More States Authorizing the Use of Overdose Fatality Review Teams

August 23, 2018 | ASTHO Staff

Overdose fatality reviews allow states to examine and understand the circumstances surrounding fatal drug overdoses. Review teams can uncover the individual and population factors and characteristics of potential overdose victims. Knowing the who, what, when, where, and how of fatal overdoses provides a better sense of the strategies and coordination needed to prevent future overdoses and results in the better allocation of overdose prevention resources and services.

As of August 2018, nine states (Arizona, Delaware, Maryland, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Virginia, and West Virginia) have authorized the review of fatal drug overdoses. The Network for Public Health Law provides a good overview of the states that had review teams at the end of 2017 (AZ, DE, MD, NH, PA, and WV). Since then, three other states enacted laws to establish overdose fatality reviews [OK (HB 2798), RI (S 2577 and H 7697), and VA (SB 399)], and two states amended their laws: DE (HB 211) and AZ (HB 2038). The laws establishing fatal overdose reviews often include the entity authorized to create and manage the review team or committee, the membership requirements for teams or committees, the scope of work of the teams or committees, confidentiality and liability protections, and data access authorizations.

State laws vary as to what entity is authorized to create and manage the overdose review teams. Virginia, Maryland, and Arizona authorize counties and/or cities to establish overdose fatality review teams. In Rhode Island, the state medical examiner establishes the review team while Oklahoma houses the review board in the state’s department of mental health and substance abuse services. The state health departments in Arizona and West Virginia are also responsible for creating and overseeing review teams, while Delaware established a Drug Overdose Fatality Review Commission to create three regional review teams.

Designated members of the review teams and committees also vary among states. Membership requirements often include representatives of state or local agencies, such as social services, public health, law enforcement, behavioral health, prosecutors, judiciary and corrections, the education system, tribes, various healthcare disciplines (e.g., primary care, addiction, forensic), emergency medical services, hospitals, funeral services, attorneys, individuals in recovery, and recovery service providers. 

Most of the state review teams have authority to review overdose deaths within their jurisdiction involving any drug; however, a few states limit the types of drug overdoses to be reviewed. The Delaware review teams are authorized to review overdose deaths involving opiates, heroin, or fentanyl; the review is limited to methadone-related deaths in Pennsylvania; and West Virginia’s review team may examine unintentional overdose deaths related to prescription or pharmaceutical drugs. Beyond the review of drug overdose deaths, the review teams and committees are often responsible for reporting their findings to the governor and/or state legislature, creating state and local overdose death databases, and recommending changes to state laws and/or agency practices.

Confidentiality requirements are another key feature of state overdose fatality review laws. The work products and records being reviewed by the teams are not subject to disclosure and may be excluded from the state’s freedom of information laws. Many of the laws also require that any discussion of individual overdose deaths be conducted in executive or closed session. The members of the review teams and committees are also often provided immunity from civil and/or criminal liability for activities related to their review work. 

Finally, some of the state laws clearly specify the records the review teams and committees are authorized to access. For example, Oklahoma’s law authorizes its review board to request and obtain “a copy of all records and reports pertaining to an adult whose case is under review,” including the medical examiner’s report, hospital records, school records, court records, vital records, medical and dental records, mental health records, and more. Delaware amended its law to grant its review teams access to data in the state’s prescription drug monitoring program and mental health and substance abuse records. Arizona also clarified its law to allow local review teams to access unredacted law enforcement reports.

The states establishing fatal overdose review teams are hopeful that the information provided by the reviews can be used to develop new and better strategies to address the opioid crisis. Providing the right scope of work, membership, and access to data needed to conduct a fatality review will be key to the success of these endeavors. ASTHO will continue to update its members on these and other developments.