Considering Potential Unintended Consequences of Collecting Identified Patient Data to Guide Nonfatal Overdose Response

In their editorial, Davis et al.¹ call for jurisdictions to make overdose a mandatorily reportable condition and argue that health departments should use identified data, collected through mandatory reporting, to facilitate individual-level responses to nonfatal overdose. Nonfatal overdose responses are critical to our collective effort to reverse the opioid epidemic, given the high risk of death following a nonfatal event. The authors rightly state that any nonfatal overdose responses should occur under public health, not law enforcement.

Although we agree that nonfatal overdose represents an opportunity for intervention, we are concerned by the assertion that collection and retention of identified data are the best way forward. In New York City, all poisonings, including overdose, must be reported to the Department of Health and Mental Hygiene under New York City’s Health Code.² However, overdoses rarely are reported, and the Department of Health and Mental Hygiene uses syndromic surveillance to monitor trends in nonfatal overdose instead of a separate name-based system.³

We affirm that responding to nonfatal overdoses while maintaining strict patient consent standards is possible. New York City’s nonfatal overdose response program, Relay, deploys peers 24-7 to deliver overdose prevention, harm reduction, and treatment resources to individuals in emergency departments and collects patient identifiers only with informed consent. This information is stored separately from surveillance data and is not obtained through mandatory reporting.

Unlike other reportable conditions (e.g., HIV, tuberculosis), drugs remain illegal and can lead to arrest and incarceration. In the current political climate, law enforcement has an expanded role in overdose, sharing the work of public health. Simultaneously, drug-induced homicide prosecutions and mandatory minimum sentences are being revived nationwide.⁴ Despite good intentions, constructing databases of overdose survivors has a high potential for misuse by law enforcement. In addition, mandatory reporting may lead to a chilling effect among people seeking emergency health services for overdose.

Davis et al. also suggest that public health has been slow to respond to nonfatal overdose without considering structural resource disparities between public health and law enforcement and the reliance on the existing treatment system for overdose response. Most federal opioid funds have gone to law enforcement. As public health professionals, we are positioned to develop rapid and far-reaching interventions, including harm reduction measures such as emergency department discharge protocols and treatment platforms such as emergency department–based buprenorphine induction. However, systemic interventions require significant and long-term investments in public health. To respond adequately to overdose, a national realignment of funding priorities is required.