Locked Out or Linked Up: Lessons in Cross-agency Data Linkage and a Call for State-based Measures for Substance Use Surveillance

As the durability of federal public health surveillance is called into question, state and local health departments are increasingly central to monitoring the overdose crisis. From interviews with stakeholders leading data linkage initiativesin 7 states, we identified pragmatic strategies for building capacity, including legislative mandates paired with funding and privacy safeguards, academic-government partnerships, and visible champions who build cross-agency trust. Two categories of opportunities emerged: linking person-level data across agencies within states and standardizing measures across states. Standardization of local addictions surveillance measures is critical for both local quality improvement and national benchmarking, and we propose the proportion of nonfatal overdoses followed by treatment as a first shared metric and offer actionable steps for advancing substance use surveillance locally.