Beyond Crisis: Lives Saved by MICA

Beyond Crisis: Lives Saved is an easily navigable scrollytelling resource for friends and family members of those suffering with opioid use disorder. The website aims to provide clarity around the opioid epidemic and encourage evidence-based solutions that are proven to reduce overdoses, save lives, and give those with substance use disorder opportunities for effective treatment rather than put them behind bars.

The Center for Disease Control and Prevention’s (CDC) provisional data from last year (2022) shows that over 100,000 people died from an opioid overdose, up over 1000% from 8,040 deaths in 1999. The opioid epidemic and Substance Use Disorder (SUD), commonly called addiction, impact people from all backgrounds. Pharmaceutical companies, an influx of illicit fentanyl, and the COVID-19 pandemic have contributed to record numbers of opioid overdoses year after year. Addiction is a long-term psychological condition, but we can save lives focusing on reducing harm and expanding healthcare and psychiatric services.

Primary Data Sources
1. Centers for Disease Control and Prevention (CDC) WONDER Database (WONDER)
2. CDC Drug Overdose Surveillance and Epidemiology (DOSE)
3. State Unintentional Drug Overdose Reporting System (SUDORS)
4. National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA)
Secondary Data Sources
1. Interviews with friends and family of people with opioid use disorder, people in recovery, and people working in the field
2. Academic Papers: found through CDC records
3. Brown University and the Department of Veterans Affairs
4. National Institute on Drug Abuse (NIDA)
5. The Surgeon General
6. Drug Enforcement Administration (DEA)

Data Processing
This project explored and processed data in Excel and R. In addition to R, Flourish and Datawrapper were also used to figure out tendencies and trends. Data was extracted from the internet, structured in Excel, then imported into R for analysis and preliminary visualization.

This project focuses on the broad story between states and across the nation. Data separated by sex, age, race, or socioeconomic status were aggregated to tell a more comprehensive story and to emphasize the widespread impact of the opioid crisis.

Ideas were sketched on the iPad App ProCreate and fleshed out in R and Flourish. Final visualizations were made in ProCreate, Illustrator and Flourish. Figma and Vev were used to build the website.

Key Findings
The CDC WONDER Online data set provides several key findings, including:
a. In 2021, 80,411 people died from an opioid overdose (up from 8,050 in 1999), nearly a 900% increase in just over 20 years.
b. 2016 was a turning point. In 2015, deaths from fentanyl totaled 9,580 (18% of the total number of deaths from overdoses). The following year, 19,413 people died from fentanyl overdoses, totalling 30% of all drug related deaths, more than deaths from any other drugs.

CDC WONDER data combined with data from Brown University and the Department of Veterans affairs uncovers:
c. 644,933 people died of an opioid overdose from 1999 – 2021. That is more than all American military casualties from World War I, World War II, the Vietnam War, Korean War, Gulf War and the War on Terror combined (623,975 deaths).

NIDA and DEA data describes:
d. A lethal dose of fentanyl, 2 mg, could fit on the tip of a pencil.
e. Fentanyl is 50-100 times more deadly than heroin.

Data from the CDC’s DOSE database reveals:
f. During the first year of the COVID-19 pandemic, 33 out of the 40 participating states saw an increase in emergency department visits for drug overdoses. The following year, when healthcare and mental health services reopened, nearly all states saw a decrease in visits to emergency deparments for drug overdoses.

Data from the NSDUH by SAMHSA explains:
g. 8.6% of people had at least one drug use disorder in 2021. That is equal to 24 million people.
h. 15.6% of people needed substance use treatment in 2021, but only 1.5% of people received any treatment.

As you can see, many sources were used to uncover data. The process of allocating information from a variety of sources impacted the way the data story is told. Source information is listed at the top of the website along with a link to all sources referenced in the story. Information is presented chronologically in a direct manner and each visualization has a tooltip that links to source information as well.

Data Challenges
Access to data, size of datasets, and scope of data were challenges for this project.

Ideally, this project would include more recent data, but the CDC only provides preliminary data for 2022. This project chooses to use the final CDC data from 2021, since preliminary data is often undercounted. Delays from Emergency Rooms to Health Departments, coding inaccuracies, missing information, or misidentified overdoses might cause undercounting of data.

Querying the massive WONDER database for information presents a challenge. NSDUH was also large, but it was time consuming to read through and not unmanageable.

In terms of scope, instead of focusing on one region, the focus of this project is nationwide. There are two challenges with this decision. First, not all states participate in reporting overdose data in the DOSE and SUDORS datasets. Second, data that aggregates states together–NSDUH data–doesn't tell the local story. Nonspecific, nation-wide information was more crucial to the rationale of this project.

Ideally, this project would highlight key data from studies that show positive outcomes from all types of harm reduction treatment. While there is three decades of research on syringe services programs (SSPs) and associated harm reduction tools, there are new forms of harm reduction still to be studied. The National Institutes of Health (NIH) announced a new study in December 2022 that will investigate “a range of harm reduction approaches, such as distributing naloxone, a lifesaving medication to reverse overdose, and fentanyl test strips, which people can use to determine if drugs are contaminated with fentanyl” (NIDA, 2022, para. 5). This would be useful information to add to the resources section of this project, but grants will be doled out over the next 5 years, so data will not be available for some time.

Design
This project was inspired by infographics, illustrations and data visualizations that center people or show drugs for context. Included are data visualizations from MICA's Jes Standfer and Information is Beautiful award-winning works featured in the Reuter's article, "Fentanyl is Fast, Cheap and Deadly" by Catherine Tai and Julia Wolfe.

Colors were tested for legibility, WCAG AAA Compliance, and for different types of color blindness. The typeface for this project is Noto Sans, a typeface available in Google Fonts and in Adobe. It's a modern, simplistic, easy-to-read sans serif typeface.

From the interviews conducted for this project, it was clear that the audience wanted something they could access whenever they felt the urge or when they were having a specific problem with a loved one. They wanted to access the information on their phone or computer. Therefore, this project is an easily navigable scrollytelling website demistifying information about the opioid crisis, including the role of pharmaceutical companies, the rise of fentanyl, the impact of COVID-19, and harm reduction tactics and resources.
Graphics and visualizations in the project purposefully show the individual in the aggregated data. The thought behind this is twofold. First, to humanize the data, combat the stigmas, stereotyping, and negative bias those with opioid use disorder face. Second, to show the audience the scope of the problem. Show the audience they are not alone in their loss, guilt, worry, and grief.

Application and User Experience
Accessibility
Considerations for accessibility include:
● Typography choice and font sizes.
● WCAG AAA color contrast checks on text and color palate.
● Evaluating colors for compatibility with various types of colorblindness using coolors.co.
● Working from grayscale to color.
● Avoiding relying solely on color to convey information. Instead, using a combination of color, labels, size, and patterns.
● Using plain language since the audience has varying degrees of knowledge.
● Using alternative text. This project is an image heavy website. Any non-text elements like photos, illustrations, charts, or graphs have concise alt text to assist people using screen readers.
● Implementing user testing. This was conducted with help from individuals who have accessibility needs, like colorblindness, age-related visual challenges, and other visual impairments.
User Experience
The project is designed as an interactive scrollytelling website that is accessible on both mobile and desktop computers. It is explanatory and is intended to inform and to educate the reader. The narrative follows Brent Dyke's data storytelling arc.
The first graphic is the “hero” image and serves as both an overview of the information to come and a hook for the reader to realize the scope of the opioid crisis. After explaining how opioids became an epidemic, data and research shows how friends and family can support their loved ones and share resources, and urges them to contact their local representatives.

Given the range of knowledge of the audience, the project includes a menu at the left side of the page, so that the reader can easily navigate through the piece and review or uncover information.

The scrollytelling site is a long narrative, therefore steps were taken to ensure engagement throughout reading the page. Each section is broken up with a dark bar that features a portrait and quote from someone interviewed for this project. This is meant to situate the reader throughout the piece and to center people in the storytelling. Additionally, there are tooltips with information and data sources throughout the site to keep people engaged through interaction. Many of the charts and graphics also feature interaction to engage the viewer.

Keeping in line with the rationale and intended use, the project ends with resources and a call to action based on the information uncovered throughout the scroll.