Drug Overdose Deaths in Kentucky,

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1 Drug Overdose Deaths in Kentucky,

2 Kentucky Injury Prevention and Research Center Drug Overdose Deaths in Kentucky, March 6, 2015 Prepared by Svetla Slavova, PhD Terry L. Bunn, PhD Wei Gao, MS Released by Kentucky Injury Prevention and Research Center (KIPRC) 333 Waller Avenue, Suite 242 Lexington, Kentucky For more information contact Svetla Slavova This project was supported by Grant No PM-BX-0010 (Data-Driven Multidisciplinary Approaches to Reducing Prescription Abuse in Kentucky) awarded by the Bureau of Justice Assistance (BJA). BJA is a component of the Department of Justice s Office of Justice Program, which includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office of Victims Crime, and the SMART Office. Points of view or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

3 Executive Summary 1. In 2013, there were 1,019 Kentucky resident drug overdose deaths. This is a 9% decrease from the 1,078 drug overdose deaths registered in For the first time in six years, the drug overdose deaths in the state showed a decline. 2. The 2013 Kentucky resident age-adjusted drug overdose death rate was 23.7/100,000, down from 25.0/100,000 in The U.S. age-adjusted drug overdose mortality rate actually increased from 2012 (13.1/100,000) to 2013 (13.8/100,000). 3. In 2013, Kentucky still had the 2nd highest age-adjusted drug overdose death rate in the United States, 23.7 deaths per 100,000 population. The corresponding U.S. rate was 13.8/100, Pharmaceutical opioids remained the primary cause of Kentucky resident drug overdose deaths in Pharmaceutical opioids were involved in 438 drug overdose deaths in 2013, a 10% decrease from the 488 pharmaceutical opioid overdose deaths in The rate of overdose deaths involving pharmaceutical opioids in Kentucky declined from 11.2/100,000 in 2012 to 10.1/100,000 in 2013, a 10% decline. At the same time, the level of involvement of pharmaceutical opioids in overdose deaths remained unchanged at the national level, 5.1/100,000 in 2012 as well as in The involvement of pharmaceutical opioids in Kentucky resident overdose deaths could be underestimated because about one third of the Kentucky death certificates do not list information on specific drugs involved in the overdose. For example, in 2013 pharmaceutical opioids were listed in 438 of the 1,019 overdose deaths (43%). However, only 761 of the 1,019 deaths listed specific drugs. Therefore, pharmaceutical opioids were involved in 58% (438 out of 761) of the deaths with involved drugs listed on the death certificate. 6. Heroin contributed to 215 Kentucky resident drug overdose deaths in 2013, a 50% increase from the 143 heroin-involved deaths recorded in There was a 50% increase in the Kentucky rate of overdose deaths involving heroin, from 3.4/100,000 in 2012 to 5.1/100,000 in A similar percentage increase (42%) was observed at the national level, from 1.9/100,000 in 2012 to 2.7/100,000 in Males remained at higher risk for drug overdose deaths (29.9 deaths per 100,000 population) compared with females (17.5/100,000) in Of the 1,019 overdose deaths, 882 (87%) were declared unintentional/accidental deaths. 9. Adults, ages years old, were at highest risk for overdose deaths (49/100,000) in 2013, followed by year olds (44.6/100,000), and year olds (37.8/100,000). 10. Over the last three years, , the following counties experienced the highest number of over-dose deaths involving pharmaceutical opioids per 100,000 county residents: Bell County (annual age-adjusted rate of 55.4 deaths involving pharmaceutical opioids per 100,000 residents), Clay County (54.6/100,000), Floyd County (53.3/100,000), Johnson County (46.3/100,000), and Knox County (40.2/100,000). 11. From 2011 to 2013, the residents of the following counties were at highest risk for overdose deaths involving heroin: Campbell County (rate of 21.4 heroin overdose deaths per 100,000 county population), Kenton County (13.4/100,000), Boone County (11.3/100,000), Fayette County (5.2/100,000), and Jefferson County (4.8/100,000).

4 Mortality Rate (# Deaths /100,000 Population) Total Number Kentucky Resident Drug Overdose Deaths, ,007 1,058 1,078 1, Produced by the Kentucky Injury Prevention and Research Center, February Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Kentucky Resident Age-Adjusted Drug Overdose Mortality Rates, Produced by the Kentucky Injury Prevention and Research Center, February Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released

5 Top Ten States with the Highest Age-Adjusted Drug Overdose Mortality Rates, 2013 States Number of drug overdose deaths Age-adjusted drug overdose death rate per 100,000 population 1 West Virginia Kentucky 1, New Mexico Rhode Island Utah Nevada Ohio 2, Oklahoma Pennsylvania 2, Arizona 1, The United States 43, Age-Adjusted Drug Overdose Death Rate by State, 2013 Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Accessed at on Feb 25,

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7 29 <10 15 <10 30 <10 <10 <10 <10 <10 < Total Number ,007 1,058 1,019 1, Kentucky Resident Drug Overdose Deaths by Contributing Drugs, Total number of drug overdose deaths Deaths with at least one code for drug contributing to the deaths (T36-T50.8) Prescription opioids (T40.0, T40.2-T40.4) Benzodiazepine (T42.4) Heroin (T40.1) Cocaine (T40.5) Produced by the Kentucky Injury Prevention and Research Center, February Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released

8 Mortality Rate (# Deaths/100,000 Population) Total Number Kentucky Resident Drug Overdose Deaths by Gender, Male Female Produced by the Kentucky Injury Prevention and Research Center, February Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Kentucky Resident Age-Adjusted Drug Overdose Mortality Rates by Gender, Male 15 Female Produced by the Kentucky Injury Prevention and Research Center, February Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released

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10 Kentucky Resident Drug Overdose Deaths by Age Group, Age Groups Year Kentucky Resident Drug Overdose Mortality Rates by Age Group, (Rate per 100,000 population in the corresponding age group) Age Groups Year

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12 Drug Overdose Deaths, by County, a County (FIPS code) Total number of drug overdose deaths, Annual rate per 100,000 population 1 Adair County, KY (21001) 14 Unreliable 2 Allen County, KY (21003) Anderson County, KY (21005) 19 Unreliable 4 Ballard County, KY (21007) Suppressed Suppressed 5 Barren County, KY (21009) Bath County, KY (21011) 18 Unreliable 7 Bell County, KY (21013) Boone County, KY (21015) Bourbon County, KY (21017) Boyd County, KY (21019) Boyle County, KY (21021) 17 Unreliable 12 Bracken County, KY (21023) Suppressed Suppressed 13 Breathitt County, KY (21025) Breckinridge County, KY (21027) 12 Unreliable 15 Bullitt County, KY (21029) Butler County, KY (21031) 15 Unreliable 17 Caldwell County, KY (21033) 12 Unreliable 18 Calloway County, KY (21035) Campbell County, KY (21037) Carlisle County, KY (21039) Suppressed Suppressed 21 Carroll County, KY (21041) 16 Unreliable 22 Carter County, KY (21043) Casey County, KY (21045) 12 Unreliable 24 Christian County, KY (21047) Clark County, KY (21049) Clay County, KY (21051) Clinton County, KY (21053) Crittenden County, KY (21055) Suppressed Suppressed 29 Cumberland County, KY (21057) 10 Unreliable 30 Daviess County, KY (21059) Edmonson County, KY (21061) 12 Unreliable 32 Elliott County, KY (21063) Suppressed Suppressed 33 Estill County, KY (21065) Fayette County, KY (21067) Fleming County, KY (21069) 16 Unreliable 36 Floyd County, KY (21071) Franklin County, KY (21073) Fulton County, KY (21075) Suppressed Suppressed 39 Gallatin County, KY (21077) 15 Unreliable 40 Garrard County, KY (21079) 19 Unreliable

13 County (FIPS code) Total number of drug overdose deaths, Annual rate per 100,000 population 41 Grant County, KY (21081) Graves County, KY (21083) Grayson County, KY (21085) Green County, KY (21087) Suppressed Suppressed 45 Greenup County, KY (21089) Hancock County, KY (21091) Suppressed Suppressed 47 Hardin County, KY (21093) Harlan County, KY (21095) Harrison County, KY (21097) 15 Unreliable 50 Hart County, KY (21099) 10 Unreliable 51 Henderson County, KY (21101) Henry County, KY (21103) Suppressed Suppressed 53 Hickman County, KY (21105) Suppressed Suppressed 54 Hopkins County, KY (21107) Jackson County, KY (21109) Suppressed Suppressed 56 Jefferson County, KY (21111) Jessamine County, KY (21113) Johnson County, KY (21115) Kenton County, KY (21117) Knott County, KY (21119) Knox County, KY (21121) Larue County, KY (21123) Suppressed Suppressed 63 Laurel County, KY (21125) Lawrence County, KY (21127) Lee County, KY (21129) 18 Unreliable 66 Leslie County, KY (21131) Letcher County, KY (21133) Lewis County, KY (21135) 11 Unreliable 69 Lincoln County, KY (21137) Livingston County, KY (21139) 12 Unreliable 71 Logan County, KY (21141) 17 Unreliable 72 Lyon County, KY (21143) Suppressed Suppressed 73 McCracken County, KY (21145) McCreary County, KY (21147) 10 Unreliable 75 McLean County, KY (21149) Suppressed Suppressed 76 Madison County, KY (21151) Magoffin County, KY (21153) Marion County, KY (21155) 19 Unreliable 79 Marshall County, KY (21157) Martin County, KY (21159)

14 County (FIPS code) Total number of drug overdose deaths, Annual rate per 100,000 population 81 Mason County, KY (21161) 13 Unreliable 82 Meade County, KY (21163) 10 Unreliable 83 Menifee County, KY (21165) 11 Unreliable 84 Mercer County, KY (21167) 12 Unreliable 85 Metcalfe County, KY (21169) Suppressed Suppressed 86 Monroe County, KY (21171) 18 Unreliable 87 Montgomery County, KY (21173) Morgan County, KY (21175) 11 Unreliable 89 Muhlenberg County, KY (21177) Nelson County, KY (21179) Nicholas County, KY (21181) 12 Unreliable 92 Ohio County, KY (21183) 19 Unreliable 93 Oldham County, KY (21185) Owen County, KY (21187) 11 Unreliable 95 Owsley County, KY (21189) Suppressed Suppressed 96 Pendleton County, KY (21191) Perry County, KY (21193) Pike County, KY (21195) Powell County, KY (21197) Pulaski County, KY (21199) Robertson County, KY (21201) Suppressed Suppressed 102 Rockcastle County, KY (21203) Rowan County, KY (21205) Russell County, KY (21207) Scott County, KY (21209) Shelby County, KY (21211) 11 Unreliable 107 Simpson County, KY (21213) 12 Unreliable 108 Spencer County, KY (21215) 12 Unreliable 109 Taylor County, KY (21217) Todd County, KY (21219) 12 Unreliable 111 Trigg County, KY (21221) Suppressed Suppressed 112 Trimble County, KY (21223) Suppressed Suppressed 113 Union County, KY (21225) Warren County, KY (21227) Washington County, KY (21229) Suppressed Suppressed 116 Wayne County, KY (21231) 15 Unreliable 117 Webster County, KY (21233) Suppressed Suppressed 118 Whitley County, KY (21235) Wolfe County, KY (21237) 17 Unreliable 120 Woodford County, KY (21239) a Data are Suppressed when the counts represent zero to nine (0-9) persons, in order to protect personal privacy ( of Confidentiality). Death rates are flagged as Unreliable when the rate is calculated with a numerator of 20 or less (

15 Annual Age-Adjusted Rate of Drug Overdose Deaths, * Rate represents average annual number of overdose deaths per 100,000 county population. Total Number of Drug Overdose Deaths, Combined* *Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Accessed at on Feb 25, Data are Suppressed when the counts represent zero to nine (0-9) persons, in order to protect personal privacy ( of Confidentiality). Death rates are flagged as Unreliable when the rate is calculated with a numerator of 20 or less ( 13

16 Top 5 counties by number of drug overdose deaths involving pharmaceutical opioids, County (FIPS code) Total number of drug overdose deaths involving pharmaceutical opioids, Annual ageadjusted rate per 100,000 population 1 Jefferson County, KY (21111) Fayette County, KY (21067) Floyd County, KY (21071) Pike County, KY (21117) Kenton County, KY (21195) Top 5 counties by rate of drug overdose deaths involving pharmaceutical opioids, County (FIPS code) Total number of drug overdose deaths involving pharmaceutical opioids, Annual ageadjusted rate per 100,000 population 1 Bell County, KY (21013) Clay County, KY (21051) Floyd County, KY (21071) Johnson County, KY (21115) Knox County, KY (21197) Top 5 counties by number of drug overdose deaths involving heroin, County (FIPS code) Total number of drug overdose deaths involving heroin, Annual ageadjusted rate per 100,000 population 1 Jefferson County, KY (21111) Kenton County, KY (21117) Campbell County, KY (21037) Fayette County, KY (21067) Boone County, KY (21015) Note: a drug overdose death involving heroin and pharmaceutical opioids is counted under both categories. 14

17 Annual Age-Adjusted Rate of Drug Overdose Deaths Involving Heroin, * The 3 counties with highest age-adjusted rate of heroin overdose deaths were in Northern Kentucky, on the border with Cincinnati area: Campbell County (21.4/100,000), Kenton County (13.4/100,000), and Boon County (11.3/100,000). The next two counties with highest risk for heroin overdose death were Fayette County/Lexington (5.2/100,000) and Jefferson County /Louisville Annual Age-Adjusted Rate of Drug Overdose Deaths Involving Pharmaceutical Opioids, * The top 5 counties at highest risk for overdose deaths involving pharmaceutical opioids were Bell County (average age-adjusted annual rate of 55.4 overdose deaths per 100,000 population, ), Clay County (54.6/100,000), Floyd County (53.3/100,00), Johnson County (46.3/100,00), Knox County (40.2/100,000). These counties are all located in the Appalachian *Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Accessed at on Feb 25, Data are Suppressed when the counts represent zero to nine (0-9) persons, in order to protect personal privacy ( of Confidentiality). Death rates are flagged as Unreliable when the rate is calculated with a numerator of 20 or less ( 15

18 About This Report This report presents drug overdose mortality data for Kentucky residents. The data source for the report is the U.S. Multiple Cause of Death files, , accessible through the CDC WONDER online query system The Multiple Cause of Death database contains mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. residents. Typically, when a drug overdose death occurs, the coroner completes a death certificate and lists the causes of death and information on how the death occurred. This information/text is then transferred in an electronic record that is sent to the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC ) to be coded according to the guidelines of the Tenth Revision of the International Classification of Diseases (ICD-10) [ to allow standardized classification of the causes of death. Each death certificate is assigned a single underlying cause of death and up to twenty additional multiple causes of death. The underlying cause of death is defined as the reason that initiated the chain of events leading directly to death. For example, the death described below is coded with an underlying cause of death being unintentional drug overdose (X42 Accidental poisoning and exposure to narcotics and psychodysleptics). The following additional multiple causes of death were assigned based on the information listed on the death certificate: T40.3 Methadone, G93.1 Anoxic brain damage, T50.9 Other and unspecified drugs. 16

19 When the information on the death certificate is not specific enough and there is no mention of a particular drug contributing to the death, the death cannot be associated with a drug/drug class. For example, about one third of the death certificates for drug overdose cases in Kentucky list only drug overdose, drug toxicity, acute drug intoxication, or polypharmacy intoxication, with no mention of particular drugs involved. Therefore, the involvement of pharmaceutical opioids or heroin in Kentucky resident overdose deaths could be underestimated as about one third of the overdose deaths are not associated with specific drugs. When an overdose death involves multiple drugs from different classes (for example heroin and methadone), each drug will receive appropriate ICD-10-coded cause of death (T40.1 for heroin, T40. 3 for methadone) and the death will be counted under both categories of drugs (heroin-associated deaths and pharmaceutical opioid-associated deaths). If an overdose death involves multiple drugs from the same drug class, only one multiple cause of death ICD-10 code will be assigned. For example, if oxycodone and hydrocodone are both listed on a death certificate, their involvement will be coded with one ICD-10 code (T40.2) that represents the involvement of natural or semi-synthetic opioids. Definition: Drug overdose deaths were identified as deaths with an underlying cause of death in the following ICD-10 code range: X40-X44(accidental/unintentional drug poisoning), X60-X64(suicide by drug poisoning), X85(homicide by drug poisoning), and Y10-Y14 (drug poisoning with undetermined intent). X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics) X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified) X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified) X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system) X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances) X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics) X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified) X62 (Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified) X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system) X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances) X85 (Assault by drugs, medicaments and biological substances) Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent) Y11 (Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent) Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent) Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent) Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent) The types of drugs contributing to drug overdose deaths can be identified using ICD-10 codes T36- T50.9 listed in any of the multiple causes of death fields. In this report we included statistics on drug overdose deaths involving heroin (T40.1), pharmaceutical opioids (T40.2, T40.3, or T40.4), cocaine ( T40.5), or benzodiazepines (T42.4). Age-adjusted morbidity and mortality rates were based on 2000 U.S. standard population data. Previous reports ( on Kentucky resident drug overdose deaths were based on data from the state Office of Vital Statistics and therefore the numbers do not necessary match with the numbers presented in this report. 17

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