Identifying and tracking cases of suspected unintentional drug overdose deaths in near real-time using the Suspected Potential Overdose Tracker (SPOT)

Background: Drug overdose deaths in the USA are at record highs. In response to the typical >6 month delay in finalizing death records, the New York City (NYC) Office of Chief Medical Examiner (OCME) implemented the Suspected Potential Overdose Tracker (SPOT), a novel methodology to identify suspected drug overdose deaths in near-real time. Our objective is to describe (1) the functionality and performance of SPOT and (2) the public health implications and a real world application of SPOT.

Methods: SPOT was developed to rapidly identify overdose deaths through a simple and duplicable process using data collected by death investigators. The tool uses data collected within 72 hours of fatality to assign each death a ranking of 1 through 3 based on the likelihood of it being an unintentional drug overdose, with 1 representing the highest likelihood that the death will be confirmed as an unintentional drug overdose and 3 representing the lowest. We measured the sensitivity, positive predictive value, and other performance measures of the tool for predicting overdose deaths by comparing suspected overdose deaths in NYC from 2018–2020 that were identified using SPOT to finalized death certificates.

Results: From 2018-2020, the sensitivity of SPOT ranged from 66-77% overall. The positive predictive value of the tool ranged from 93–97% for cases assigned a ranking of 1, 87–91% for cases assigned a ranking of 2, and 62–73% for cases assigned a ranking of 3. Among all unintentional overdose deaths in 2018, 2019, and 2020, 21%, 28%, and 33% were missed by the SPOT tool, respectively. During this timeframe, the proportion of type 1 errors ranged from 15%-23%.

Conclusion: SPOT provides a novel method for tracking suspected overdose deaths and allows for the timely evaluation of public health interventions, programs, and policys. A real world application of SPOT that examines the implementation of Safe Consumption Servcies on overdose death rates in NYC will be discussed.