States Worse Than Death Among Hospitalized Patients With Serious Illnesses

tegic expansion of evidence-based interventions in geographic areas heavily affected by heroin and fentanyl is needed to reduce demand and stop deaths.The letter by Arens et al 1 demonstrates the importance of public health surveillance of emerging drugs but also conveys the inadequacy of our current approaches: detection requires exposure to drugs at levels that almost cause death.One surveillance strategy to spare lives, detect trends earlier, and influence product safety in illicit drug markets is provision of drug checking services, which conduct forensic analysis of publicly submitted drug samples, the individual results of which are shared anonymously and aggregated for surveillance.In many European countries, drug checking services facilitate clinical and consumer understanding of blackmarket products while providing low-threshold points of contact between supportive services and people who use drugs. 8 New surveillance approaches and rapid expansion of evidencebased interventions are the missing parameters needed to shift the curve of the epidemic of opioid use.The Office of National Drug Control and Policy has provided leadership in supporting closer public health and public safety collaborations to address recent surges in heroin use.Similar oversight, direction, and coordination are needed to expedite implementation of responses and to navigate local, state, and federal opportunities and tensions around these new approaches.