Nonfatal overdoses represent a critical and under-recognized component of the contemporary substance use crisis. Unlike fatal overdoses, nonfatal events offer unique opportunities for timely intervention and biosurveillance because individuals often interact with clinical systems shortly after experiencing an overdose. This project piloted a comprehensive biosurveillance approach to examine the demographic, clinical, and toxicological characteristics of patients presenting with nonfatal overdoses in Wisconsin emergency departments. By linking biological specimens with clinical and contextual data, we aimed to identify patterns of substance use and risk factors that can inform targeted prevention and public health response efforts.
Funding Partners
Research Objectives
The primary goals of this research are to:
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Implement a state-wide biosurveillance strategy using residual urine specimens from emergency department patients to characterize nonfatal overdose events.
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Assess demographic and clinical profiles of individuals experiencing nonfatal overdose, including age, sex, substance use history, mental health status, and discharge outcomes.
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Characterize toxicological findings through clinical screening and analytical toxicology to understand patterns of substance involvement and polysubstance use.
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Identify associations between risk factors and clinical outcomes, such as the presence of synthetic opioids, stimulants, or combinations of drugs, to inform risk stratification and intervention design.
This project contributes to establishing biosurveillance as a practical complement to existing surveillance systems and a bridge between clinical care and public health action.
Significance and Impact
The findings of this study provide important insights into nonfatal overdoses that are often missed by traditional surveillance systems:
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Highlights the prevalence of polysubstance use: A majority of individuals in the study exhibited polysubstance exposure, underscoring the complexity of overdose events and the need for multifaceted screening and intervention strategies.
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Identifies key demographic and clinical risk factors: Substance use disorder, mental health conditions, and previous overdose history were common among participants, suggesting important targets for prevention and clinical practice improvements.
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Demonstrates the utility of biosurveillance: This work illustrates how integrating residual clinical specimens with health data can yield actionable information about substance use patterns, providing a proof of concept for real-time surveillance applications.
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Supports public health intervention design: Understanding associations between specific drug exposures and outcomes (such as discharge status) can help tailor harm reduction and treatment approaches, potentially reducing morbidity and mortality associated with overdose.
By focusing on nonfatal events, the project fills a critical gap in overdose research, offering evidence that can improve both population-level strategies and individual patient care.
Outputs and Dissemination
Data collection for this project is ongoing. Work from this project has generated:
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Collaboration with state health departments and emergency medicine partners.
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Foundational data supporting future biosurveillance expansion, including larger-scale studies and integration with other data streams (e.g., EMS and syndromic surveillance).
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Conference presentations and symposia contributions at public health and toxicology meetings to share methodological lessons and findings with both academic and practitioner audiences.
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Peer-reviewed publications in open-access and domain-specific journals.
These outputs collectively advance the field’s capacity to monitor and respond to overdose trends more effectively and with greater real-world relevance.