Author ORCID Identifier

Date of Award


Degree Type

Closed Dissertation

Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Richard Rothenberg

Second Advisor

Sheryl Strasser

Third Advisor

Alana Vivolo-Kantor


The drug overdose crisis remains a public health concern in the United States; in 2022, over 109,000 persons died from a drug overdose. The overdose epidemic has been primarily fueled by opioids, with an estimated 75% of overdose deaths in 2022 having been opioid involved; in recent years, synthetic opioids, including illicitly manufactured fentanyls, are driving increases in overdose morbidity and mortality. Through the use of multiple data sources, surveillance of drug overdose trends can help to inform public health on the changing epidemic. Emergency department (ED) syndromic surveillance data, hospital billing/discharge data, emergency medical services (EMS) data, and national vital statistics data can each provide useful and complementary information on drug overdose trends. The three studies in this dissertation utilize one or more of these data sources to address a knowledge gap in the understanding of overdose trends.

The first study examined trends and usage of newly implemented ICD-10-CM discharge diagnosis codes for poisonings by fentanyl, tramadol, and other synthetic narcotics in ED syndromic surveillance data queried from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program BioSense platform the year prior to (October 2019–September 2020) and after the code change (October 2020–September 2021); data from EDs in 33 states and the District of Columbia were included. The second study compared trends in the counts and rates of nonfatal opioid-involved overdose encounters in EMS and ED data in nine states from 2020–2022. The third study examined the ratio of fatal to nonfatal overdoses involving all drugs, all opioids, synthetic opioids, heroin, or stimulants from 2010–2020 using vital statistics data to estimate fatal overdoses and hospital billing/discharge data to estimate the number of nonfatal overdoses treated in EDs.

The collective results of this dissertation project were to analyze ED, EMS, and national vital statistics data to advance scientific knowledge concerning nonfatal fentanyl-involved overdose surveillance, as well as enhancing understanding of EMS and ED data comparability for tracking opioid-involved overdose trends, and understanding the ratio of fatal to nonfatal overdoses by drug type. Altogether, study findings can be used to better understand the drug overdose crisis in the US and inform response and prevention efforts.


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