How Alabama Is Synthesizing Data to Strengthen Its Opioid Crisis Response

Opioid-related overdose deaths continue to devastate communities throughout the country and put a strain on local resources, including emergency medical services, law enforcement, and health care providers. Understanding the scale of the problem is critical to tackling this public health threat, and that requires comprehensive data from a myriad of sources.

A new brief from The Pew Charitable Trusts examines how Alabama is fostering data collaboration between state agencies and private organizations to better understand opioid use disorder within the state. From 2006 to 2014, fatal drug overdoses (including, but not limited to, opioids) in Alabama grew by 82%. By 2016, the state led the nation in per capita opioid prescriptions, with a rate of 121 prescriptions for every 100 people. In response, in 2017, Governor Kay Ivey ordered the creation of the Alabama Opioid Overdose and Addiction Council.

Advance Health & Well-Being Alabama's Cross-Agency Data System Strengthens Opioid Crisis Response

Issue Brief

Led by the commissioner of the Alabama Department of Mental Health (ADMH), the state health officer overseeing the Alabama Department of Public Health (ADPH), and the state attorney general, the council recommended creating a central data repository (CDR) to overcome legal and confidentiality barriers impeding data collaboration between different public agencies and private organizations.

The CDR pools data from the state’s departments of public health and mental health, the Alabama Law Enforcement Agency, poison control, insurers, and other organizations. By analyzing this cross-sector data, Alabama public health officials, researchers, policymakers, and others can see and understand opioid and other substance use problems holistically. They can also use the data to develop strategic approaches to curb overdoses and measure the effectiveness of ongoing initiatives, improving them as needed. The CDR’s interactive dashboards also serve as an educational tool, allowing the public and key stakeholders to view the data broken down by county, race, sex, and other categories.

Originally funded through what is now the Department of Justice’s Comprehensive Opioid, Stimulant, and Substance Use Program, the CDR today is financially supported by ADPH and implemented by the University of Alabama’s Institute of Data and Analytics.

In the eight years that the CDR has been in operation, Alabama officials have used the repository to inform and support their work in many ways. For example, when data analyses showed state officials that overdoses per capita were much higher in one county than in others, ADMH responded by focusing prevention and peer support programs in that location.

Officials have also used data from the CDR to apply for and obtain grants, including federal funds, that support many of the state’s opioid-related programs. County-level officials have disseminated data and findings from the CDR when presenting to community groups and giving lectures, helping to raise public awareness around the risk of drugs in the community and offering a platform about overdose prevention and response. More broadly, state agencies use the CDR as an evaluation tool to identify areas where they are performing well in their opioid response, areas where they need to improve, and what populations are underserved and require interventions most urgently.

Promising practices for all states

Through interviews with Alabama officials who designed, implemented, and/or participated in the state’s CDR—including public health leadership, representatives from multiple state agencies, and a technical implementer from the University of Alabama—Pew identified several promising practices that other states can look to as they build their own data-sharing practices:

1. Ensure utility of the data being shared. Have a realistic understanding of what bringing data together from multiple agencies may help the state to accomplish. Couple that with a strategic plan to guide data-sharing efforts. Make sure that shared data is updated regularly.
2. Minimize the burden on data providers. When engaging with potential partners, be clear about the purpose of data sharing and ensure that partners know that they are not being asked to collect new data. If new data streams are necessary, keep them to a minimum to lessen the burden on agencies and encourage participation. Be flexible in the data formats that are accepted into the shared repository.
3. Always demonstrate value. Even after the database is authorized and operating, it is critical to continually show stakeholders—executive leadership, especially—that the investments of time and resources are yielding tangible benefits.
4. Identify a wide range of potential partners. Be open to partners beyond what is typical within the state. Successful collaboration may be found with groups outside of government agencies, such as universities or other independent trusted third-party organizations. Once engaged, treat all partners in a fair and transparent manner.

By establishing trust, generating buy-in, and ensuring fairness, the CDR has helped state officials better identify program needs, improved communication between Alabama’s state agencies, and provided communities a platform to help raise awareness around overdose prevention and response. The creation and use of Alabama’s CDR shows that bringing together disparate data sources is crucial to understanding and combating large-scale public health issues, such as opioid use disorder.

Ian Leavitt is a principal associate and Margaret Arnesen is a senior officer with The Pew Charitable Trusts’ public health data improvement project.