Missouri State Unintentional Drug Overdose Reporting System (SUDORS)

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What is SUDORS?

SUDORS stands for the State Unintentional Drug Overdose Reporting System and is funded through the Overdose Data to Action in States (OD2A-S) grant provided by the Centers for Disease Control and Prevention (CDC).  The overall goals of SUDORS are to give insight to the circumstances surrounding overdose deaths, utilize enhanced toxicology information to analyze different drug types or substances being used at the time of death, and to improve fatal overdose data timeliness and accuracy.

SUDORS utilizes both death certificate data to identify cases, and coroner/medical examiner narratives and toxicology to glean circumstantial information as well as full toxicology panels for all substances present at time of death.  This data is unique in that it utilizes different data sources to gather as much information on each death as possible.  All data within Missouri’s SUDORS dashboard is displayed as a percentage of the total overdose deaths captured within the SUDORS system.

For more information on the SUDORS program, including more details on what is captured within the system, visit CDC’s SUDORS Webpage.  View a quick fact sheet on this program.

Map shows counties that participate in SUDORS program in light teal.  When hovering over the counties, two numbers will appear.

Resident Drug Overdose Total: Indicates how many total resident drug overdose deaths were in that selected county.  This includes drug overdose deaths of all intents: unintentional, suicide, homicide, or deaths of undetermined intent.

SUDORS Drug Overdose Total: Indicates drug overdose deaths of unintentional or undetermined intent that occurred in that county.   This number will not always match the resident drug overdose total, due to the difference in county of residence for the decedent, versus the county of death occurrence. 

• For Example: If an individual lived in St. Charles County but died in St. Louis, this individual would fall into the SUDORS occurrent count for St. Louis, but the St. Charles resident overdose count. 

These are two different ways to group drug overdose deaths and cannot be directly compared but are good to use as reference to one another.

Map data can be broken out by single year, to see the fluctuation in county participation each year. The goal for each year is to acquire as many counties as possible to participate in the SUDORS program, to continue to increase our coverage percentage each year.  With this increased percentage, Missouri can continue to work towards a more complete data set.

Participating vs Not Participating:

A “Participating” county is one that contributes coroner/medical examiner narratives and toxicology results to the SUDORS program in Missouri.  These counties make up at least 75% of Missouri’s overdose deaths and allows for the analysis of circumstantial and enhanced toxicology information.

A “Not Participating” county is one that does not submit coroner/medical examiner narratives or toxicology results to the SUDORS program in Missouri.  Due to this, circumstantial information cannot be analyzed for these individual counties.  These counties are excluded from all state circumstance data displayed on the SUDORS dashboard.  Limited information on specific drug types involved in these overdose deaths is available and incorporated into SUDORS through what substances are listed on the death certificate.  This is not as comprehensive as what is listed in the full toxicology report, and only includes the specific substances that caused the death.

Reimbursement Opportunity:

Counties that participate in the SUDORS program have the opportunity to be reimbursed a total of $30 per narrative provided.  In addition, participating counties can submit toxicology testing invoices for reimbursement up to an allowable contracted amount.  For more information on the reimbursement process, email MOSUDORS@health.mo.gov.

Demographic information helps to identify certain subpopulations that are at greater risk of drug overdose. 

The percentages viewed on this page represent the percent of total accidental/undetermined drug overdose deaths captured within the SUDORS data.  This data is supplied by the death certificate of each decedent, and therefore is captured for all SUDORS deaths within the system for all indicators on this page, except for the housing instability/homelessness indicator.

Housing Instability/Homelessness Indicator:

This indicator is pulled from the narrative provided by coroners and medical examiners.  Therefore, the SUDORS dashboard only captures information from participating counties for this indicator.  The counties captured within this indicator can be seen listed at the bottom of the dashboard.  These counties will change based on which year is currently selected, as county participation fluctuates throughout the years.

An individual is marked as experiencing housing instability or homelessness at time of death only if it is explicitly noted within the coroner/medical examiner narrative.  Clear evidence must be present, otherwise this variable cannot confidently be endorsed. Due to these reasons, this indicator is known to be underestimated. 
Homeless: defined as those who reside in one of the following:

• Places not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car or other private vehicle, park, on the street or other outdoor place, abandoned building/home, bus or train station, airport, or camping ground.
• A supervised publicly or privately operated shelter or drop-in center designated to provide temporary living arrangements, congregate shelters, or temporary accommodations provided by a homeless shelter.

Housing Instability: represents those who were not experiencing homelessness, but who lack the resources or support to obtain or retain permanent housing.  This includes several different scenarios surrounding various challenges such as inability to pay rent, moving frequently, or staying with friends or relatives.  Examples of housing instability consist of:

• A series of short stays with different friends/family with no other more permanent residence.
• Temporary housing facilities provided by nonprofit organizations.
• Living in a hotel or motel.
• Not having a permanent place to stay following an eviction or loss of housing.  Note that the eviction or loss of housing itself is not enough to endorse housing instability, but an inability to obtain long-term housing in the aftermath of the eviction must have been stated.

Each indicator on this page comes from the coroner/medical examiner narrative.  Information on the circumstances surrounding each death can help tell the story of what one was experiencing leading up to the fatal overdose.  All data is displayed in percentages of the total number of fatal overdose deaths where a coroner/medical examiner narrative was available.  Due to this, data presented represents at least 75% of Missouri’s unintentional/undetermined drug overdose deaths.  This data can be used in conjunction with death certificate data to add insight to the “why” behind fatal overdoses captured within SUDORS.  Circumstance information is likely underestimated as coroners/medical examiners often have limited information.

Opportunity for Intervention

This indicates the percentage of SUDORS cases where at least one opportunity for intervention was present at some point before the fatal overdose occurred.  This is calculated using a formula provided by CDC which summarizes documented evidence of at least one of the following: potential bystander presence, a mental health diagnosis, prior overdose, fatal drug use witnessed, recent release from institutional setting (within 1 month of death), or current treatment for substance use disorder.  If any of these indicators are present, then the decedent is noted to have had at least one opportunity for intervention before the fatal overdose occurred.

Potential Bystander Definition

This is defined as an individual who was nearby during the drug overdose event and potentially had an opportunity to intervene or respond.  Included are individuals aged at least 11 years old, and who were in the nearby area, including within the same structure as the decedent.  An exception to being listed as a bystander due to proximity within the same structure is for individuals living in different self-contained parts of a larger building.  An example of this would be individuals living within a different apartment in the same apartment building or staying in a separate room within a hotel/motel. 

SUDORS offers the unique opportunity to have the ability to further break out all substances that were present at the time of death.  While death certificate data will often list the substances that immediately caused death, SUDORS toxicology allows for further analysis of the additional drugs present.

Drug Type Variables:

Substances Listed as Cause of Death: These are the specific substances listed within the toxicology report as the substance that caused the death.  Other substances that were present but did not cause death would not be included within this category. The denominator for this variable is all accidental/undetermined drug overdose deaths in the state.

Substances Present on Toxicology Report at Time of Death: These are all substances that were found and noted as positive on the decedent’s toxicology results at time of death.  This includes the substance/s that caused death, as well as all other substances present within the decedent’s system at the time of death. The denominator for this variable is all deaths with a toxicology report available.

Example: If an individual has been identified as dying of a Fentanyl overdose, but also had Methamphetamine and Marijuana present at time of death, Fentanyl would appear on the substance that caused death chart, while Fentanyl, Methamphetamine, and Marijuana would appear on the substances that were present at time of death chart.

Route of Administration: Indicates the route that substances were administered before death.  Clear scene evidence must be present in order to select this indicator.  Due to lack of evidence, this indicator is often not reported, therefore percentages are likely underreported as well.