An Analysis of Opioid Related Overdose Deaths on Cape Cod, : Implications for Trades/Service Workers and the Straight To Work Population

Transcription

1 BARNSTABLE COUNTY REGIONAL SUBSTANCE USE COUNCIL (RSAC) An Analysis of Opioid Related Overdose Deaths on Cape Cod, : Implications for Trades/Service Workers and the Straight To Work Population October 5, 2017 Vaira Harik, MSc, Senior Project Manager Melissa Janiszewski, MSW, Prevention Specialist Barnstable County Dept. of Human Services

2 Introduction Antecedents of this analysis Findings of a death records review by the Medford MOAPC (Mystic Valley Public Health Coalition) staff showed a high number of deaths from opioids among tradespeople ( ). Barnstable MOAPC staff decided to replicate this work in Barnstable County to gain greater insight into sub-populations that may be at disproportionate risk for opioid-related death. 2

3 Introduction So, what is MOAPC? MOAPC Grant Program: The Massachusetts Opioid Abuse Prevention Collaborative BSAS is funding local municipalities across the Commonwealth to prevent the misuse of opioids and opioid overdoses. The Barnstable County Dept. of Human Services is a MOAPC grantee. Barnstable County s MOAPC work is integrated with the work of the Barnstable County Regional Substance Use Council (RSAC). 3

4 Introduction The Mystic Valley Public Health Coalition s work 4

5 Introduction The Mystic Valley Public Health Coalition s work 5

6 Introduction Barnstable MOAPC conducted a similar analysis of opioidrelated death records, and extended the analysis to further identify sub-populations of disproportionate risk. 1. Age, gender, race (confirmatory) 2. Education level of decedents 3. Decedents employment, with occupational subcategories. 6

7 Methods 1. Quantitative Methods Analysis of death records for the years : Data source is the MA DPH Registry of Vital Records & Statistics. Cause of Death = Accidental Poisoning to identify substance misuse-related deaths. Cases were defined using the International Classification of Disease (ICD-10) codes for mortality. The following codes were selected from the underlying cause of death field to identify poisonings/overdoses: X40-X49, X60-X69, X85-X90, Y10-Y19, and Y35.2. All multiple cause of death fields were then used to identify opioidrelated deaths: T40.0, T40.1, T40.2, T40.3, T40.4, and T40.6. Relative risk approach to describe excess risk of death. (The relative risk (RR) is the probability that a member of an exposed group will develop a disease relative to the probability that a member of an unexposed group will develop that same disease.) 7

8 Methods 2. Qualitative Methods Consultant (via MOAPC funds) Held focus groups and key informant interviews with youth in non-traditional high school programs. Literature Review 8

9 Introduction Following the death records analysis and a literature review we further identified two sub-groups for study: 1. Persons in the trades and service industries 2. Non-traditional high school students (in special programs within H.S., in technical schools, and in GED programs) And began to focus on the Straight-To-Work (STW) Population Defined as: persons who have gone straight from high school into the workforce, frequently finding work in the trades and service industries. 9

10 Results: Opioid-Related Deaths, Barnstable County, Total Deaths Due to Poisoning in Barnstable County, = 411 Total Deaths Due to Poisoning by Opioids in Barnstable County, = 281 Opioids, Primary Cause of Death Opioids, Involved in Death Total =

11 Results: Opioid-Related Deaths Barnstable County, Year Deaths: From Death Records Data Deaths: From DPH Tally (Reported Quarterly; as of Aug. 2017) Total Data not avail Data not avail

12 Results: By Gender, Race Total Deaths Due to Poisoning by Opioids in Barnstable County, = 281 Male % Female 80 28% (MA, 75%/25%) White-Alone % Black 13 5% Native American (2) + Asian (1) + White-Hispanic (2) 5 <1% Each 12

13 Results: By Age Barnstable County Deaths from Opioids , By Age Bracket (Primary Cause of Death or Opioid-Involved, N = 281) Number of Deaths Age at Death (Range = 16 89; Mean = 41; Median = 40) 13

14 Results: By Age Number of Deaths Barnstable County Deaths from Opioids , By Age Bracket (Primary Cause of Death or Opioid-Involved, N = 281) 51% 36% < < Age at Death (MA, 54% age 25 44)

15 Results: By Education Total Deaths Due to Poisoning by Opioids in Barnstable County, = 281 Percent of Opioid Overdose Decedents with High School Education or Less (n = 193) Versus Percent of Barnstable Population age 18+ with Education Level = HS/GED or Less (Source: US Census Bureau, for 2015) 69% 31% 15

16 Results: By Employment, Educ. Trades/Services Opioid-Related Deaths Among Workers in the Trades/Services = 182 Percent of all Opioid Overdose Decedents Employed in the Trades & Service Industries* (n = 182/281) (Range = 19-41, Mean & Median = 39) Versus Percent of Barnstable Population Employed in the Trades/Service Industries* (Source: US Census Bureau, ACS ) 65% 46% * Includes "Homemaker" (n = 17) Gender Male 81% Female 19% Education H.S. or Less 81%

17 Results: By Employment Trades/Services Occupation by Gender for the Civilian Employed Pop., Age American Community Survey 5 Year Estimates, Barnstable County MA % of Working Total Pop. Civilian Employed Population, 16 years and over 102,995 Add "Homemaker" (8% of Adult population of 178,639) 14,291 Barnstable County "Working Population" 117, % Management, business, science, and arts occupations: 38,119 33% Sales and office occupations: 25,157 21% Service occupations: 21,020 18% Healthcare support occupations 2,827 Protective service occupations: 2,742 Food prep. and serving 6,403 Building and grounds clean. & maint. 5,129 Personal care and service occupations 3,919 Homemaker 14,291 12% Natural resources, construction, and maintenance occupations: 11,491 10% Farming, fishing, and forestry 511 Construction and extraction 7,807 Installation, maintenance, and repair 3,173 Production, transportation, and material moving occupations: 7,208 6% Production occupations 2,648 Transportation occupations 3,137 Material moving occupations 1,423 Employed in the Trades/Service Industries = 54,010 46% of Working Pop. 17

18 Results: By Employment Trades/Services Opioid-Related Deaths Among Workers in the Trades/Services = 182 (of 281) Opioid Related Decedents in Trades/Services % of Trades/Services Deaths Occupation's % in the County Trades/Services Workforce* Trades/Services Deaths: % with High School Education or Less Bureau of Labor Statistics Occupation Profiles Construction 69 38% 14% 84% Building/Grounds Cleaning & Maint % 9% 82% Food/Beverage Service 20 11% 12% 65% Homemaker 17 9% 26% 88% Installation/Maint./Repair 14 8% 6% 93% Truck/Heavy Equip. Driver 10 5% 6% 100% Healthcare Support 9 5% 5% 33% Automotive or Boat Repair 8 4% 6% 100% Fishing 5 3% 1% 80% Hair/Nail Care 5 3% 7% 40% Production 3 2% 5% 100% Total, Trades/Services % Sources: Barnstable County Dept. of Human Services, and *Bureau of Labor Statistics. accessed 8/30/

19 Results: By Employment Trades/Services The percentage of decedents employed in the construction trades was greatly in excess of their representation in trades/service industries (38% vs. 14%) and in excess of their representation in the total workforce (25% vs. 7%). 19

20 Relative Risk: (Some Epidemiology) Probability of an event occurring (death from overdose) in an exposed group (trades/service workers) comparted to the probability of the event occurring in a non-exposed group (all other workers). Relative risk gives an indication of the strength of an association between the event and the group to which it occurred. Those working in the trades/services during were (on average) at times greater risk of dying from opioid overdose than were workers in other occupations. Those working in construction during were (on average) at 4.63 times greater risk of dying from opioid overdose than were workers in other occupations. 20

21 Findings 1. Persons with educational attainment of H.S. graduate or less are disproportionately represented among opioidrelated deaths. 2. Persons working in trades and service industries are disproportionately represented among opioid-related deaths. 3. Likely interaction of occupational injury, opioid prescription, and self-medication. 4. Need for employment and housing assistance for STW youth/young adults and persons in recovery. 5. Need for additional inquiry economic context, culture, and practices of trades and service industry workers and of STW youth/young adults. 21

22 Preliminary Recommendations A. Actions that can be taken now: 1. Engage employers and employees to disseminate substance use prevention and education strategies. 2. Increase promotion and dissemination of Narcan. 3. Assist youth and young adults entering/in the STW population. B. Further inquiry needed: 1. Trades/Services Workers 2. STW Youth/Young Adults 22

23 Preliminary Recommendations A. Actions that can be taken now: 1. Engage employers and employees to disseminate substance use prevention and education strategies. a. Employee Assistance Programs b. Peer-based program interventions c. Apprenticeship model d. Workplace policy e. Injury prevention, education, and training 23

24 Preliminary Recommendations A. Actions that can be taken now: 2. Increase promotion and dissemination of Narcan a. Prescribe and/or distribute Narcan to patients with opioid prescriptions and to patients in treatment programs. b. Employer-Related c. Public Policy 24

25 Preliminary Recommendations A. Actions that can be taken now: 3. Assist youth and young adults in the STW population. a. Improve links to external mental health and behavioral services. b. Take a Harm Reduction Approach. c. Establish/Expand Career Pathways Programs i. Apprenticeships ii. iii. Coordinated workforce development resources Financial literacy 25

26 Preliminary Recommendations B. Further inquiry needed: 1. Trades and services workers economic context, culture, and practices that have bearing on substance misuse. 2. Further define the STW population. 26

27 Next Steps 1. Review by RSAC, relevant agencies and employers, and members of the public. 2. Development of an action plan by the RSAC with likely assignment to RSAC workgroups for work on particular recommendations. 3. Pursue recommended areas of further inquiry. 27

28 Thank you Contact information Vaira Harik Melissa Janiszewski 28