C O P E. Opioid-Related Overdose in Milwaukee County MILWAUKEE COMMUNITY OPIOID PREVENTION EFFORT

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1 Opioid-Related Overdose in Milwaukee County MILWAUKEE C O P E COMMUNITY OPIOID PREVENTION EFFORT For additional information or if you have questions about the data presented in this report, please contact: Nicole Fumo, MPH mkecommunityopioid@gmail.com 1

2 Executive Summary This report shows that opioid-related overdose deaths are rising in Milwaukee County. However, the deaths only illustrate one small part of the effect the opioid epidemic has on the Milwaukee community. In fact, for every death, there are more than 6 additional people experiencing an overdose that require naloxone. In approximately one third of those cases, the emergency medical services system is not being accessed. While the largest proportion of those who experience a fatal overdose are older white men, this epidemic is touching every sector of our county and no geographic region, race, or age group is spared. Additionally, there has been a steep rise in fentanyl-related overdose deaths in the past year. The presence of these potent drugs may be known to the user, or it may be mixed into their drugs without their knowledge. There is no singular solution for combating this public health crisis. In order to significantly reduce the number of overdose deaths we must combat this epidemic at every level. We must continue to reduce recreational use, work with providers to prevent those in pain management from developing a substance use disorder, and create systems for ensuring that individuals suffering from substance use disorder have access to comprehensive treatment options. 231 Opioid Deaths ~1442 Opioid Overdoses Individuals Suffering from Opioid Use Disorder (2015) Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database (2015) Data Source: AIDS Resource Center of Wisconsin Needle Exchange Program Surveys (2015) 2

3 Opioid-Related Overdose Deaths by Year January September * *Data represents overdose deaths from January 1, 2016 September 24,

4 Opioid-Related Overdose Deaths by Age Range January September The majority of opioid-related overdose deaths, 88%, occur between years of age. 4

5 Opioid-Related Overdose Deaths by Age Range and Race/Ethnicity January 2012 September 2016 Almost 50% of all opioid-related overdose deaths occured among white victims between the ages of While the distribution of white overdose deaths mirrors the overall distribution, black overdose deaths skew older with 45% occuring between the ages of

6 Opioid-Related Overdose Deaths by Race/Ethnicity Opioid-Related Overdose Deaths by Sex January 2012 September 2016 January 2012 September % 2% 20% 71% White 38% Black Hispanic Other 62% Male Female Of the 967 opioid-related overdose deaths between January 1, 2012 and September 24, 2016, 71% were white and 62% were male. 6

7 Comparison of 2015 Medical Examiner and Milwaukee County EMS Data by Race and Sex 2015 EMS Response for Suspected Opioid Overdose based on Naloxone Administration by Race 2015 Opioid-Related Overdose Deaths by Race 4% 3% 20% White 38% White 45% Black Hispanic/Latino 73% Black Hispanic /Latino Other 3% 14% Unknown/Not Specified While there were a large number of cases with unknown races among EMS response data, the percent among those that were known (N=630) were consistent with race ratios of overdose deaths. When unknown cases were removed, the distribution was: White: 73%, Black: 23%, Hispanic/Latino: 4% EMS Response for Suspected Opioid Overdose based on Naloxone Administration by Sex 2015 Opioid-Related Overdose Deaths by Sex 36% Male 35% Male 64% Female 65% Female Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 7

8 Comparison of 2015 Medical Examiner and Milwaukee County EMS Data by Age Range 2015 Opioid-Related Overdose Deaths by Age Range EMS Responses for Suspected Opioid-Related Overdose Based on Naloxone Administration In 2015, 19% of opioid-related overdose deaths occurred among victims years of age compared to 31% of EMS responses for suspected opioidrelated overdose for the same age range. Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 8

9 Fentanyl-Related Overdose Deaths January 2012-September Of the 191 opioid-related overdose deaths between January 1, 2016 and September 24, 2016, 29% involved the drug fentanyl. In 2015, only 13% of opioidrelated overdose deaths involved fentanyl; the rate of overdose deaths involving fentanyl for the first nine months of 2016 alone already surpasses the rate for all of

10 Fentanyl-Related Overdose Death by Age Range January 2012-September Heroin-Related Overdose Deaths by Age Range January 2012-September Fentanyl-related deaths stay relatively steady from ages 20-59, while heroin-related deaths affect younger groups, with year olds having the highest incidence. 10

11 Laypeople Overdose Reversal Attempts Using Naloxone in Milwaukee County In 2015, 424 laypeople reported using naloxone to reverse an overdose. This data was collected by the AIDS Resource Center of Wisconsin (ARCW) through self-reported surveys collected by the Needle Exchange Program when replacement naloxone was requested. Within the state of Wisconsin they recorded 1,135 peer saves Self-Reported Number of 0.4mg Naloxone doses given Intramuscularly by Laypeople to Reverse an Overdose 2015 Self-Reported Calls Following Laypeople Administering Naloxone to Reverse an Overdose % No Call Reported Call Reported 1 shot 2 shots 3 shots 4 shots 5 shots No Data % In 2016, ARCW collected self-reported data indicating 192 overdose reversal attempts. This number is significantly lower than those reported in 2015 but is considered an under-estimate. During 2016, the program was out of naloxone for approximately two months, new staff were being trained on data collection methods, and a new database was implemented. However, despite likely under-reporting, a similar proportion of individuals (12%) reported calling at the time of the overdose. It is also important to note that based on additional survey questions, 6% reported taking the victim to the hospital in Data Source: AIDS Resource Center of Wisconsin Needle Exchange Program Surveys

12 Location of Opioid-Related Overdose Death in Milwaukee County by Year January 2013-September LEGEND Death 12

13 Residence of Opioid-Related Overdose Victims Who Died in Milwaukee County January 2012 September 2016 Of the 967 opioid-related deaths in Milwaukee County, 64 (7%) had a residence outside of the county. Four of those residences are not in this map s range. LEGEND Residence 13

14 Percent of Opioid-Related Overdose Deaths Occurring at the Victims Residence in Milwaukee County January 2012-September 2016 From January 2012 through September 2016, 69% of people who experienced a fatal opioid-related overdose died in their place of residence. 14

15 Location of EMS Responses for Suspected Opioid-Related Overdose Based on Naloxone Administration Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 15

16 Density of EMS Response Location for Suspected Opioid-Related Overdose in Milwaukee County Based on Naloxone Administration January 2014-May 2016 Legend EMS Call Location Density Low Density of Opioid-Related Deaths in Milwaukee County by Death Location January 2012-September Legend 2016 EMS Call Location High Legend Opioid Death Density 0 3 Low High Hospital with one or more opioid deaths Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 16

17 EMS Transport Destination for Suspected Opioid-Related Overdose Victims Who Received Naloxone January 2014 May 2016 Transport Destination Number of calls Hospital Emergency Department 2314 (90%) Medical Examiner 140 (5.5%) Refused Transport 96 (3.7%) Other 1(<1%) Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 17

18 Summary of Opioid-Related Overdose Deaths in Milwaukee County All Opioid Overdoses Total Frequency Percent Frequency Percent Frequency Percent Frequency Percent Frequency Percent Frequency Percent Sex Male % 87 60% % % % % Female % 57 40% 79 44% 87 40% 81 35% 60 31% Age Range under 9 7 1% 0 0% 2 1% 0 0% 1 0% 4 2% % 2 1% 5 3% 1 0% 4 2% 3 2% % 23 16% 35 19% 50 23% 45 19% 38 20% % 36 25% 32 18% 48 22% 64 28% 56 29% % 30 21% 53 29% 44 20% 46 20% 30 16% % 42 29% 42 23% 49 22% 42 18% 44 23% % 9 6% 9 5% 24 11% 26 11% 15 8% % 2 1% 3 2% 3 1% 3 1% 0 0% % 0 0% 0 0% 1 0% 0 0% 0 0% % 0 0% 0 0% 0 0% 0 0% 1 1% Race/Ethnicity White % 95 66% % % % % Black % 33 23% 34 19% 46 21% 47 20% 36 19% Hispanic 64 7% 11 8% 16 9% 14 6% 9 4% 14 7% Other 18 2% 5 3% 5 3% 3 1% 5 2% 2 1% Drug Type* Heroin % 53 37% 69 38% % % 99 52% Oxycodone % 60 42% 64 35% 82 37% 59 26% 40 21% Methadone % 26 18% 26 14% 23 10% 39 17% 18 10% Morphine % 24 16% 37 20% 31 14% 48 21% 19 10% Fentanyl % 5 3% 11 6% 16 7% 30 13% 56 29% Not mutually exclusive **Heroin metabolizes to 6-monoacetylmorphine and is detectable in the blood for up to two hours in a living person. 6-monoacetylmorphine is then metabolized to morphine. When 6-monoacetylmorphine is found on a toxicology screen, the Medical Examiner can identify heroin as the cause of the overdose. However, if 6-monoacetylmorphine is not detected, morphine is identified as the cause of death. 18

19 Summary of EMS Responses for Suspected Opioid-Related Overdose Based on Naloxone Administration All Suspected Opioid Overdoses Total Sex Frequency Percent Frequency Percent Frequency Percent Male % % % Female % % % Age Range under 9 4 0% 1 0% 3 0% % 26 2% 27 3% % % % % % % % % % % % % % 111 9% 80 8% % 84 7% 32 3% % 59 5% 21 2% % 17 1% 6 1% Race/Ethnicity White % % % Black % % % Hispanic 76 3% 49 4% 27 3% Other 11 1% 7 1% 4 0% Unknown % % % Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database 19

20 Data Source: Milwaukee County EMS Call Response with Naloxone Administration: January 1, 2014 May 1, 2016 EMS Responses for Suspected Opioid-Related Overdose in the North Shore Region of Milwaukee County January 2014-May 2016 EMS responses in this analysis were identified using EMS medical record data that was submitted to Milwaukee County s Office of Emergency Management (OEM) (N=102). Cases identified were those that received a response from a Fire Department based EMS Unit and were documented to have received naloxone. In the North Shore Region of Milwaukee, they use the data management and analysis tool First Watch ( to identify overdoses in their region. First Watch reviews both key variables (e.g., primary/secondary impression and medication administration) and narratives for key words to identify potential opioid overdose victims. We compared our identified cases from the Milwaukee County OEM- EMS medical records database to those from the First Watch search and found that the two methods for identifying cases were equivilent, with the exception of one case. This case was likely not identified in the county data due to a documentation error. LEGEND Data Source: Milwaukee County Office of Emergency Management s (OEM) Countywide EMS Medical Record Database EMS Response Location 20

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