Overdose Fatality Review (OFR) teams are multidisciplinary and include individuals who can share information about a decedent or contribute to the analysis of available data to make recommendations that will prevent future overdose deaths.

• OFRs increase members’ understanding of area agencies’ roles and services as well as the community’s assets and needs, substance use and overdose trends, current prevention activities, and system gaps.
• OFRs increase the community’s overall capacity to prevent future overdose deaths by leveraging resources from multiple agencies and sectors to increase system-level response.
• OFRs continually monitor local substance use and overdose death data, as well as recommendation implementation activities. Status updates on recommendations are shared at each OFR team meeting and with a governing committee, reinforcing accountability for action.

​Overdoses impact a variety of communities; therefore, OFRs should include a diverse group of individuals spanning different agencies and disciplines representing the community. 

OFR in Michigan

With support from the Michigan Overdose Data to Action (MODA) team at the Michigan Department of Health and Human Services (MDHHS) and Michigan State Police (MSP), Michigan Public Health Institute (MPHI) launched Michigan Overdose Fatality Review (MiOFR) in 2020.  

MPHI’s Center for Child and Family Health (CCFH) has over 30 years of experiencing supporting fatality review and prevention, primarily with the Michigan Child Death Review Program (CDR) which was established in 1995.  In Michigan, there are 76 local CDR teams covering all 83 counties. Some teams serve a two- or three-county jurisdiction, with the overarching goal of preventing future fatalities, as well as improving death scene investigations, and the delivery of services to families and communities. MiOFR has grown out of the relationships and best practices built from CDR by MPHI’s team at CCFH.  While Overdose Fatality Review (OFR) and CDR are not identical, all fatality review processes aim to prevent fatalities, identify system-level gaps, and tailor recommendations for policy and practice changes.  

In 2020, MPHI kicked off the  work of building MiOFR by scanning the state for areas of need, researching and learning best practices around OFR from national partners, and discussing implementation and building relationships with local and statewide stakeholders and potential partners.  MPHI then began working with MDHHS to determine which counties to pilot teams in by considering the local need and community readiness. Factors like an existing active local CDR team or substance use prevention task force, number of overdoses, and interest of the medical examiner offices were considered. 

MiOFR is excited to continue to grow and thrive in Michigan through the expansion of OFR sites across the counties of Michigan. MiOFR is continuously engaging and learning with national and state partners, building support at the state-level by creating the Michigan OFR State Advisory Group, and by continuing to support existing OFR teams to drive recommendations forward in their communities. 

Who is on the County OFR Team

County Overdose Fatality Review (OFR) teams are multidisciplinary and include individuals who can share information about a decedent or contribute to the analysis of available data to make recommendations that will prevent future overdose deaths. 

• OFRs increase members’ understanding of area agencies’ roles and services as well as the community’s assets and needs, substance use and overdose trends, current prevention activities, and system gaps. 
• OFRs increase the community’s overall capacity to prevent future overdose deaths by leveraging resources from multiple agencies and sectors to increase system-level response. 
• OFRs continually monitor local substance use and overdose death trends, as well as recommendation implementation activities. Status updates on recommendations are shared at each OFR team meeting and with a governing committee, reinforcing accountability for action. 

​Overdoses impact a variety of communities; therefore, OFRs should include a diverse group of individuals spanning different agencies and disciplines representing the community.  

Each county OFR team is multidisciplinary and key members of the team should aim to include representatives from: 

• local law enforcement agencies,  
• the medical examiner’s office,  
• hospital emergency departments,  
• substance use treatment providers,  
• medication for opioid use disorder (MOUD) treatment providers,  
• substance use prevention professionals,  
• harm reduction outreach professionals.  

Teams benefit greatly from having members in a wide variety of disciplines, and so in addition, it is recommended that teams also include representatives from: 

• the local health department,  
• the prosecutor’s office,  
• local MDHHS officials,  
• mental health providers,  
• pain management clinics,  
• primary care providers,  
• pharmacy/toxicology professionals,  
• the local sheriff’s office,  
• the probation/parole office,  
• drug treatment courts,  
• patient advocates,  
• child protective services,  
• school counseling,  
• tribal leadership,  
• the local housing authority,  
• Veteran’s Affairs,  
• community leadership,  
• the High Intensity Drug Trafficking Area team.   

MiOFR is continuing to seek feedback identifying other important disciplines to engage with about becoming involved in the process.  Building relationships among diverse partners are key to building successful county OFR teams.  

Findings and Recommendations

County OFR teams in Michigan develop recommendations after case reviews. These recommendations are provided to a local action team, often an already existing SUD coalition or harm reduction agency. One example of the effectiveness of this collaboration comes from MiOFRs first pilot site. The OFR team identified the need for Naloxone to be available at all hotel front desks and near fire extinguishers, especially in high need zip codes. This recommendation was shared with the SUD community action taskforce and the taskforce moved ahead with the implementation of “I CAN, NARCAN”, a distribution and awareness campaign. This resulted in 30 hotels in their community having Narcan on site. 

MiOFR strives to reduce overdoses by reviewing fatal overdose events and identifying touchpoints throughout a decedent’s life that may have been a point of intervention or prevention.  

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