Washtenaw County is one of just 12 of Michigan’s 83 counties with an Overdose Fatality Review Team.
Formed in 2023, this multidisciplinary team–with representatives from the public health department, medical examiner’s office, criminal legal justice system, substance use disorder treatment community, and more–meets every other month. Each time, they review and discuss overdose fatalities. The goal? To understand where things went wrong and, importantly, what we can do to prevent future overdoses.
While the team is not given the name of the individual, or personal details, they do have access to investigative details from the medical examiner’s office and law enforcement agencies, details from emergency medical system provider reports, prosecuting attorney records, parole and probation records, court records, school records, social service agency records, and, when requested, testimony from family and friends.
With all of this information, the team can uncover factors that contributed to the overdose. In one death, unaddressed post-traumatic stress disorder may have been a factor. In another, using drugs alone, or stigma against the gold-standard medications that can be used to treat opioid use disorder. After a series of overdose investigations over the course of a year, overdose fatality review teams identify common themes in factors related to opioid overdose death and discuss where community-based programs and services could make changes to better prevent overdose.
The Washtenaw County overdose fatality review team documented common themes that emerged through their reviews so far. In addition to providing statistics about the number of overdoses and the race, gender, and zip code of those who died, the document includes a series of evidence-based recommendations to fight overdose in our county. The recommendations are broken out into four categories: 1) educating the community and providers, 2) harm reduction, 3) advocacy, and 4) health care.
Under educating the community and providers, recommendations include increasing awareness of helpful resources, such as:
- Never Use Alone, a toll-free, 24/7 judgment free overdose prevention line managed by peers (877-696-1996). If someone is choosing to use drugs alone, peers stay on the line to monitor them until danger of overdose has passed. If the individual does not respond to peer check ins, peers contact emergency medical services. Here is the flyer, and business cards.
- Project ASSERT, a nationally recognized, peer and evidence-based program that uses motivational interviewing to encourage patients and family members to seek care for risky use of substances while helping patients access primary care, clinical preventive services, and treatment for alcohol and substance use disorders.
- The partnership between Home of New Vision’s Recovery Opioid Overdose Team (ROOT), Washtenaw County Community Mental Health, the Washtenaw County Sheriff’s Office, Huron Valley Ambulance, and the University of Michigan’s School of Nursing that sends recovery coaches and community members to check in on overdose survivors 48-72 hours after the event, offering non-judgmental support and resources.
Under harm reduction, the team provides the following recommendations:
- Placing additional Narcan dispensers in areas that can be accessed outside of normal business hours.
- Training the community on how to self-administer Narcan or naloxone.
Under prevention, the team recommends:
- Advocating for universal checking of the Michigan Automated Prescription System (MAPS) regardless of the number of days of prescribing. MAPS is a tool used by prescribers and dispensers to review previous prescriptions dispensed for controlled substances and is used to prevent drug abuse and diversion at the prescriber, pharmacy, and patient levels.
And under healthcare, the team urges providers to:
- Ensure that all area hospitals understand their role as entry points to substance use disorder treatment and create multi-disciplinary teams to engage with patients during medical hospitalizations.
- Consider prescribing non-opioids for pain management including nonsteroidal anti-inflammatory drugs (NSAIDs), a group of medicines that relieve pain and fever and reduce inflammation, or to prescribe the partial opioid agonist buprenorphine.
- Use the EPIC and Great Lakes Connect systems to see a patient’s history and ensure better care across systems.
- Prescribe Narcan with all opioid prescriptions.
Dr. Allecia Wilson, Washtenaw County’s medical examiner, leads the reviews. “We go all the way back to childhood, back to their families, and there’s a lot of trauma,” says Wilson. “You realize how much empathy you have for their lives. To have one of these things happen to you, that would be hard and traumatic. But they happen over and over and over again.”
Recently, overdose fatality review teams across Michigan have been given legislative authority to share the names of the individuals whose cases they review. This is important so that the programs that interacted with those individuals can identify and share relevant health and human service system details. It will also help the teams recommend changes to prevent drug overdose fatalities at participating organizations and better understand the laws, policies, funding shortfalls, and practices that played a role in the fatality.
“We really need to do these reviews to intervene earlier,” says Wilson, “to get resources into the community where they’re needed, and hopefully to prevent that death.”
Washtenaw County’s Overdose Fatality Review Team includes representatives from the county’s:
public health department
medical examiner’s office,
probation and parole system,
local court system,
law enforcement agencies,
harm reduction provider community,
mental and behavioral health provider community,
substance use prevention, treatment, and recovery provider community,
education community,
county jail,
child protective services agency,
emergency medical services program,
health care provider community,
prescription provider community, and
peer recovery community.