Opioids infiltrate nearly every facet of U.S. society—they are found in every community and every walk of life—and addiction and overdose deaths are on the rise. Opioid addiction has become such a pervasive epidemic that the drugs are now a bigger killer in the United States than breast cancer, guns, and vehicle-related accidents.
Synthetic opioids such as fentanyl, fentanyl analogs, and tramadol accounted for two-thirds of the 63,000 drug-related deaths in the U.S. in 2016, according to the National Center for Health Sciences. Opioid addiction knows no racial, socioeconomic, or geographic lines, which makes the problem even more difficult to solve.
Today, more and more communities are looking toward technology to address the opioid problem. Specifically, innovative new solutions involving geographic information systems (GIS) are helping communities identify where and how opioid usage is most pervasive, enabling them to better allocate resources to prevent and/or mitigate addiction.
Esri, an SAP partner, has developed a spatial mapping and analytics software solution that leverages data residing in an in-memory computing platform, and this tool is now being implemented in jurisdictions across the United States.
With this approach, a powerful geographic platform allows users to leverage tools like “story maps” that turn raw data resources into powerful insights on any topic. “Whether it’s the opioid crisis, refugees in Bangladesh, or tracking a killer whale population, mapping technology has the ability to help organizations and businesses make more intelligent and evidence-based decisions,” said Dr. Este Geraghty, chief medical officer and health solutions director at Esri.
“The idea is to use geographic data to improve decision-making and resource allocation. In the health sector, we can help organizations transform the way they do business,” said Geraghty, a physician who joined Esri more than three years ago. “While we all love data, it’s not very inspiring to simply talk about the amazing things you can do with geographic data. Rather, we get motivated by helping people solve real problems and we know the power of geographic intelligence to do that. Our health and human services team focuses their energy on tackling the big issues that impact our personal and community’s health and well-being.”
To Geraghty, the opioid epidemic is a personal mission. One of her colleagues, Jeremiah Lindemann, lost his brother to a drug overdose in 2007. Lindemann used his technical background to launch a crowdsourced story map called “Celebrating Lost Loved Ones,” where people can contribute a photo and narrative in memory of someone who died from opioids. So far, more than 1,500 people have added the names of mothers, fathers, sons, daughters, and friends.
“When you explore that map, you begin to notice that the opioid crisis is affecting people from all walks of life—people who had families. People who loved them and were loved by them. It’s heartbreaking. The story map is meant to allow people to share their grief, but it also reminds us that opioid addiction can happen to anyone, anywhere,” Geraghty said. “Jeremiah inspires all of us. He’s spent the last several years broadly sharing his story and his perspective on the topic. He’s even testified before Congress about the dangers of opioids. Our focus on this issue and our drive to be a force for good all began with him.”
Mapping a problem to find a solution
The first step in the GIS mapping technology is to identify where overdoses and deaths are happening. That information is mapped to help police and other organizations determine where to best allocate their resources.
“Everything happens somewhere, but so many people still take ‘somewhere’ for granted. It takes a little practice to think spatially and use location information strategically,” Geraghty explained. “But after a while, it becomes natural to consider relevant questions like, What’s the geographic extent of the problem? Where is it worse? Where is it not so bad? Are there patterns in the data? What can I learn from less impacted communities?
“Most communities don’t have the means to evenly spread resources across every jurisdiction. That means that they need to make strategic decisions about where to do more and what kinds of interventions will have the greatest impact in different places. It’s never the same thing from one place to another.”
Sometimes a geographic analysis will show that one or more epidemics overlap. We call that a syndemic. Understanding these spatial relationships can be critical to formulating the best strategy, Geraghty said.
For example, when one California county experienced a major Hepatitis A outbreak, GIS indicated that the disease correlated spatially with opioid and homeless epidemics in the county and that interventions would require consideration of those co-occurring issues. Public restrooms in the county were mapped and put on a regular cleaning schedule, sidewalks in and near homeless encampments were sanitized, handwashing stations were placed in relevant areas, and vaccinations were offered to high-risk populations in their neighborhoods. These methods and more were deployed in the right places to help the right people and ultimately stop the outbreak.
“You want to get out ahead of it. To do that, you need to understand where people are dying, when, and why,” Geraghty said. “Information can be a powerful weapon for communities to help people.”
For example, in one U.S. county, the highest cluster of overdoses comprised males in their 30s who died between 6 pm and 8 pm. The GIS technology showed that most of the county’s resources were working between 8 am and 5 pm and had been targeting females at risk. “We showed them the spatial data, and now they’ve allocated their resources more effectively,” Geraghty said.
The benefit of understanding the geographic context for such complex problems cannot be understated, according to Geraghty. For example, one community leader promised to eliminate all the “pill mills” in his jurisdiction. That effort was successful, but an unintended consequence was that addicts turned to other drugs, such as heroin, which then became a bigger problem. “Taking a broader view of the community might have helped avoid that consequence,” Geraghty noted. “If you cut off the supply of the drug without also considering the continuing demand, you can run into trouble. Our solution includes a tool for providing resources that could decrease opioid demand, like providing alternative pain control modalities that prevent addiction and identifying treatment options for those already addicted.”
Developing a solution—together
Increasingly, local governments are recognizing that help from the state and federal level may not be enough to address the problem. They need solutions that help them do more with their resources.
“The big thing with the opioid crisis is that it’s a concern across multiple organizational sectors. This is not just a public health or a mental health or a health care problem. It’s also a police problem, pharmaceutical company problem, an emergency personnel problem, and a government funding and policy problem, to name a few. A lot of different entities are involved in addressing the crisis. Communication and collaboration are critical, and spatial mapping and analytics can facilitate those needs,” Geraghty said.
One challenge is getting many disparate organizations and communities to share information, a problem exacerbated by protections around personal health information. “Organizations tend to be reluctant to share data, even when it is appropriate and legal. Saying ‘no’ to sharing is undoubtedly the best answer to avoid potential data breaches, but it doesn’t help in addressing the problem,” Geraghty said. “Cross-sector collaborations and appropriate data-sharing agreements need to increase if we’re going to make any real progress. In turn, in-memory computing helps democratize and distribute the data.”
“Opioids have such a dramatic impact on our lives. Addiction affects our families and our society, it diminishes tax revenue and productivity. It even impacts the needs of our foster care systems. It can cripple an entire community,” Geraghty said. “We’re a B2B company and we’re passionate about providing authoritative health organizations with outstanding tools to support their populations. This is important to all of us.”