Crisis Epidemiology Slides Crisis Epidemiology
Mapping the Three Waves of the Opioid Epidemic
Public Health Policy & Intervention Design
The Longitudinal Perspective
Historical Context
Wave 1: 1990s
Prescription Opioids
Increased prescribing of natural and semi-synthetic opioids and methadone since the late 1990s.
Aggressive marketing of OxyContin.
Wave 2: 2010
Heroin Influx
Rapid increases in overdose deaths involving heroin as users transitioned from pills to injectable heroin.
Market saturation and low cost.
Wave 3: 2013
Synthetic Opioids
Significant increases in overdose deaths involving synthetic opioids, particularly illicitly manufactured fentanyl.
Adulteration of the non-opioid drug supply.
GIS & Hotspot Analysis
Methodology
Spatiotemporal Clustering
Using Anselin Local Moran's I to identify statistically significant spatial clusters of high overdose rates.
Correlative Indicators
Unemployment rates (lagged)
Pharmacy density per 10k
Medicaid expansion status
Interactive Map Segment Placeholder
Visualizing the rural-to-urban shift (2010 vs. 2022)
Epidemiological Data Literacy
Analysis Skills
Primary Repositories
NVSS
National Vital Statistics System
The gold standard for mortality data.
NSDUH
National Survey on Drug Use and Health
Self-reported usage and prevalence.
PDMP
Prescription Drug Monitoring Programs
Real-time clinical data and prescribing patterns.
Discussion Prompt:
"What are the inherent limitations of mortality data in capturing the scope of the synthetic wave, considering the rapid evolution of fentanyl analogs?"
Think about: Autopsy protocols and toxicology screening delays.
Hotspot Analysis Worksheet Epidemiological Hotspot Analysis
Public Health Research Portfolio | Module 1.1
Name:
Date:
Investigative Objective
Analyze longitudinal overdose mortality data to identify significant spatiotemporal clusters. Correlate identified hotspots with three primary socioeconomic indicators to determine the strength of the relationship between economic distress and the evolving waves of the opioid crisis.
Part 1: Longitudinal Shift Analysis
Examine the hypothetical data set below representing Age-Adjusted Death Rates (AADR) per 100,000 population across three distinct county types.
County Type 2002 (Wave 1) 2012 (Wave 2) 2022 (Wave 3) Rural Appalachian 12.4 34.8 68.2 Urban Industrial 4.2 18.6 74.5 Affluent Suburban 2.1 8.4 24.1
1. Interpret the Urban Industrial trend. How does the rate of change from 2012–2022 differ from 2002–2012? What does this suggest about the "synthetic wave"?
2. Calculate the Percent Change for Rural Appalachian counties from Wave 1 to Wave 3. Show your work.
Part 2: Spatial Clustering Interpretation
Imagine a heatmap showing high-intensity "red zones" concentrated in the Ohio River Valley in 2010, then diffusing into New England and the Mid-Atlantic by 2018.
Scenario Analysis:
The map exhibits significant positive spatial autocorrelation (Moran's I = 0.74). High-High clusters (hotspots) are primarily found in regions with high pharmacy density and low labor force participation.
Observation:
Part 3: Indicator Correlation
Select one socioeconomic indicator (e.g., unemployment, median income, or educational attainment) and hypothesize how its correlation coefficient with overdose rates might have changed between Wave 1 (pills) and Wave 3 (fentanyl).
Selected Indicator:
Hypothesized r (W1):
Hypothesized r (W3):
Justification for change in correlation strength or direction:
Social Roots Slides Social Roots of Addiction
Determinants, Equity, and the Ecology of Crisis
Module 2: Social Determinants of Health
Competing Frameworks
Theory Critique
The Moral Model
Views addiction as a failure of willpower or character. Focuses on individual choice and punitive deterrence.
Result: Criminalization and Stigma
The Disease Model
Views addiction as a chronic, relapsing brain disorder. Focuses on neurobiology and clinical treatment.
Result: Medicalization and Clinical Care
Graduate Task: How do both models fail to account for structural determinants?
Structural Determinants
Sociological Lens
Housing Stability
"Housing First" vs. Abstinence-contingent shelter models.
Economic Agency
The correlation between industry collapse and opioid volume.
Systemic Trauma
ACE scores and their predictive power for dependency.
Health Equity
Racialized disparities in MOUD access and sentencing.
The Zip Code Prediction
Application
Prompt for Analysis:
"If we can predict addiction clusters with 80% accuracy using only median income and vacancy rates, to what extent is opioid use a 'medical' issue versus an 'economic' one?"
Intervention Alpha
Fund more clinical detox beds.
Intervention Beta
Universal basic income & rent caps.
Zip Code Destiny Worksheet Zip Code Health Report
Critical Sociology & SDOH Analysis | Module 2.1
NAME:
DATE:
Case Profile: District 402 (Hypothetical)
Median Income
$24,500 (-40% vs state avg)
Housing Vacancy
18.4% (High Concentration)
Uninsured Rate
22.1% (Access Barrier)
1. Predict the Relative Risk Score (1-10) for opioid overdose in District 402 based solely on these variables. Justify your score using the Social Determinants of Health (SDOH) framework.
2. Sociological Critique: How does the "Moral Model" of addiction fail to account for the vacancy rate in District 402? What systemic factors might link empty housing to increased dependency?
Part 2: Health Equity & Access Disparities
Research indicates that BIPOC populations in urban centers often face different barriers to Medications for Opioid Use Disorder (MOUD) compared to rural white populations, even when socioeconomic status is matched.
Identify two structural barriers to treatment specifically relevant to marginalized urban populations:
Proposed Policy Fix (Structural): Describe one non-clinical intervention (e.g., related to transportation or legal reform) to improve treatment retention:
Reflection: The "Deaths of Despair" Thesis
Case and Deaton (2020) argue that the rise in overdose deaths is a symptom of a broader "despair" caused by the long-term decline of the working class.
To what extent should a public health intervention for opioids focus on "Job Creation" vs. "Narcan Distribution"? Balance your response with evidence-based reasoning.
Harm Reduction Evidence Slides Harm Reduction Efficacy
Evidence, Ethics, and International Models
Module 3: Pragmatic Intervention Strategies
Pragmatism Over Punishment
Core Tenets
Meeting People Where They Are
"Not leaving them where they are."
Incrementalism
Focus on reducing the harms associated with drug use (disease, overdose, abscesses) rather than just the use itself.
Radical Compassion
The Evidence Base
Data Review
Syringe Service Programs
50% reduction in HIV & HCV incidence.
5x more likely to enter treatment.
Overdose Prevention Centers
Zero fatal overdoses recorded on-site globally.
Reduced public injecting and litter.
Naloxone & Test Strips
Rapid reversal of opioid respiratory depression.
Empowers users to detect lethal supply.
The Portugal Model (2001)
Success Metric
Decriminalization & Reinvestment
Personal drug possession is an administrative offense, not criminal. Savings from prisons redirected to social reintegration.
-75% HIV Infections
+60% Treatment Enrollment
Transferability Challenge:
"Can the Portugal model survive a fentanyl supply wave that didn't exist in 2001? Why or why not?"
Harm Reduction Policy Analysis Worksheet Harm Reduction Policy Analysis
Public Health Ethics & Evaluation | Module 3.2
NAME:
DATE:
Part 1: Strategy Evaluation Matrix
Evaluate each strategy based on clinical efficacy, community acceptability, and cost-benefit ratio.
Intervention Primary Public Health Goal Common Political Obstacle Syringe Service Programs (SSPs) Overdose Prevention Centers (OPC) Drug Checking (Fentanyl Strips) Low-Barrier MOUD Access
Part 2: Ethical Inquiry - The Hypothetical Site
The Scenario:
A non-profit proposes a Safe Consumption Site (SCS) in a zip code with the city's highest overdose rate. However, the site is 200 feet from a local primary school. Residents argue it will attract "drug tourism" and needles in the park. Public health officials argue it will save 50 lives per year and reduce public injections.
1. Utilitarian Argument: How would a "greatest good for greatest number" analysis justify or condemn this site?
2. Deontological Argument: What "duty" do officials have toward the safety of the children vs. the lives of the users?
Stakeholder Compromise
Identify one mitigation strategy that could address community concerns while maintaining the site's clinical integrity:
Part 3: Global Benchmarking
Critics often argue the "Portugal Model" only works due to the country's social safety net. List three US-specific structural barriers that would hinder the success of a similar decriminalization effort:
A.
B.
C.
Policy Reform Slides Policy Reform Frameworks
From Criminalization to Medicalization
Module 4: Legal & Legislative Infrastructure
The Controlled Substances Act (1970)
Federal Baseline
The Scheduling System
Drugs are categorized (Schedules I-V) based on accepted medical use and potential for abuse.
Sched I Heroin, Fentanyl-Related Substances (No medical use)
Sched II Oxycodone, Morphine, Fentanyl (High abuse potential)
Legislative Critique:
How has the scheduling of fentanyl analogs hindered research while failing to stop the street supply?
Consider: Class-wide scheduling vs. individual chemical analysis.
Section 1115 Waivers
Funding Mechanisms
Re-entry Support
States can use Medicaid funds for incarcerated individuals 30 days pre-release.
IMD Exclusion
Removing barriers to large residential treatment facilities.
Social Supports
Funding for "Health-Related Social Needs" like stable housing.
"Policy is only as strong as its financing mechanism."
Drug Courts: Treatment or Coercion?
Analysis
The Promise:
Reduces recidivism compared to standard probation.
Diversion away from felony records.
The Critique:
"Cherry-picking" participants (excluding high-risk cases).
Medical decisions made by judges, not doctors (e.g., banning MOUD).
Debate Prompt:
"Is mandated treatment under threat of jail an evidence-based intervention or a violation of medical ethics?"
Policy Brief Workshop Worksheet Policy Brief Workshop
Legislative Analysis & Advocacy | Module 4.2
NAME:
DATE:
TO: Health & Human Services Committee Chair
FROM:
RE: Analysis of Proposed Senate Bill 402
STATUS: PENDING REVIEW
Section 1: Executive Summary
Draft a 3-4 sentence summary of the core public health problem and your primary recommendation regarding SB 402.
Part 2: Legislation Deep-Dive
Summary of SB 402:
"This bill mandates the involuntary commitment of any individual who has survived more than two opioid-related overdoses requiring EMS intervention in a 12-month period. Commitment would be for a minimum of 60 days in a state-run clinical stabilization unit."
1. Legislative Conflict: Does this bill violate current federal mandates regarding the "least restrictive environment" for medical care? Cite potential legal challenges.
2. Epidemiological Critique: Predict the likely impact of SB 402 on EMS call volume. Might it discourage overdose reporting? Why or why not?
Part 3: The Recommendation
Based on your analysis, should the committee support, amend, or reject SB 402? Defend your position using two pieces of peer-reviewed evidence or international models discussed in this sequence.
Proposed Action: Support / Amend / Reject
Detailed Justification:
Alternative Proposal 1
Expected Fiscal Impact Intervention Design Slides Intervention Design Workshop
Designing for Impact: The $5 Million Challenge
Module 5: Culminating Project Workshop
"The RFP" (Request for Proposals)
Project Scope
The Objective:
Design a multi-faceted public health intervention for one high-risk county. You must reduce overdose deaths by 20% over 3 years.
$5,000,000
Total Grant Budget
36 Months
Implementation Timeline
Evidence-Based Allocation
Design Rules
Proposals MUST allocate funds across three distinct categories:
1. Primary Prevention
Addressing social determinants & prescribing patterns.
Min: 15% of Budget
2. Clinical Treatment
Expanding MOUD, residential care, and medical detox.
Min: 30% of Budget
3. Harm Reduction
Naloxone, SSPs, and contingency management.
Min: 20% of Budget
Peer Review Rubric
Assessment
01
Scientific Validity
Is the intervention supported by current epidemiological evidence?
02
Equity & Justice
Does it address specific barriers for marginalized populations?
03
Feasibility
Are the budget and timeline realistic for the proposed scope?
04
Sustainability
What happens when the $5M grant ends in 3 years?
Intervention Proposal Worksheet Community Intervention Proposal
Graduate Culminating Project | $5M Grant Challenge
TEAM:
DATE:
Target County / Municipality:
Project Title:
Statement of Need: Summarize the epidemiological profile of your target area (referencing "Three Waves" data) and the primary Social Determinants of Health (SDOH) driving the crisis there.
Pillar Design: The Integrated Model
1. Prevention & Social Determinants (Min 15%):
How will you address upstream factors? (e.g., housing, employment, youth programs)
2. Clinical Treatment & Recovery (Min 30%):
Describe your MOUD expansion and stabilization strategies.
3. Harm Reduction (Min 20%):
Naloxone, SSPs, drug checking, or safe consumption site details.
Financial Allocation & Evaluation
Budget Allocation Table:
Category Amount ($) Personnel / Staffing Infrastructure / Rent Clinical Supplies (MOUD) Harm Reduction Kits Outreach & Education TOTAL: $5,000,000
Key Performance Indicators (KPIs):
How will you measure the 20% reduction? List three specific data points you will track quarterly.
01
02
03
Sustainability Analysis
What policy or funding shifts are required at the state level to ensure this program continues after Year 3? (Hint: Section 1115 Waivers, opioid settlement funds, etc.)
