engaged in care. Clinical services were initiated 3/31/15. ART data updated through 2/18/16.
N=183 N=164 N=135 N=111 N=85
100%
90%
74%
61%
46%
0
10
20
30
40
50
60
70
80
90
100
Eligible* Engaged in Care** Care coordination Prescribed ARV's*** Virally suppressed***

43. Partner…
… and speak to your
audience…

44. What I learned as an advocate
Public health does not always easily translate to
public policy, particularly in areas with different
value systems or which are rural or resource
poor… We must truly understand community
beliefs and obstacles, and speak to citizens in
ways that resonate. You can’t “educate” away
firmly held beliefs.

45. Transformative public health leadership is less about
knowing what to do, and more about knowing how to
get people to do it…
RWJ, A new way to talk about social determinants of health
Colin Woodard, “The 11 American Nations”

46. Syringe exchange programs=
Community Partnerships
• Need comprehensive programs, not handouts
– Handouts don’t facilitate clean up, or connection
to services
– Actually hurt our cause in Austin
• Local buy in, local control, targeted,
community convinced of “epidemic,” or last
resort.
– Not proven to be a barrier in Indiana so far*

47. Testing at high risk venues = Jail/
Hospital/ SEP partnerships
• Need for testing in jails
– Sheriffs don’t want the hassle or the cost of diagnosis
• Need to test in ERs and inpatient settings (e.g. skin
infections, endocarditis)
– Extra time? Reporting? Who is going to pay? Follow up?
Stigma?
• Syringe exchanges and substance use disorder
treatment venues
– Already overworked? Reporting?

48. Medication assisted treatment= Partnerships
with providers, payers, community
• People don’t understand the concept, or the options:
Methadone vs Suboxone® vs Vivitrol®
– Think we are substituting one addiction for the other
– Rural/ conservative communities more likely to embrace
Vivitrol initially*
• MAT can and is being misused and abused
– This is hurting our credibility with decision makers
– “I believe the science on MAT, I just don’t trust the
people I see applying it…”
– Need more education about comprehensive recovery
approaches (not a magic bullet), and need increased
oversight of MAT practices.

49. Diversion/ early release/ alternatives to
incarceration = partnership with the courts and
the community
• Need more of them/ can’t incarcerate our way out of this
problem
– All local jails in the area at over 2x capacity
• Police, prosecutor, defender, judge, legislators, all key
– Lots of fear that weaker enforcement hurts the case. Need both
sticks and carrots to change behavior
• But very labor intensive to do it right/ hard to implement in
resource poor area. Ratio of 10:1 in Hamilton vs 100s:1 in
Scott
• Not being made equally available to all offenders.
– Income? Race? Fair assessment of support systems/ most likely to
be successful?

50. Naloxone = partnership with first
responders, families
• We administered over 5000 doses in IN last yr
• Many still feel it is enabling
– Must share stories- i.e. police officer who saved an
elderly woman who mixed up her meds, survivor
stories
– Must develop and speak to connections to recovery
• Not all states allow for lay providers
• State websites to help teach about naloxone
– Optin.IN.gov, dontdie.org

51. Coverage= Partnership with
payers, Medicaid, hospitals,
docs
• Almost all HIV positive were uninsured
• Healthy Indiana Plan = Indiana’s alternative to
Medicaid Expansion. HDHP with savings accnt
– Higher physician reimbursement so coverage =
access (5000+ new providers), mental health
parity/ pays for substance use disorder treatment
• Re-enrollment (ie maintenance) has been a
challenge.
Medicaid

53. Be Aware
• Hepatitis rates are an indicator of IVDU, and
harbinger of potential HIV outbreak.
• KNOW YOUR LOCAL OVERDOSE STATISTICS!
– Who ODed, who prescribed, where, from what
substances…

54. Be Aware
• Need to do state and local vulnerability
assessments
– CDC has released these, but can and should supplement
– PDMPs
– We put together county reports (HIV/HepC/OD)
– Look at your reporting processes
– People don’t believe you unless you can show them local data,
compared to peers

55. Look for opportunities to intervene
• Test at high risk venues
• Comprehensive SEPs
• Consider PREP among high risk individuals
• Need to have conversations about who receives
treatment for HCV, who prescribes, and how to pay
• Increase availability of addiction recovery services
and Naloxone, and increase awareness, acceptance,
proper administration of MAT
• Coverage for vulnerable populations

56. Partner
• Law enforcement
– Local, County, State police all play different but
important roles
– Prosecutors and judges have particular power to
help or to veto initiatives
• Legislators
– Key to convincing public, getting laws changed,
can advocate on your behalf to your boss/bosses

57. Partner
• Hospitals
– Major touchpoint (ER), have resources, have
community standing, can advocate
• Faith based community
– Essential for community outreach
– Set the tone for controversial moral interventions
– Already have infrastructure and contacts
– Perfect for counseling (e.g. w MAT), and “after”
care

58. Partner
• Federal partners (CDC, SAMHSA, HHS, etc)
other agencies (AG, Judicial, Mental Health,
Medicaid, etc)
• With the community!!!
– Via media, town halls, public events
– Must know that you care before they care what
you know

59. Preventing
Hepatitis and HIV
Outbreaks
After Scott County: NC’s Overdose and
Communicable Disease Collaboration

60. Disclosure statement
• Scott Proescholdbell, MPH, has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services.
• Nidhi Sachdeva, MPH, has disclosed no relevant,
real or apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.

61. Learning Objective
• Outline North Carolina’s plan to reduce
injection drug use and associated infectious
disease transmission.

62. Overview
• NC Overdose Situation
• NC Hepatitis C Situation
• Collaboration
• Next Steps

63. NC OVERDOSE EPIDEMIC

64. Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2014
Analysis by Injury Epidemiology and Surveillance Unit
Medication or drug overdose: X40-X44, X60-X64, Y10-Y14, X85
Medication or Drug Overdose Deaths by Intent
North Carolina Residents, 1999-2014
1,306
1,064
203
38
0
200
400
600
800
1,000
1,200
1,400
Numberofdeaths
All intents
Unintentional
Self-inflicted
Undetermined
Assault

65. 65
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Deathsper100,000population
Year
Motor Vehicle Traffic (Unintentional)
Drug Poisoning (All Intents)
Firearm (All Intents)
*Per 100,00, age-adjusted to the 2000 U.S. Standard Population
α - Transition from ICD-8 to ICD-9
β – Transition from ICD-9 to ICD-10
National Vital Statistics System, http://wonder.cdc.gov, multiple cause dataset
Source: Death files, 1968-2014, CDC WONDER
Analysis by Injury Epidemiology and Surveillance Unit
Death Rates* for Three Selected Causes of Injury, North Carolina, 1968-2014
α

66. Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2014
Analysis by Injury Epidemiology and Surveillance Unit
Substances Contributing to Medication or Drug Overdose Deaths
North Carolina Residents, 1999-2014
684
202
246
0
100
200
300
400
500
600
700
800
900
Numberofdeaths
Prescription Opioid
Cocaine
Heroin

67. NC Heroin Deaths: 2008-2015*
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2008- 2015*
*2015 data are provisional and likely increase as cases are finalized
Analysis by Injury Epidemiology and Surveillance Unit
554% increase from
2010 to 2014
63
75
37
76
147
179
246
174
0
50
100
150
200
250
300
2008 2009 2010 2011 2012 2013 2014 2015*

68. NC Heroin Deaths: 2014
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2014
Analysis by Injury Epidemiology and Surveillance Unit
Sex Age
Male 196 18-24 39
Female 50 25-34 83
Race 35-44 67
White 218 45-54 36
Black 24 55-64 16
Other 4 65+ 5

71. Heroin Hosp. and ED Overdoses: 2008-2014
Source: N.C. State Center for Health Statistics, Vital Statistics-Hospital Discharge 2008- 2013
NC DETECT- Statewide ED Visit data, 2008-2014
Analysis by Injury Epidemiology and Surveillance Unit
213
252
213
311
474
643
1,127
76 75 58
101 122
195
0
200
400
600
800
1000
1200
2008 2009 2010 2011 2012 2013 2014
ED Hosp
From 2010 to 2014
a 429% increase
for ED visits

72. Recent Publications on Heroin Increases

73. Rate of Unintentional/Undetermined Prescription Opioid Overdose Deaths
and Rate of Outpatient Prescriptions Dispensed for Opioids
North Carolina Residents, 2012-2013

74. NC HEPATITIS C

75. Hepatitis C
• Most commonly transmitted
through injection drug use
• 75%‒85% of infected develop
chronic illness
CDC, 2010

76. Numberofcases
Year
Reported Acute Hepatitis C Cases
NC, 2000‒2014

77. Characteristic N (%)
Race/ethnicity
White
Black
Hispanic
Other
96 (85%)
5 (4%)
3 (3%)
9 (8%)
Age (years)
<20
21-30
31-40
41-50
>50
7 (6%)
47 (41%)
27 (24%)
21 (19%)
11 (10%)
Gender
Male
Female
Missing
60 (53%)
51 (45%)
2 (2%)
Reported risk factors*
Injection drug use
Multiple sex partners
Men who have sex with men
History of blood transfusion
Missing
42 (37%)
5 (4%)
2 (2%)
1 (1%)
63 (56%)
Characteristics of Reported
Acute Hep C Cases
NC, 2014 (N = 113)
*May report >1 risk factor

78. Rates of reported acute hepatitis C cases
by NC county, 2014

79. What about chronic hepatitis C in NC?
• Not reportable by law
• Use CDC national prevalence projections
(1.1%) and census data to estimate
~110,000 people with
chronic HCV in NC

80. Changing Landscape of Hepatitis C Treatment
• Older drugs
– Prolonged treatment
– Serious side effects
• New direct acting antivirals (DAAs)
– Shorter treatment
– Fewer serious side effects
– Highly effective
– Expensive
– Mainly prescribed by specialists

81. NC HIV

82. ~110,000 people
with chronic HCV
in NC
HIV in NC

83. ~110,000 people
with chronic HCV
in NC
HIV Infection Rates Diagnosed in NC
119 131 144 157 170 182 194 208 221 234 244 256 266 276 287
18
20 20
19
18 18 19
20 20
18
15 15
13 14 14
0
5
10
15
20
25
0
50
100
150
200
250
300
350
Rateper100,000population(NewCases)
Rateper100,000population(Prevalence)
Year at Diagnosis
Prevalence New Cases

84. CROSS OVER EFFORTS

85. Reducing
New HCV Infections
• Targeted HCV/HIV screening
• Accessible mental health services and substance use disorder treatment
• Comprehensive programs to reduce HCV/HIV transmission (i.e., SSPs) and address stigma/disparities
• Make all positive HCV laboratory results reportable by ELR
• Expand targeted HCV screening of at-risk populations
• Link HCV-infected persons to appropriate care and treatment
• Expand primary care capacity to treat HCV in communities
Hepatitis C virus (HCV); Electronic Laboratory Reporting (ELR); Regional Networks of Care and Prevention (RNCP); Controlled Substances Reporting System (CSRS);
Syringe Services Programs (SSPs)
• Support harm reduction (e.g., naloxone)
• Identify at-risk persons through CSRS
• Strengthen community outreach programs
• Link persons to appropriate services
o Substance use disorder treatment
o Mental health
o Other medical and social
• Expand targeted HIV testing of at-risk
populations
• Reach disproportionally impacted
minorities through community programs
• Link persons to care and maintain
engagement through HIV RNCP
Conquering the Syndemic:
A systems approach to addressing HCV, HIV, and Opioid Overdoses in North Carolina
Reducing
Opioid Overdoses
Reducing
New HIV Infections
Addressing the Syndemic

86. NC Collaboration
• Enhanced surveillance
• Sharing of information
• Increasing communication
• Joint presentations

87. NC HARM REDUCTION EFFORTS

88. Number of Two Dose Naloxone Kits Distributed by the North Carolina
Harm Reduction Coalition by County
8/1/2013 - 2/1/2016 ( 20,000+ total kits distributed)
Source: North Carolina Harm Reduction Coalition, Feb. 2016
Analysis: Injury Epidemiology and Surveillance Unit

89. Number of Opioid Overdose Reversals with Naloxone Reported to the
North Carolina Harm Reduction Coalition by Date
8/1/2013 - 2/1/2016
Source: North Carolina Harm Reduction Coalition, Feb. 2016
Analysis: Injury Epidemiology and Surveillance Unit
22 15 20 16 15
25
40
15
34
97
47 50
125
28
111
187
128
204197
302
290
0
50
100
150
200
250
300
350
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Numberofopioidoverdosereversals
withNaloxonereportedtoNCHRC
35 189 1,510 290
Overall 2,024

90. Number of Opioid Overdose Reversals with Naloxone Reported to the
North Carolina Harm Reduction Coalition by Date
1/1/2015 - 2/1/2016
Source: North Carolina Harm Reduction Coalition, Feb. 2016
Analysis: Injury Epidemiology and Surveillance Unit
0
50
100
150
200
250
300
350
Numberofopioidoverdosereversalswith
NaloxonereportedtoNCHRC
1 reversal by
Guilford Co Sheriff
1 reversal by
Fayetteville Police
Dept
1 reversal by
Henderson Co
Sheriff
4 reversals by
Greenville Police
Dept
1 reversal by
Pitt Co Sheriff
1 reversal by
Winston Salem
PD
1 reversal by
Carrboro Police
Dept
1 reversal by
Carrboro Police
Dept
5 reversals by
Fayetteville
Police Dept
2 reversals by
Fayetteville
Police Dept
2 reversals by
Pitt Co Sheriff
Cramerton PD, 1 reversal, 2015
1 reversal by
Fayetteville
Police Dept
1 reversal by
Winston
Salem PD
1 reversal by
Fayetteville
Police Dept
3 reversals by
Winston
Salem PD
Law Enforcement reversals: 33
2 reversals by
Dare PD
1 reversal by
Winston-Salem
PD

91. Number of Opioid Overdose Reversals with Naloxone Reported to the
North Carolina Harm Reduction Coalition by County
8/1/2013 - 2/1/2016 (2,024 total reversals reported)
5 reversals in an unknown location in North Carolina and 28 reversals using NCHRC
kits from other states reported to NCHRC.
Rocky Mount (9)
High Point (201)
Elkin (1)
Asheville (520)
Greensboro (335)
Maiden (1)
Charlotte (66)
Wilmington (267)
Winston-Salem (89)
Source: North Carolina Harm Reduction Coalition, Feb. 2016
Analysis: Injury Epidemiology and Surveillance Unit
Burgaw (15)
Fayetteville (34)
Asheboro (24)
Thomasville (31)
Rocky Point (22)

92. Counties with Law Enforcement Carrying Naloxone (44)
As of February 1, 2016 (34 reported reversals)
App State University Police
Watauga Co. Sheriff
Ayden Police Dept
Bethel Police Department
Greenville Police Dept
East Carolina Univ Police Dept
Pitt Co. Sheriff
Canton Police Dept
Clyde Police DeptGraham County Sheriff
Waynesville Police Dept
Haywood Co. Sheriff
Clyde PD
Maggie Valley PD
Orange Co. Sheriff
Carrboro Police Dept
Cramerton Police Dept
Mount Holly PD
Fayetteville Police Dept
Guilford Co. Sheriff
Halifax Co. Sheriff
Roanoke Rapids Police Dept
Kinston Police Dept
Lenoir Co. SheriffPink Hill Police Dept
N.C. State Bureau of Investigation and Alcohol Law Enforcement also carry
Naloxone-statewide.
Agencies that have reported opioid overdose reversals with Naloxone
Henderson Co. Sheriff
Fletcher PD
Waynesville Police Dept
Brevard Police Dept
Transylvania Co. Sheriff
Rutherfordton Police Dept
Winston-Salem PD
Source: North Carolina Harm Reduction Coalition, Feb. 2016
Analysis: Injury Epidemiology and Surveillance Unit
Warren Wilson PD
Brunswick Co. Sheriff
Butner Police Dept
Dare Co. Sheriff
Statesville PD
Nags Head PD
Duck PD
New Hanover PD
Highlands PD
High Point PD

93. NC TRACKING & MONITORING

94. NC DETECT / ED Data Mandate
GS § 130A-480
(a) For the purpose of ensuring the protection of the public health, the State Health Director
shall develop a syndromic surveillance program for hospital emergency departments in
order to detect and investigate public health threats that may result from
(i) a terrorist incident using nuclear, biological, or chemical agents or
(ii) an epidemic or infectious, communicable, or other disease.
The State Health Director shall maintain the confidentiality of the data reported pursuant to
this section and shall ensure that adequate measures are taken to provide system security
for all data and information. The State Health Director may share data with local health
departments for public health purposes, and the local health departments are bound by
the confidentiality provisions of this section. The State Health Director shall not allow
information that it receives pursuant to this section to be used for commercial purposes and
shall not release data except as authorized by other provisions of law.
*Effective 1/1/2005
*Law modified in 2007 to allow sharing of reported hospital ED data with CDC

95. NC DETECT Overdose Visits
Source: North Carolina NC DETECT

96. Access to NC DETECT
• NC DETECT web application access for
– Local Health Departments
– Data Providers (Hospitals, EMS, Poison Center)
• Authorized users are able to view data from
– Emergency Departments
– Carolinas Poison Center
– Pre-hospital Medical Information System (PreMIS)
• Training webinars provided by DPH, NC DETECT
• Datasets shared with researchers after DUA and
IRB approval

97. Hot Topics Dashboard
Click on a point to
access line listing

98. NC COORDINATED RESPONSE

99. North Carolina Injury and Violence Prevention Branch, Partners
Poisoning Death Study
Comprehensive Community Approach
Chronic Pain Initiative
Opioid Death Task Force
Policy and Practice
Research
North Carolina
Prevention and
Harm Reduction
Drug Take Back
Prescription
Drug
Substance
Abuse
SAC Poisoning/Overdose
Team Communication, Policy,
and Advocacy
Enforcement
SBI and Medical &
Pharm Board
DPH, DMA, DMH/DD/SAS,
ORH
Carolinas Poison Center
Monitoring
Program

100. CDC PRESCRIPTION DRUG OVERDOSE
(PDO) PREVENTION FOR STATES (PFS)

102. DEVELOPMENT OF
COMMUNICATIONS PROTOCOL

103. Development of Injury Warning
• IVPB had new role in response
• IVPB ‘thin’ bench and lack of response experience
– Must coordinate with others
• Several debriefings with key partners
• Creation of Early Injury Warning system
• IVPB staff added to NC HAN, Situation Report lists
• Asked to expand our role

104. NC Injury Warning
Communication Protocol
1. Activation
2. Investigation/
Monitoring
3. Communication

105. For more information…
Scott Proescholdbell, MPH
scott.proescholdbell@dhhs.nc.gov
Nidhi Sachdeva, MPH
nidhi.sachdeva@dhhs.nc.gov
Injury and Violence Prevention Branch
NC Division of Public Health
www.injuryfreenc.ncdhhs.gov | www.injuryfreenc.org

106. Preventing Hepatitis C
and HIV Outbreaks
Presenters:
• Joan Duwve, MD, MPH, Chief Medical Officer, Indiana State Department of Health
• Jerome Adams, MD, MPH, State Health Commissioner, Indiana State Department
of Health
• Scott Proescholdbell, MPH, Epidemiologist, Injury and Violence Prevention
Branch, North Carolina Department of Health and Human Services
• Nidhi Sachdeva, MPH, Injury Prevention Consultant, Division of Public Health,
North Carolina Department of Health and Human Services
Prevention Track
Moderator: Jinhee J. Lee, PharmD, Public Health Advisor, Division of
Pharmacologic Therapies, SAMHSA, and Member, Rx and Heroin Summit
National Advisory Board