Table 4.

Secondary Data Sources to Support Strengthening Data for Better Public Health Surveillance.

Data Elements (by Topic)	Sources	Strengths and Limitations
Prescription drug monitoring data
Detection of opioid misuse •Prescription name/type •Prescription dose •Prescriber •Payment	•State PDMP •PBSS	Strengths:	+Comprehensive data on prescribing (i.e., multi-payer) +Can be used to develop measures around patient, prescriber, and pharmacist risky behaviors
		Limitations:	-Access barriers -State capacity issues may limit ability to link PDMP data with other datasets
Mortality data
Opioid-related overdose •Cause of death •Drugs involved in death •Demographics	•NDI •NVSS MCOD •CDC WONDER* •State vital records	Strengths:	+National data with information on opioid overdose mortality +CDC WONDER is readily downloadable and publicly available
		Limitations:	-Lags in data availability -Variation in quality of reporting detail on drug involvement
Other national sources
Detection of opioid misuse •Inpatient stays and ED visits •Nonfatal overdose •Opioid use disorder •Diagnoses and procedures	•HCUP (national and state inpatient and emergency department databases)	Strengths:	+Large collection of longitudinal data, nation-wide and state-level +State data is mapped to a standardized format
		Limitations:	-Not all states participate in the three state-level databases -Costs to obtain full datasets
	Enhanced state opioid overdose surveillance	Strengths:	+Very rich detail integrated from ED hospital billing, EMS, and syndromic surveillance data +Timely data availability and comparability across jurisdictions
		Limitations:	-Not currently available for all states
Toxico-surveillance •Opioid-related poison center calls •Exposure type (e.g., intentional abuse exposures)	Poison Control •NPDS	Strengths:	+Product and drug specific information
		Limitations:	-Must be requested and purchased -Lags in availability vary by poison center
Product-specific use & trends •Opioid use/initiation •Route of administration Toxico-surveillance •Nonfatal opioid overdose Illicit opioid markets •Source of opioids	Proprietary surveillance •RADARS •NAVIPPRO	Strengths:	+Multifaceted data collection including product and drug specific information +Can identify exposure among high-risk groups (e.g., pregnant women) +RADARS has information on product street prices
		Limitations:	-Not nationally representative -Possible sampling biases -Costs to obtain
Toxico-surveillance •Opioid-related ED visits •Substance with composition and formulation-specific differentiation	ED surveillance •DAWN*	Strengths:	+Nationally representative and generalizable +Mortality data available for a subset of states
		Limitations:	-Discontinued in 2011 -Possible sampling and information biases
Illicit opioid markets •Drug category; drug chemistry •Prevalence and location of emerging drugs •Street price (STRIDE)	Drug seizure or testing data •NFLIS •STRIDE	Strengths:	+Data on illicit drug supply, prices, and purity +Seizure data often available with less lag time +Useful in constructing models of the likely course of the epidemic
		Limitations:	-Access barriers (particularly for sub-state data) -Some drugs seizures are not analyzed by participating laboratories
Other state and local sources
Illicit opioid markets •Criminal history •Drug-related offenses and arrests •Demographics	Drug arrest data from state or local criminal justice agencies	Strengths:	+Could be used to examine network patterns of co-arrests +If linked with other data, can assess systematic histories leading to arrest
		Limitations:	-Often not available in electronic form that is usable -Difficulties in obtaining data use permissions
Detection of opioid misuse •Opioid-related inpatient stays and ED visits •Diagnoses and procedures •Costs	HCUP (State Inpatient and State Emergency Department Databases)	Strengths:	+Large collection of state-level longitudinal data +State data is mapped to a standardized format
		Limitations:	-Not all states participate -Costs to obtain full datasets
	State inpatient, ED, mortality, or syndromic surveillance sources	Strengths:	+Often available with less time lag than national sources +May be linkable to variety of state data sources
		Limitations:	-Access and cost barriers vary across sources -State-specific so challenges for cross-state comparison
National surveys
Illicit opioid markets •Self-reported drug use •Urinalysis test results •Substance abuse treatment history •Drug acquisition and payment	Arrestee Survey •ADAM*	Strengths:	+Captures a high-risk population with uniform data collection across sites
		Limitations:	-Limited to few sites collecting data and male arrestees only -No longer fully operational -Certain data elements are restricted access

^*Publicly available at no cost.