E. Omohundro, PhD, 3/15/2017 Office of Research 2

Transcription

1 Ellen Omohundro, PhD, 3/15/217

2 Successes Both the number of prescriptions and quantity of opioids prescribed are decreasing. Challenges Opioid crimes, especially heroin crimes, are on the rise. Injection drug use is increasing. Most drug overdose deaths are opioid related, especially opioids in combination with benzodiazepines. Community impacts Opioid abuse is highest in rural counties and small towns. Heroin abuse is spreading from urban to suburban areas. Heroin poisoning hospitalizations are increasing while opioid poisoning hospitalizations have dropped slightly since 211. Over 1, babies experienced withdrawal from drug exposure prior to birth in 214 and

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4 Number of prescriptions (in millions) Number of controlled substance prescriptions written to Tennessee patients (in millions) and reported to the Controlled Substance Monitoring Database: Opioids Benzodiazepines Other Stimulants , fewer opioid prescriptions reported to the CSMD in 215 compared to the peak in CY 212 CY 213 CY 214 CY 215 Source: Tennessee Department of Health, CSMD Annual Report to the Legislature, February 1, 216 Note: Excludes prescriptions from methadone opioid treatment programs and prescriptions reported from VA pharmacies. 4

5 Opioid prescriptions per 1, population 212 DeKalb Prescriptions per 1k Grundy Sequatchie 215 DeKalb Prescriptions per 1k Grundy Sequatchie Source: Tennessee Department of Health, January 12, 217. Note: Excludes prescriptions from methadone opioid treatment programs and prescriptions reported from VA pharmacies. 5

6 MMEs (in millions) Amount of morphine milligram equivalents (MMEs) 1 dispensed to Tennessee patients (in millions) and reported to the Controlled Substance Monitoring Database: , 8, 8,792 8,562 8,82 7,536 14% drop in MMEs for PAIN 6, from 212 to 215 4, 2, ,64 1,134 MMEs Opioids for Pain 2 MMEs Opioids for Treatment of Addiction 3,4 75% increase in MMEs for ADDICTION TREATMENT from 212 to Source: Tennessee Department of Health, CSMD Annual Report to the Legislature, February 1, 216 Notes: (1) MMEs are reported per million (unit = 1,, MMEs); (2) includes prescription opioids for pain and treatment; (3) excludes FDA approved buprenorphine products indicated for treatment of opioid dependence and prescriptions reported from VA pharmacies; (4) excludes prescriptions from methadone opioid treatment programs and prescriptions reported from VA pharmacies. 6

7 Percentage of opioid users with an average daily MME >9 212 Campbell Claiborne Union Grainger Morgan Roane Jefferson Cocke Percent MME >9 215 Unicoi Percent MME >9 Source: Tennessee Department of Health, January 12, 217. Note: Excludes prescriptions from methadone opioid treatment programs and prescriptions reported from VA pharmacies. 7

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9 Number of People arrested Number of drug seizures Number of people arrested 1, Opioids Heroin Number of confirmed drug seizures, Opioids Heroin 8, 7,149 28% 6,896 8, 6,858 6, 5,398 6, 5,58 18% 4,585 4, 4, 797% 2, 1,516 2, 63% Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, , Lab data Notes: (1) Includes expunged records. (2) Opioid-related arrests include arrests for morphine, opium, and all narcotic-related arrests with the exception of cocaine and crack-cocaine arrests. Arrestees were only counted once if more than one type of narcotic was present. 9

10 Rate per 1k population Rate per 1k population Number of people arrested 6 (per 1K population) by area: Tennessee, Opioids Heroin Metro counties Suburban Small towns Rural Small towns Rural 4 4 Suburban Metro counties 1 1 Notes: (1) Metro counties: The most densely populated counties were examined as a group and are: Shelby, Davidson, Knox, and Hamilton counties. (2) Suburban: Metropolitan Statistical Areas have an urban cluster with a population of 5, or more. (3) Small towns: Micropolitan Statistical Areas have an urban cluster with a population at least 1, but less than 5,. (4) Rural: not a metro or micropolitan county. (5) Opioid-related arrests include arrests for morphine, opium, and all narcoticrelated arrests with the exception of cocaine and crack-cocaine arrests. Arrestees were only counted once if more than one type of narcotic was present. (6) Includes expunged records. Source: Tennessee Bureau of Investigation CJIS Support Center,

11 Number of people arrested for opioid-related crimes (per 1K population) Trousdale Clay Fentress Scott Campbell Claiborne Anderson Unicoi DeKalb People arrested per 1k Wayne Trousdale Smith Clay Picket Scott Campbell Union Roane People arrested per 1k Van Buren Rhea Grundy Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, Notes: Rates are only shown for counties where the combined count during the time period was 5 or greater. Rates based on two year averages. Opioids exclude heroin. 11

12 Number of people arrested for heroin-related crimes (per 1K population) People arrested per 1k Cheatham Sumner Tipton Madison Davidson Knox Sevier People arrested per 1k Shelby Source: Tennessee Bureau of Investigation (TBI) CJIS Support Center, Notes: Rates are only shown for counties where the combined count during the time period was 5 or greater. Rates based on two year averages. Opioids exclude heroin. 12

13 TBI confirmed opioid 1 drug seizures (per 1K population) Seizures per 1k Clay Campbell Claiborne Smith Humphreys Cocke Seizures per 1k Source: Tennessee Bureau of Investigation (TBI) lab data, Notes: Rates are only shown for counties where the combined count during the time period was greater than 5. (1) Opioids exclude heroin & buprenorphine. 13

14 TBI confirmed heroin seizures (per 1K population) Seizures per 1k Seizures per 1k Source: Tennessee Bureau of Investigation (TBI) lab data, Notes: Rates are only shown for counties where the combined count during the time period was greater than 5. 14

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16 Number of drug poisonings Number of hospital discharges 1 for opioid and heroin poisonings: Tennessee Opioids Heroin 6, 5,883 5,783 Source: Tennessee Department of Health, , 4, 3, 2, 1, 5,334 5,423 5,435 5,49 Opioid hospitalizations increased 1.4% between 29 and 214 Heroin hospitalizations increased 641% between 29 and Notes: (1) The data represents all outpatient (emergency room visits and 23-hour observations) and inpatient (stays of 24- hours or longer) hospital discharges of Tennessee residents. All 18 diagnoses and all three external cause on injury (e-codes) were evaluated. (2) Opioid poisonings include hospital discharges with ICD-9 codes of 965.9, E85.2, E (3) Heroin poisonings include hospital discharges with ICD-9 codes of 965.1, E85., E935.. Calendar Year 16

17 Hospital discharges 1 for drug poisonings (per 1K population), Source: Tennessee Department of Health, Heroin Hancock Hancock Cheatham Cheatham Davidson Davidson DeKalb DeKalb Discharges per 1k Shelby Tipton Fayette Shelby Tipton Fayette Opioids Jackson Fentress Overton Claiborne Benton Cannon Warren Discharges per 1k Grundy Giles Notes: (1) The data represents all outpatient (emergency room visits and 23-hour observations) and inpatient (stays of 24-hours or longer) hospital discharges of Tennessee residents. All 18 diagnoses and all three e-codes were evaluated. (2) Heroin poisonings include hospital discharges with ICD-9 codes of 965.1, E85., E935.. (3) Opioid poisonings include hospital discharges with ICD-9 codes of 965.9, E85.2, E

18 Overdose deaths 1,4 1,2 1, 8 71% of drug overdose deaths are opioid-related Source: Tennessee Department of Health, All drugs All opioids Opioids with benzodiazepine Heroin Methadone 1,451 1,263 1,168 1,94 1, Opioid-related deaths increased 48% (includes heroin & other opioids) Opioids with benzodiazepine 8% increase Heroin 355% increase Methadone 34% decrease Notes: Not all drug overdose deaths specify the drug(s) involved, and a death may involve more than one specific substance. Increases in overdose deaths may be due to increases in reporting by medical examiners. 1) All drug overdose deaths are based on the following ICD-1 underlying cause of death codes: X4-X44, X6-X64, X85, Y1-Y14. 2) All opioids" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing at least one of the following ICD-1 codes: T4.-T4.4, T4.6. 3) "Heroin" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing at least one of the following ICD-1 codes: T4.1. 4) Methadone overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing ICD-1 code: T4.3. 5) "Opioids with benzodiazepine" overdose deaths were summarized based on an underlying cause of death being a drug overdose and the multiple causes of death containing at least one of the following ICD-1 codes: T4.-T4.4, T4.6 in addition to T

19 Age adjusted rate per 1, population Tennessee death rates involving Heroin increased 44% Natural and semisynthetic opioids increased 13% Synthetic opioids increased 91% Methadone did not change Drug overdose deaths involving opioids Tennessee death rates for natural/semisynthetic opioids are more than 2x the U.S TN U.S. TN U.S. TN U.S. TN U.S. Heroin Natural/Semisynthetic Synthetic Methadone Source: MMWR, Early Release, December 16, 216, CDC. 19

20 Drug overdose deaths (per 1K population), Source: Tennessee Department of Health, Heroin Dickson Davidson Deaths per 1k Tipton Shelby Opioids Benton Deaths per 1k Hardin Notes: Not all drug overdose deaths specify the drug(s) involved, and a death may involve more than one specific substance. Increases in overdose deaths may be due to increases in reporting by medical examiners. 1) All opioids" overdose deaths were summarized based on an underlying cause of death of at least one of the following ICD-1 codes: X4-X44, X6-X64, X85, Y1-Y14 and the multiple causes of death containing at least one of the following ICD-1 codes: T4.-T4.4, T4.6. 2) "Heroin" overdose deaths were summarized based on an underlying cause of death of at least one of the following ICD-1 codes: X4-X44, X6-X64, X85, Y1-Y14 and the multiple causes of death containing T4.1. 2

21 Number of NAS cases Unique cases 1 of Neonatal Abstinence Syndrome (NAS): Tennessee ,31 1,41 1, Number of unique cases of NAS and live births: Tennessee Year Number of NAS Cases (% of live births) 1 Number of Live Births (1.17%) 79, ,31 (1.26%) 81, ,41 (1.28%) 8, Calendar Year Notes: 1) Tennessee Department of Health, Neonatal Abstinence Syndrome Surveillance System, provided number of NAS cases, and readers are advised to interpret small numbers with caution. Please contact Angela M. Miller, PhD, MSPH,(angela.m.miller@tn.gov) if you need assistance in interpreting the NAS data. 2) Tennessee Department of Health, Division of Policy, Planning and Assessment provided number of live births Unique cases 1 of NAS per 1, live births 2 : Jackson Morgan Campbell Hancock Hawkins Grainger Hamblen Greene Sullivan Unicoi Carter Rhea Cases per 1k births 21

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23 Number of admissions Number of opioid and heroin substance abuse treatment admissions 1 funded by Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS): FY 211-FY 216 7, 6, 5,245 5,671 6,194 6,166 6,158 6,25 5, 4, 3, 2, 1, Heroin 3 admissions increased 414% Opioid 2 admissions are declining but are 15% higher than FY 211 levels ,135 1,67 FY 211 FY 212 FY 213 FY 214 FY 215 FY 216 Number of opioid and heroin substance abuse treatment admissions 1 funded by TDMHSAS: FY 211-FY 216 Year (CY) FY 211 FY 212 FY 213 FY 214 FY 215 FY 216 Opioids 2 5,245(37.6%) 5,671 (39.9%) 6,194 (41.3%) 6,166 (4.8%) 6,158 (41.5%) 6,25 (39.1%) Heroin (2.2%) 397 (2.8%) 627 (4.2%) 765 (5.1%) 1,135 (7.7%) 1,67 (1.4%) Total 13,967 14,225 14,986 15,123 14,823 15,395 Note: Count (% of total admissions) Source: Tennessee Department of Mental Health and Substance Abuse Services WITS, FY 211-FY 216 Notes: (1) TDMHSAS-funded substance abuse treatment admissions only include treatment admissions for Tennessee residents age 12 and older, below the 133% poverty line and have no insurance for which there was a bill. Up to three substances can be listed for each treatment admission. (2) opioid treatment admissions include any mention of opioids or methadone; (3) Heroin admissions include any mention of heroin. 23

24 Rate per 1k poverty population Rate per 1k poverty population TDMHSAS treatment admissions 1 (per 1K poverty population) by age group: FY 211-FY Heroin Opioids FY 211 FY 212 FY 213 FY 214 FY 215 FY FY 211 FY 212 FY 213 FY 214 FY 215 FY Heroin Opioids Ages % Ages % Ages % Ages % Source: Tennessee Department of Mental Health and Substance Abuse Services WITS, FY 211-FY 216 Notes: (1) TDMHSAS-funded substance abuse treatment admissions only include treatment admissions for Tennessee residents age 12 and older, below the 133% poverty line and have no insurance for which there was a bill. Up to three substances can be listed for each treatment admission. (2) Heroin admissions include any mention of heroin. (3) Opioid treatment admissions include any mention of opioids or methadone. 24

25 Rate per 1k poverty population Rate per 1k poverty population Rate per 1k poverty population TDMHSAS treatment admissions 1 (per 1K poverty population) by population area: FY 211-FY Heroin 6 rates are highest in urban areas FY 211 FY 212 FY 213 FY 214 FY 215 FY Opioid 7 rates are highest in rural areas and small towns FY 211 FY 212 FY 213 FY 214 FY 215 FY Injection drug use 8 rates are now similar across areas FY 211 FY 212 FY 213 FY 214 FY 215 FY Source: Tennessee Department of Mental Health and Substance Abuse Services WITS, FY 211-FY 216 Notes: (1) TDMHSAS-funded substance abuse treatment admissions only include treatment admissions for Tennessee residents age 12 and older, below the 133% poverty line and have no insurance for which there was a bill. Up to three substances can be listed for each treatment admission. (2) Metro counties = most populated counties. (3) Suburban = centered on an urban cluster with a population >5,. (4) small town = centered on an urban cluster with a population 1, - 5,. (5) not part of an urban cluster. (6) Heroin admissions include any mention of heroin. (7) Opioid treatment admissions include any mention of opioids or methadone. (8) Injection drug use includes all drugs. 25

26 TDMHSAS treatment admissions per 1K poverty population, FY 215-FY 216 Heroin Davidson Knox Admission per 1k Madison Chester Shelby Hamilton Opioids Clay Jackson Fentress Campbell Hawkins Sullivan Washington DeKalb Admission per 1k Notes: (1) Rates are only shown for counties where the combined count during the time period was greater than 5. Rates based on two year averages. (2) Rates computed per 1K of the population of those 12 years and older, living in poverty. (3) Heroin admissions include any mention of heroin. (4) Opioid treatment admissions include any mention of opioids or methadone. Source: Tennessee Department of Mental Health and Substance Abuse Services WITS,

27 Number of admissions Number of TDMHSAS admissions by drug injected: FY FY 216 All drugs Opioids Methamphetamine Heroin 4,11 Of all injection drug admissions: 4, 3, 2,21 2,412 59% inject opioids 2, 1,737 1,339 33% inject methamphetamine 1, 384 1,263 31% inject heroin 245 FY 211 FY 212 FY 213 FY 214 FY 215 FY

28 TDMHSAS treatment admissions per 1K poverty population, FY 215-FY 216 All injection drug users Lewis DeKalb Clay Grundy White Van Buren Fentress Morga n Campbell Blount Hancock Hamblen Washington Greene Admission per 1k Hardin Opioid injection drug users Fentress Campbell Hancock Washington DeKalb Blount Admission per 1k Grundy Source: Tennessee Department of Mental Health and Substance Abuse Services WITS, FY 215-FY 216 Notes: (1) Rates are only shown for counties where the combined count during the time period was greater than 5. Rates based on two year averages. (2) Rates computed per 1K of the population of those 12 years and older, living in poverty. (3) Opioid treatment admissions include any mention of opioids or methadone. 28