Hope in the Data: The CDC's Role in Preventing Overdose

In this episode, Safe States Executive Director Sharon Gilmartin is the guest host and talks with Allison Arwady, Director of the CDC's National Center for Injury Prevention and Control. To kick off the conversation, Dr. Arwady shares that the CDC has recently released 2024 provisional drug overdose death data that highlights a nearly 27% decrease in predicted deaths from the previous year's data and is seen in 48 states nationwide. Dr. Arwady credits changes in drug use, public health investments, and interventions along with community coordination and collaboration in the successful effort to reduce deaths from drug overdoses. During their conversation, they also discuss public health infrastructure, prevention strategies, and the role the CDC's Injury Center plays in these including the importance of the programs they offer. 

Transcript

Sharon Gilmartin: 0:03

Welcome to the IVP INdepth podcast, a Safe States Alliance production. I'm Sharon Gilmartin, Executive Director at Safe States Alliance, and I'm happy to be your guest host for this episode of IVP INdepth. Our guest today is Allison Arwady, Director of the National Center for Injury Prevention and Control, where she leads the CDC's innovative research and science based programs to prevent injuries and violence and reduce their consequences. Allison, thank you so much for being here today with us.

Allison Arwady: 0:28

Yeah, thanks for having me. Sharon, looking forward to the conversation.

Sharon Gilmartin: 0:31

Well, we're grateful you're here. So let's start with the headline. CDC is reporting a 27% drop in overdose deaths in 2024 which, as I understand, is the largest one-year decrease in its 45 years of tracking such data. Can you walk us through what this data means and some of the highlights?

Allison Arwady: 0:52

Yeah, can I just tell you how excited we are to be seeing the kind of progress that we are seeing on this topic? Overdose remains the leading cause of death for people between the ages of 18 and 45 in this country. But boy, are we making progress. So yes, we've just released the newest data. It's the provisional data through the end of calendar year 2024 and it compares the number of people who died from an overdose in 2024 to the number that died in 2023 and in just one year, we across this country saw a 26.9% drop, almost a 27% drop. And for people who work in public health, you know, it is not typical for us to be talking about even double digit drops, much less a 27% drop. I'll put a couple more numbers on that before we get into that. We know that more than 110,000 Americans died of an overdose in 2023 this provisional data for 2024 were down to about 80,000 so that means we are seeing more than 80 fewer deaths every day in 2024 compared to 2023 again, these are provisional numbers, but it is undoubtable that the progress here is remarkable, and it is across the country.

Sharon Gilmartin: 2:16

It's incredible. Like you said in public health, these numbers are almost unheard of. So what do you point to that contributed to this significant decline?

Allison Arwady: 2:25

So there are lots and lots of things that go into a decline that is this big. First, I will just note a little bit of where we're seeing it, because it would be one thing if one part of the country was seeing a 50% decline and another part really was not seeing much of a decline. But the excellent news here is that this kind of a decrease is really national, across the whole country, where we compare again, 2023 and provisional, 2024 data, 48 states are down. We did have two states that had slight increases, still between 2023 and 2024 and that was in South Dakota and Nevada. But those were very small increases, less than 5% and we're anticipating that their progress is still coming. So this progress is not exactly the same everywhere, but we did have seven states that had decreases over 35% and West Virginia is leading the country with decreases of more than 43% in a single year. So first, we know that this is quite widespread in terms of high level. What is going into this? We know that there have first of all, been changes in in demand, in drug use. It would be one thing, if all we were seeing were decreases in deaths, but no, we are seeing decreases in deaths. We are seeing decreases in non-fatal overdoses. We are seeing decreases in people being diagnosed with opioid use disorder or going untreated. We are seeing decreases in drug use, and even in youth drug use, and that is progress that has been coming due to public health investment over the last decade or so, but a lot of that progress was eliminated by the emergence of fentanyl. Over the last decade, we now are seeing what we're calling fentanyl saturation, meaning that fentanyl, at this point, this very potent opioid, has really displaced heroin. It is in the majority of overdoses that involve an opioid, and so although every use of an opioid remains high risk, high risk of death, we're not seeing that risk increasing over time as much, since there are fewer people transitioning to fentanyl from less potent opioids. So there's a lot that kind of goes into this, and we can talk about some more detail, but what I really want people to hear is that we are seeing changing patterns on both the demand side in a good way and on the supply side, and public health data underlies all of that progress we're. If you're talking about the public health interventions or the public safety work of really making sure that these, these really potent drugs are less available, it's been an all hands on deck approach, and it has to be to see improvements at this kind of level.

Sharon Gilmartin: 5:16

I think one of the things that really strikes me thinking about what is contributing to this decline is this widespread, coordinated approach, which is what we know works in public health, but rarely do we have the investments and the widespread investments to make that a reality for a lot of our other outcomes that we discussed. Can you share a little bit about the programs that you all have been running and how they're part of that larger coordinated effort?

Allison Arwady: 5:46

Yeah, absolutely. I love this question, because you're right. You do not see progress like this without coordination and without investment. President Trump was the first to declare the opioid crisis to be a public health emergency. Back in 2017 with that declaration, Congress then appropriated a lot of funding, gave a lot of support for public health to respond in the public health emergency, and CDC received that funding. And then, as you know, 80% of CDC domestic funding goes out the door goes to state and local health departments, goes to communities, goes to making sure that we are turning the tide all across the country. And so we have a couple of flagship programs here. The main one is called Overdose Data to Action. It is well over $200 million it funds 49 states as well as 41 large local health departments, and it's what the name sounds like. It's making sure that all over this country, we have the data infrastructure in place, not just to count overdoses, but to know how the threat is changing, making sure there's standardized testing after a fatal overdose from a medical examiner or a coroner after a non fatal overdose in an emergency department that we're understanding how the threat is changing helps us on the public health side, know how we need to be where we need to be getting Naloxone, or how we need to be changing our responses, or making sure clinicians know new things to be looking for, where we're seeing new contaminants In the drug supply, but also that data is really important for public safety, and so CDC funds in every single state. We have a program that funds a Public Health Analyst and then someone from the High Intensity Drug trafficking area that's really more on the public safety side. We protect individual patient privacy always, but we're sharing how is that threat changing, and how can that data be used to intervene and make those drugs less available? And how can we interview intervene to decrease risk? One other program I would maybe just highlight quickly points to one of the priorities from the White House that were just released a couple of months ago. There are six priorities that were released for from the Office of National Drug Control, policy and public health work is squarely represented in there. The fourth one is called Stop Drug Use Before It Starts. Beautiful example of prevention, primary prevention, public health- bread and butter. And we fund a program with funding from the Office of National Drug Control Policy called Drug Free Communities. Funding goes to 750 communities across this country, mostly in rural areas, with a focus on youth, on preventing drug use in our kids. And it's all about pulling together different sectors at the community level, making sure data is available, and then working to make sure that young people have the information and have and their parents and their communities know what is needed to stop those kids from even ever being exposed or having decreased risk of ever having a fatal overdose. We know that these approaches work. We know that over just the last 10 years, CDC data shows between 2013 and 2020 23 we saw a 40% drop in high schoolers saying, I have tried these illicit drugs, excluding marijuana, these really dangerous, potentially lethal drugs, we've seen a 40% drop in young people, even experimenting. That's how we know that these 27% death drop numbers, which are amazing, are not a flash in the pan, that they represent years of investment and progress, but that we have to keep these kinds of investments up. We have to stay ahead of the changing drug crisis, and we have to make sure that we are not just focused on the intervention side, on the supply, but continuing to make progress on the demand side, getting people connected to treatment and. And helping people really understand the risks.

Sharon Gilmartin: 10:03

What you're sharing is so rich because I'm hearing a number of things. I'm hearing about the harm reduction strategies that have been so helpful in our communities, with Naloxone and Narcan. I'm hearing about using data to identify emerging threats so that we can pivot our interventions. And I'm really excited to hear about the primary prevention efforts, which are oftentimes the hardest to quantify, yes, and so to be able to link the primary prevention efforts to measurable changes and outcomes is really exciting. So thinking about now, knowing what we know and the learning that we've done, what is CDC looking to continue, and where are you looking to grow moving forward?

Allison Arwady: 10:49

So obviously, overdose is a priority for the administration, which we are glad to know, and we are thrilled to be the public health component of that of that work across the country, we are very focused still on building data infrastructure. Not only are the numbers themselves better, but if we kind of get under the surface for people who work in public health, the National Center for Health Statistics is who pulls together all of the vital records, data, the death certificates in this case, and as recently as 2017, only 15 states and Washington DC actually had the capacity for toxicology testing and epidemiology and systems from their Medical examiners and coroners. Only 15 states actually could report detailed enough information beyond just that someone had died from a drug overdose, they couldn't necessarily say was this cocaine? Was which opioid was involved? What were the details? There just had not been enough investment in those data infrastructures. I'm really proud to share that the data that was recently released from CDC now is including that detailed level of information for 48 states. So we've gone from just 15 states to 48 states in terms of the data capacity, even for something as basic as knowing on the death certificate what was the underlying toxicology. We got to get that to all 50 states, of course, but making this kind of data very real time is something that we are really focused on. CDC and public health is not just about counting data to admire a problem, even though, right now, we are admiring our progress, it is about having data that is real time enough to be used to change interventions. So that's why we've been doubling down, not just on the fatal overdose side. The numbers we recently released are the top line numbers, but you can go online to what's called our SUDORS system, SUDORS, and really look at the details in your state, what was happening over time with different drugs, etc. But we're also building up on the non-fatal side. And this is where someone hasn't died of an overdose. If someone has a non-fatal overdose, that is a moment. Let me tell you for intervention. You want to get that person connected to treatment. You want to make sure everybody who may have been near that overdose has Naloxone. Knows what to do with it in case they are in another situation where there is another potential overdose, you want to really take care of that family. It's not just about the individual. Often there may be children or others. Lots of opportunities for prevention there in public health departments through the funding that they receive from CDC under overdose data to action are really focused on intervening around those non fatal drug overdoses and making sure we have real time data right now all over the country, health departments, not universally yet. We want to get universal. Are able to notice when there is a spike in 911, calls in emergency department visits for overdose. Notice that right away and right away, look at the data. Where exactly is this? Does this look like something out of the ordinary? This looks like something out of the ordinary. Let's jump into action. Let's make sure our partners are doing the outreach like Let's make sure our hospitals and our ambulance folks know they may need more Naloxone or anything else unusual about this. Let's get the information out. Let's share that again in a way that protects patient privacy with public safety so they can do what needs to happen to see if there are places to intervene or new distribution patterns. And all over the country because of public health data and public health investments, we jump into action now. We had none of this in place a decade ago, and so the progress that we are making is about building on what we know works. We're able to with CDC data, again funded and collected all over the country. We're able. Able to say, in your community, you're seeing a high number of people die from an overdose after they've been released from an institutional setting like incarceration or maybe even a treatment facility if they haven't maybe gotten the ongoing evidence based treatment that's available. This is something your community in particular should work on, or we can say your community still has a lot of people who are dying, and there was a bystander present, meaning there was an opportunity for Naloxone, and maybe Naloxone wasn't used. That is where your community should focus. So the need to have this national picture where we're all measuring and counting and testing in standardized ways. We are using our data, we're using our laboratories, and we're using our response capabilities in ways that are tailored to communities. That is bread and butter public health. That's the same approach we take to a Measles outbreak, and we are doing it, and we are turning the tide for overdose. We just have to be able to continue, continue to build that work and make sure every part of this country has that same data lab and response infrastructure in place.

Sharon Gilmartin: 16:08

Here, here, you're so right, and you know what you're sparking for me is the fact that we have all been watching the news. We've all been paying attention to what's happening with our federal proposed restructuring of HHS and the direction that injury may go, and specifically related to the funding that we have across all of our topical areas in our states and our local communities. And what you're saying is really ringing true for me, that the approach that we've used for overdose is foundational public health data to action exactly like the grant is titled, whatever may be with funding. We know that there are a lot of different ways that this could go, but I think there are some conclusions that we would be able to draw based on the way that things have gone thus far, that we will see a reduction in funding for some of our injury priorities. Are there data systems? Are there interventions that we can be leveraging with the opioid funding and the infrastructure that we've been developing for other topical areas in injury that may not have this same dedicated level of funding?

Allison Arwady: 17:18

Yeah, it's a great question. So first, I will just say, related to funding, we were really pleased to see Secretary Kennedy re-up the declaration of the public health emergency. This signals again that this administration believes that this is a public health emergency, which means it believes that public health needs to continue to be part of that solution. So certainly, you know, we are hopeful that, as we are seeing such good progress, this will be an area where we may not see as significant cuts to funding as have been seen in some other areas. But you are correct, there have been a lot of cuts. And one of the best things I think, we've been doing in public health, particularly coming out of COVID, is not solve problems, one off for one disease or one community. We've really been working to try to build data platforms, ways of working with states and communities that are taking a single public health approach. So with one example, our non-fatal overdose data, which I highlighted, is something we're really working to improve, the timeliness, the completeness, the ability to take action that platform. It's called dose that is one that we nominated and is being included in what's called CDC's, one data platform, so that it is a single data platform where infectious disease information is coming, where information about overdose or suicide or the injury related and violence related topics that the injury center covers are all in one system. We protect privacy. This does not have individual names in this system, but it means that hospitals across the country, public health departments across the country, you know, the ambulance drivers across the country, et cetera, et cetera, are not trying to report into different systems. We're using single systems, single ways of reporting that let us understand individual problems, but then how those are all connected, right? I gave the example of being able to know what's happening with overdoses after someone has been released from incarceration that requires pulling together different data systems, knowing that if, if someone has just given birth and had a history of opioid use disorder, that might be a particularly important time to make sure that new mom is in treatment, is getting support. We want to make sure, um. That that you know that can be a vulnerable time. Having that kind of information really calls for continued investment in core public health strategies, data, lab response and funding to states and locals and the partners that support them. That is what public health is really about, and it's not good enough for me. If we just say, Okay, we're gonna we're gonna fund some overdose work over here, if that, in some way were to dismantle these core investments in the public health infrastructure. So I'm hopeful that these investments and continued improvements that have been made since COVID. COVID really pointed out we needed big investments and big improvements in how this country handles its public health data. And I'm really hopeful, of course, that with this administration prioritizing overdose so much that it will lead to continued investments in these kinds of data improvements that are fundamental to every single community's ability to stay ahead of every changing public health threat.

Sharon Gilmartin: 21:11

I can't help but think that injury has been a little bit of a leader in this space when you think about the National Violent Death Reporting System, and you know the way that that system showed us how to really bring together multiple data sources and the linkages and all that rich contextual information, and then the syndromic surveillance processes that we were able to develop. You know, injury, this field has a lot to be proud of. It has a I feel very confident, has a rich future ahead of it, despite what storms we may have to weather temporarily.

Allison Arwady: 21:42

Yes, 100% as you know very well, the National Violent Death Reporting System was one of our first huge national efforts, where CDC funds individuals in every state to pull together disparate data sources to help us really understand patterns. So that's how we can know, for example, that people in a particular occupation have a higher risk of suicide. It's pulling together information from, you know, from medical examiner reports, or, you know, where relevant medical reports, police investigations, etc. It really helps us know how to intervene. What does that rural picture look like? Where? How do we have opportunities? Where have people been in treatment? Where have they not? Where can we intervene? And you are right that the work of sudars, which again funded through overdose data to action, is patterned on that, it says we've got to have a way of pulling together data from disparate sources, really good toxicology data, really good data from the public safety side, the public health side, the healthcare side, because too many people are dying here, and we have to know at a population level. Where can we intervene? How do we know we focus? Always in public health, we use data to focus where the impact will be greatest. That is what epidemiology is about. That is what public health is about. And having those data infrastructures, those have come from years of really innovative work out of injury and and we're proud of that. There are we don't see big divisions between the infectious disease work and the non infectious disease work. It is all public health work, and it is all built on the same principles, the same community led, data driven interventions, and we've just got to make sure data lab response and funding to states and locals, along with the expertise that public health really has to bring, continues to be applied to everything that is killing Americans in large numbers in this country.

Unknown: 23:54

I think this is really helpful framing as those of us in the field wrap our heads around a potential move to AHA, the Administration for a Healthy America, and what the implications are for injury and violence prevention there. And so it sounds like what I'm hearing for you is we have the opportunity both to be a leader and show how we've modeled this and how we have integrated various processes and systems across a variety of outcome areas, but also that we may have opportunities ourselves to learn and grow from the other branches of public health that will also be moved under the Administration. Yes, there are still a lot of questions as to exactly what, aha, the Administration for a Healthy America is going to look like. Our understanding is it's pulling together a lot of the health agencies across the federal government. So it's pulling together HRSA, which funds the federally qualified health centers and a lot of the really critical safety net primary care, especially for low income Americans. It pulls together SAMHSA, the Substance Abuse Mental Health. Services Administration, and it is looking likely that some portions of CDC, including potentially our overdose work, is going to be in that milieu. There are lots of opportunities there, as long as we make sure the critical public health infrastructure, the data, the lab, the response, the funding to health departments that has built all this across the country remains. You know, in that continuum, we started the top of this conversation with talking about deaths going down. That's the top priority for the administration, but it's been all about, what does that continuum look like? So CDC and public health, we do not fund the evidence based treatment and recovery, right? That's what SAMHSA funds. For example, we fund everything up to that point. We fund the data, and we fund the community based prevention work. We go out after an overdose and make sure that person knows how to get connected to treatment, but we do not do the treatment ourselves. So there's been a lot of years of really making sure we have some clean lines here. Everybody knows we're not going to treat our way out of the overdose crisis any more than we're going to treat our way out of the suicide crisis, any more than we're going to treat our way out of a huge measles outbreak. It is about prevention at the at the end of the day, along with treatment. And I think if you know if this comes to pass, and and the the work of CDC that works on things like overdose and suicide and some of these other topics is part of Aha, there are real opportunities there, but we've got to make sure that the parts we do really well, are not disturbed, and we do not sever those connections to the public health infrastructure.

Sharon Gilmartin: 26:47

You made a really important point that I just want to lift up once more. The Injury Center is uniquely positioned and does work that no other federal agency does for so many of these topics. And so you know, when we're having these conversations with other stakeholders, that is something that isn't always clear to those on the outside. And I'd like to just double down on what you said, the role of the CDC Injury Center. There is no other federal agency taking on these specific tasks, for overdose, for for all of the various topics. And it is so important that we are clear on that and that we're protective of that.

Unknown: 27:25

Yeah, that's right. Let me give you just one tiny example of that, because lab work is often very behind the scenes, right? People don't really think about the lab work, but there is no laboratory right at AHA or HRSA, for example, right the laboratory at CDC, one of the things that the opioid funding supports there is they are able to send out, every single month the reference materials to public health labs and other labs all over the country that have more than 1000 here are the emerging substances in the drug supply right now. So we respond when we see we are seeing changing threat all the time. We see meta tomadine or Carfentanil, or, you know, Xylazine in new forms. We see that emerge. We might see that emerge in Massachusetts. We want to make sure Oregon is testing for it, so that as soon as it appears, they know and can take action without that behind the scenes, lab and that federal approach, we lose the ability all across the country to stay ahead. And so there are really unique things on lab, on data, on response, on expertise, and on our connections to the state and local public health departments, of course, that we are the only ones really doing that work. We're proud of it. We know we are not the whole picture. Nobody is the whole picture, but we have shown with the improvements on overdose that the investments being made across that spectrum in the federal government are working, and we're proud to be a part of that, and we're proud to be the data and community based prevention part of that. Well, your

Sharon Gilmartin: 29:06

Well your partners in the field are grateful for all that you do. We want to see all of this not just preserved but growing. It is so hugely valuable to to our society writ large. Allison, before we wrap up, I just want to give you the opportunity. Are there any additional thoughts that you have or things that you'd like to share with our listeners?

Allison Arwady: 29:26

I mean, I'd just like to say thank you to anyone listening who works in public health or who works on topics related to overdose. This progress that we are making as a country is all of our progress. And I know I used to be a local health department leader. I know what that work looks like every single day on the ground, and I know how hard that work has been. I know that there is not a family in the United States that has not been directly or indirectly impacted. By our overdose crisis. And I hope you hear some hope in these numbers, as I do, and I hope you take that hope and turn it into renewed energy and really lifting your voice for the importance of protecting the progress that we are making and that you are part of in your communities. So if you've got an opportunity, if you heard something that made you think today, oh, this is interesting. You know, I wonder what this looks like in my community. Your local health department can tell you what overdose looks like in your community, or they can link you into your state. All of that in every community is part of our progress nationally. And I think it really becomes real for people when we take it out of the numbers and say, This is what it looks like where I live, and I know and I hope that people listening have all played a role in this. We are not done focusing on this topic, leading cause of death still for 18 to 45 year olds. So this is hardly a hooray. We're done. We had fewer than 10,000 Americans dying from an overdose 25 years ago. So the fact that we're back down to 80,000 is great, but there's a long way to go still, and I hope that people take some heart from this and really double down on that work and really explain, especially some of the behind the scenes public health work. It doesn't seem as obvious why you always need that public health work. It's not, it's not as tangible to people, necessarily, as somebody has gone to a doctor and gotten the treatment for opioid use disorder, which we love and is amazing, and that has to keep happening. It's not as obvious as here was a drug bust where we caught, you know, this much, fentanyl and taken out of life. These are amazing events. When they happen, we have to celebrate them. They are part of the picture, but so is the picture of all of the young people who never even tried these, these illicit drugs, and that prevention piece is less obvious, but it is as much a part of the picture as the things that are in the news every day. And it's important that all of us talk not just about the treatment and the public safety side, but about that public health and that prevention side, because that is I know how we are going to get our way out of this and keep getting our way out of this.

Sharon Gilmartin: 32:26

Well, thank you, Allison. You are a delight. It was wonderful to have you on a podcast today. But more importantly, thank you for your incredible leadership, for the injury and violence prevention, community and public health more broadly. Well, thank you,

Allison Arwady: 32:37

Sharon, for your leadership, and really, all of the all of the work in this space it takes everybody to make progress on the topics that kill the most Americans. And we are, we are always pleased to partner and be able to lift up some of this work together. So thank you for the opportunity.

Sharon Gilmartin: 32:55

Thank you all for listening to this episode. I'd like to thank our sponsor, the American Trauma Society for supporting this conversation and their commitment to injury and violence prevention overall. If you're interested in supporting the CDC Injury Center, consider joining the Keep America Safe Coalition and advocating for continued funding for their programs. You can learn more by visiting our website@www.safestates.org or www.KeepAmericaSafe.info Thanks again for listening to IVP INdepth. Don't forget to hit that subscribe button so you never miss an episode, whether it's on Apple podcasts or Spotify. We'll see you next time, and until then, stay safe and injury free.