Drug Overdose Fatality Surveillance System (DOFSS) 2015 Annual Report

Transcription

1 Drug Overdose Fatality Surveillance System (DOFSS) 05 Annual Report Released: October 07 Sarah L. Hargrove, MS Patrick J. Ward, MPH Terry L. Bunn, PhD Kentucky Injury Prevention and Research Center, bona fide agent for the Kentucky Department for Public Health University of Kentucky 333 Waller Avenue, Suite 0 Lexington, Kentucky (859)

2 Table of Contents Contents GREETINGS... 5 OVERVIEW... 6 Data Sources... 6 Funding... 6 Additional Information... 6 Acknowledgement... 6 Survey... 6 Suggested Citation... 6 EXECUTIVE SUMMARY... 7 DEFINITIONS KENTUCKY DRUG OVERDOSE FATALITY SURVEILLANCE DATA... 9 Table. Drug Classes Detected Among Drug Overdose Decedents in Kentucky, Table. Most Frequent Drugs Detected Among Drug Overdose Decedents in Kentucky, Figure. Most Frequent Drugs Found in Combination with a Commonly Detected Drug Among Drug Overdose Decedents in Kentucky, Table 3. Most Common Two-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, Table 4. Most Common Three-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, Table 5. Most Common Four-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, DRUG OVERDOSE FATALITY DEMOGRAPHICS... 0 Table 6. Most Common Drugs Identified Among Drug Overdose Decedents in Kentucky by Gender, Table 7. Most Common Drugs Identified Among Drug Overdose Decedents in Kentucky by Age Group, Table 8. Top Drugs Identified Among Drug Overdose Decedents in Kentucky by Race, Figure. Most Common Prescription Drugs Identified Among Drug Overdose Decedents in Kentucky by Median Blood Concentration and Therapeutic Range, Table 9. Most Common Drug Classes Identified Among Drug Overdose Decedents in Kentucky by Suicide and Accidental Manners of Death, Table 0. Kentucky Resident Drug Overdose Fatality Counts and Rates, Figure 3. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population, Table. Kentucky Resident Drug Overdose Fatality Counts and Rates by Kentucky Area Development District (ADD),

3 Table. Kentucky Resident Drug Overdose Fatality Counts Involving Scheduled and Non-Scheduled Drugs by Kentucky Area Development District (ADD), Table 3. Kentucky Resident Drug Overdose Fatality Counts Involving Specific Drugs by Kentucky Area Development District (ADD), Figure 4. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population by Area Development District, Figure 5. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule I Drugs by Area Development District (ADD), Figure 6. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule II Drugs by Area Development District (ADD), Figure 7. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule III Drugs by Area Development District (ADD), Figure 8. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule IV Drugs by Area Development District (ADD), Figure 9. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Non-Scheduled Drugs by Area Development District (ADD), Figure 0. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Heroin by Area Development District (ADD), Figure. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Fentanyl by Area Development District (ADD), Figure. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Heroin and Fentanyl by Area Development Districts (ADD), Figure 3. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Methamphetamine by Area Development District (ADD), Figure 4. Other Significant Conditions Contributing to Death for Drug Overdose Decedents in Kentucky, Figure 5. Body Mass Index (BMI) Range for Drug Overdose Decedents in Kentucky, Table 4. Drug Overdose Decedent Body Mass Index Percentile Median Determination Figure 6. Morphine-Codeine Ratio (MCR) in Drug Overdose Decedents in Kentucky with Negative Heroin Postmortem Toxicology Results and Scene Indication of Possible Heroin, Table 5. Common Drugs Detected in Post-mortem Toxicology Testing Results of Drug Overdose Decedents in Kentucky with Non-Medical Related Needle or Track Marks, Table 6. Common Drugs Detected in Post-Mortem Toxicology Test Results of Drug Overdose Decedents in Kentucky with Drug Paraphernalia Recovered at Scene and/or Autopsy (N=355), Table 7. Decedent Known History of Substance Abuse by Drug Paraphernalia Recovered at Scene and/or Autopsy (N=355), Table 8. Common Drugs Detected in Post-mortem Toxicology Test Results of Drug Overdose Decedents with Known Histories of Substance Abuse, in Kentucky (N=64),

4 Figure 7. Demographics of Drug Overdose Decedents in Kentucky with Known Histories of Substance Abuse (N=64), Table 9. Suicide vs. Other Manners of Death among Drug Overdose Decedents in Kentucky with Known Histories of Substance Abuse (N=64), Table 0. Opioid-Involved Drug Overdoses among Drug Overdose Decedents in Kentucky with Known Histories of Chronic Pain (N=03), Table. Common Drugs Detected in Post-mortem Toxicology Test Results of Drug Overdose Decedents in Kentucky with Known Histories of Mental Illness (N=58), Figure 8. Demographics of Drug Overdose Decedents in Kentucky with Known Histories of Mental Illness (N=58), Table. Suicidal Manner of Death vs. Accidental Manner of Death among Drug Overdose Decedents in Kentucky with Known Histories of Mental Illness (N=58), Table 3. Top Prescription Drugs Found at Scene and/or at Autopsy Among Drug Overdose Decedents in Kentucky, DOFSS Quality Control Measures Table 4. Number and Percentage of Drug Overdose Fatality Coroner Investigation Reports Received for DOFSS, Table 5. Contribution of Individual Kentucky Drug Overdose Fatality Surveillance System Data Sources in the Identification of Specific Drug Involvement,

5 GREETINGS The Kentucky Injury Prevention and Research Center located at the University of Kentucky s College of Public Health, bona fide agent for the Kentucky Department for Public Health, in collaboration with the Kentucky Office of the State Medical Examiner s Office and county coroner offices, is pleased to present the inaugural Kentucky Drug Overdose Fatality Surveillance System (DOFSS) report. Kentucky s unique DOFSS adds utility and value to drug overdose fatality surveillance by providing an additional lens to the drug overdose epidemic through the integration of multiple data sources that contribute additional case-level information that helps identify new and emerging risk factors and health conditions associated with drug overdose deaths in the Commonwealth of Kentucky. For example, DOFSS data results show that the most common other significant conditions contributing to cause of death for drug overdose deaths was hypertensive heart disease. Confirming that result, Lisinopril, an angiotensin converting enzyme (ACE) inhibitor drug that is prescribed to treat hypertension and heart failure, was the third most common prescription drug found at the scene of drug overdose deaths or at autopsy of drug overdose decedents. These results may indicate that individuals with heart disease are more susceptible to drug overdoses, or that heart-related conditions may be a primary outcome associated with substance use. Further research is needed to more fully examine this finding. DOFSS year 06 data results will include linked dispensed prescription data from the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system that may provide additional information to generate targeted hypotheses related to this unique finding. Also, the DOFSS figures comparing mean blood concentrations of commonly identified drugs to related therapeutic ranges in drug overdose decedents show that amphetamine was detected above the related therapeutic range, in addition to the well-known opioids (fentanyl, hydrocodone, morphine, and oxymorphone). This finding indicates that amphetamine (either licit or as a metabolite of illicit methamphetamine) is a major drug contributing to drug overdose fatalities in the Commonwealth of Kentucky that deserves further tracking through DOFSS trends over time, examining linked amphetamine prescriptions dispensed, and further research into amphetamine sourcing. Last, DOFSS data results highlight the involvement of gabapentin in fatal drug overdoses. Gabapentin was detected in over one-third of all drug overdose decedents with available specific drug results, and was the most frequent drug detected in female drug overdose decedents and among drug overdose decedents over the age of 44 years; gabapentin also was detected in almost half of all drug overdose decedents with histories of mental illness. These results illustrate the need for more research into the prescribing of gabapentin in association with substance use and substance use treatment, either alone or in association with other health conditions, such as chronic pain. Our heartfelt sympathies go out to the surviving family members, friends, and others who have suffered a loss due to a fatal overdose. Our hope is that this report can help coroners, medical examiners, family members, and healthcare providers, to inform and improve scheduled drug prescribing, substance use disorder treatment, prevention, policy making, and law enforcement drug interdiction. Sincerely, Terry Bunn, Director Kentucky Injury Prevention and Research Center 5

6 OVERVIEW Kentucky s Drug Overdose Fatality Surveillance System (DOFSS) is a comprehensive database that utilizes multiple sources to enhance the Commonwealth s analytical capacity to identify and characterize drug overdose fatalities. Without a centralized death investigation system, Kentucky drug overdose fatality data are not collected by a single agency. DOFSS bridges the gaps by inputting drug overdose decedent data into one centralized database. A comprehensive multi-source database captures additional information on drug overdose fatalities and identifies emerging trends and patterns of drug use that may not be readily identified through analysis of data from a single source. Data Sources DOFSS is comprised of: Vital statistics death certificates (with NCHS ICD-0 coding) Medical examiner autopsy reports Coroner investigation reports Post-mortem toxicology reports o Post-mortem toxicology reports were unavailable in cases Kentucky All Schedule Prescription Electronic Reporting (KASPER) records o Year 05 KASPER records were not available for this report Funding This report was supported by Cooperative Agreement Number 5 NU7CE , funded by the Centers for Disease Control and Prevention, and awarded to the Kentucky Injury Prevention and Research Center as the bona fide agent for the Kentucky Department for Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The RedCap database used to enter DOFSS data is supported by the Center for Clinical and Translational Research grant support (NIH CTSA ULTR0007). Additional Information Data in DOFSS is provisional and subject to change. Data for this report was analyzed on July 4 th, 07. Acknowledgement KIPRC would like to thank the Kentucky Department for Public Health, Office of Vital Statistics for access to death certificate records, Office of Inspector General for access to KASPER data, Office of the State Medical Examiner for access to autopsy reports and post-mortem toxicology reports, and all county coroners for access to coroner report. Survey Please take a moment to complete our brief survey regarding this report: Suggested Citation Hargrove SL, Ward PJ, Bunn TL. Kentucky Drug Overdose Fatality Surveillance System 05 Annual Report. Kentucky Injury Prevention and Research Center. October, 07. 6

7 EXECUTIVE SUMMARY. Of the,95 drug overdose deaths in year 05, opioids (8% of all drug overdose deaths) and benzodiazepines (49%) were the drug classes most frequently identified in drug overdose decedents.. Morphine (44% of all,48 drug overdose deaths with drug-specific results) and gabapentin (36%) were the drugs most frequently detected among drug overdose decedents. 3. The most common two-drug and three-drug combinations identified in drug overdose decedents involved heroin and known heroin metabolites and adulterants. Heroin and morphine were found in 8% of all drug overdose decedents and codeine, heroin, and morphine in 0% of all drug overdose decedents. 4. The most common four-drug combination identified in drug overdose decedents was codeine, heroin, morphine, and THC-COOH (7% of all drug overdose decedents). Morphine is a known metabolite of heroin and codeine is a known adulterant of heroin. 5. Morphine was the most frequent drug detected in male drug overdose decedents (50% of all male drug overdose decedents), whereas, gabapentin was the most frequent drug detected in female drug overdose decedents (45% of all female drug overdose decedents). 6. The most common drug identified in drug overdose decedents under 45 years of age was morphine (65% of all those aged 0-4 years; 60% of all those aged 5-34 years; and 4% of all those aged years), whereas, the drug most commonly detected in drug overdose decedents aged 45 years and older was gabapentin (48% of all those aged years; and 39% of all those aged 55 and older). 7. Mean blood concentrations of amphetamine, fentanyl, hydrocodone, morphine, and oxymorphone were detected above relevant therapeutic ranges among drug overdose decedents. 8. Opioids were the class of drugs most commonly identified in drug overdose decedents who died either from accidental or suicidal causes of death. 9. The highest numbers of drug overdose deaths occurred in Jefferson (n=), Kenton (n=), and Fayette (n=06) counties in year The highest drug overdose fatality rates occurred in Bell (8 deaths per 00,000 population), Butler (78/00,000), and Kenton (68/00,000) counties in year 05.. The most common other significant conditions contributing to cause of death for drug overdose decedents was heart-related conditions, specifically hypertensive heart disease; 3 of the,95 drug overdose decedents (0%) also had hypertensive heart disease that contributed to their deaths.. The most common drugs detected in autopsied drug overdose decedents with non-medical related needle or track marks was morphine (83% of the 04 drug overdose decedents with needle or track marks) and heroin (6%). 3. The most common drugs detected in drug overdose decedents with history of mental illness were gabapentin (48% of the 58 drug overdose decedents with histories of mental illness), morphine (38%), and alprazolam (34%). 4. Of the drug overdose decedents who died due to intentional drug overdose (suicide) (n=5), 4% had histories of mental illness. 5. The top prescription drugs found at the scene and/or at autopsy among drug overdose decedents were gabapentin (34% of the 47 drug overdose decedents with pills found at the fatal drug overdose scene), oxycodone (%), and lisinopril (7%). 6. Autopsy, toxicology, and coroner reports increased the identification of specific drugs involved in drug overdose deaths to 98%, compared to identifying 79% of specific drugs with the use of drug overdose death certificates alone (8% increase). 7

8 DEFINITIONS Drug overdose fatalities were identified from Kentucky death certificates as any deaths with the following underlying cause of death ICD-0 codes: ) X40-X44 (accidental/unintentional drug poisoning); ) X60-X64 (suicide by drug poisoning); 3) X85 (homicide by drug poisoning); and 4) Y0-Y4 (drug poisoning with undetermined intent). DOFSS cases include all drug overdose fatalities that occurred in Kentucky, regardless of decedent state of residence. Unless otherwise noted, both Kentucky residents and out-of-state residents who died of drug overdoses in Kentucky are included in DOFSS data counts. Chi-Squared Test: A statistical test of the dependence of two categorical variables, under the null hypothesis that the two variables are independent. The alternative hypothesis is that the variables are dependent. Fischer s Exact Test: An exact statistical test of the dependence of two categorical variables, under the null hypothesis that the two variables are independent. The alternative hypothesis is that the variables are dependent. Exact tests are used when the sample size is too small to meet the assumptions of traditional statistical tests, such as the chi-square test of independence. Interquartile Range (IQR): A measure of statistical dispersion between 75 th and 5 th percentiles, IQR= Q 3 -Q P-Value: The probability of finding the observed results under the assumption that the null hypothesis is true. P-values less than 0.05 are typically treated as significant, that is, that there is sufficient evidence to reject the assumption that the null hypothesis is true in favor of the alternative hypothesis. Therapeutic Range: A clinical reference range of blood plasma or serum concentration of a drug that is expected to achieve the desired therapeutic effects. 8

9 05 KENTUCKY DRUG OVERDOSE FATALITY SURVEILLANCE DATA Table. Drug Classes Detected Among Drug Overdose Decedents in Kentucky, 05 Drug Class,3 Count 4 Percentage 5 OPIOIDS 6, % BENZODIAZEPINES % ANTICONVULSANTS % CANNABINOIDS % ALCOHOL % COCAINE 64.66% AMPHETAMINES 60.36% STIMULANTS % ANTIDEPRESSANTS 5 4.0% NON-OPIOID ANALGESICS % BARBITURATES 8.6% CARDIOVASCULAR AGENTS.70% ANTIHISTAMINES.6% SEDATIVES/HYPNOTICS 3.00% ANTIPSYCHOTICS 0.93% NARCOTICS <5 - ANTIBIOTICS <5 - ANESTHETICS <5 - GASTROINTESTINAL AGENTS <5 - BATH SALTS <5 - NEUROLOGICAL AGENTS <5 -. Drug testing of blood, urine, and/or vitreous fluids.. Drug classes are not mutually exclusive; decedents may have multiple drug classes detected 3. Multiple drugs within the same drug class are counted as one drug class incident per decedent 4. Counts less than 5 were suppressed according to state data release policy 5. Percentage is based on total number of DOFSS drug overdose fatalities, n=,95 6. Opioids includes all opium-like substances (including natural opiates and synthetic opioids) Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 9

10 Table. Most Frequent Drugs Detected Among Drug Overdose Decedents in Kentucky, 05 Drug - Count Percentage 3 MORPHINE % GABAPENTIN % HEROIN % ALPRAZOLAM % FENTANYL % CODEINE % CARBOXY-TETRAHYDROCANNABINOL (THC-COOH) % OXYCODONE 9.47% HYDROCODONE % OXYMORPHONE % ETHANOL % CLONAZEPAM % HYDROMORPHONE % DIAZEPAM % OXAZEPAM 67.90% COCAINE % TEMAZEPAM 5.66% TETRAHYDROCANNABINOL (THC) % BUPRENORPHINE % METHAMPHETAMINE 8.65% AMPHETAMINE % METHADONE % Drug testing of blood, urine, and/or vitreous fluids. Drugs are not mutually exclusive; decedents may have more than one drug detected 3 Percentage is based on total number of DOFSS drug overdose fatalities, n=,95 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 6 Fentanyl identified by fentanyl. and/or norfentanyl. 7 Clonazepam identified by clonazepam. and/or 7-aminoclonazepam. 8 Cocaine identified by cocaine., cocaethylene, and/or benzoylecgonine. 9 Buprenorphine identified by buprenorphine. and/or norbuprenorphine. 0 Methadone identified by methadone and/or EDDP Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 0

11 Figure. Most Frequent Drugs Found in Combination with a Commonly Detected Drug Among Drug Overdose Decedents in Kentucky, 05 - MORPHINE (n=574) HEROIN CODEINE FENTANYL GABAPENTIN THC-COOH ALPRAZOLAM HYDROMORPHONE ETHANOL COCAINE CLONAZEPAM 4, 37.8% 8, 3.7% 70, 9.6% 44, 5.09% 34, 3.34% 7,.3% 00, 7.4% 94, 6.38% 303, 5.79% 363, 63.4% 0% 0% 0% 30% 40% 50% 60% 70% GABAPENTIN (n=466) MORPHINE OXYCODONE ALPRAZOLAM CLONAZEPAM HYDROCODONE OXYMORPHONE THC-COOH HYDROMORPHONE DIAZEPAM FENTANYL 5, 3.6% 5, 3.6% 35, 8.97% 9, 7.68% 9, 7.68% 6, 4.89% 07,.96% 98,.03% 98,.03% 8, 39.06% 0% 5% 0% 5% 0% 5% 30% 35% 40% 45% Drug testing of blood, urine, and/or vitreous fluids. Drugs are not mutually exclusive; decedents may have more than one drug detected. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change.

12 HEROIN (n=366) MORPHINE CODEINE THC-COOH FENTANYL ALPRAZOLAM GABAPENTIN ETHANOL HYDROMORPHONE COCAINE THC 6, 34.43% 3, 33.6% 03, 8.4% 95, 5.96% 9, 4.86% 77,.04% 69, 8.85% 60, 6.39% 58, 70.49% 363, 99.8% 0% 0% 0% 30% 40% 50% 60% 70% 80% 90% 00% ALPRAZOLAM (n=35) GABAPENTIN MORPHINE OXYCODONE HYDROCODONE OXYMORPHONE THC-COOH HYDROMORPHONE HEROIN CLONAZEPAM CODEINE 5, 43.30% 44, 4.03% 9, 36.75%, 34.47% 09, 3.05% 09, 3.05% 03, 9.34% 03, 9.34% 84, 3.93% 8, 3.08% 0% 5% 0% 5% 0% 5% 30% 35% 40% 45% 50% 3 Heroin identified by metabolite 6-monoacetylmorphine. 4 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change.

13 FENTANYL (n=334) MORPHINE HEROIN THC-COOH GABAPENTIN ALPRAZOLAM OXYCODONE CODEINE COCAINE OXYMORPHONE ETHANOL 3, 36.83% 0, 30.4% 98, 9.34% 80, 3.95% 75,.46% 70, 0.96% 67, 0.06% 6, 8.6% 56, 6.77% 4, 64.07% 0% 0% 0% 30% 40% 50% 60% 70% CODEINE (n=309) MORPHINE HEROIN THC-COOH GABAPENTIN HYDROMORPHONE ALPRAZOLAM FENTANYL ETHANOL CLONAZEPAM COCAINE 99, 3.04% 9, 9.77% 84, 7.8% 8, 6.% 70,.65% 63, 0.39% 56, 8.% 53, 7.5% 58, 83.50% 303, 98.06% 0% 0% 0% 30% 40% 50% 60% 70% 80% 90% 00% 5 Fentanyl identified by fentanyl. and/or norfentanyl. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 3

14 Carboxy Tetrahydrocannabinol (THC-COOH) (n=30) MORPHINE THC HEROIN GABAPENTIN ALPRAZOLAM FENTANYL CODEINE CLONAZEPAM OXYCODONE HYDROMORPHONE 34, 44.5% 6, 4.86% 6, 38.54% 09, 36.% 0, 33.55% 99, 3.89% 78, 5.9% 74, 4.58% 65,.59% 70, 56.48% 0% 0% 0% 30% 40% 50% 60% 70% ETHANOL (n=37) MORPHINE HEROIN GABAPENTIN CODEINE ALPRAZOLAM FENTANYL HYDROCODONE THC-COOH COCAINE HYDROMORPHONE 65, 7.43% 63, 6.58% 58, 4.47% 56, 3.63% 49, 0.68% 48, 0.5% 4, 7.30% 35, 4.77% 9, 38.40% 7, 53.59% 0% 0% 0% 30% 40% 50% 60% Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 4

15 BUPRENORPHINE (n=3) GABAPENTIN ALPRAZOLAM CLONAZEPAM MORPHINE THC-COOH HEROIN OXAZEPAM CODEINE METHAMPHETAMINE TEMAZEPAM DIAZEPAM 3, 6.0% 3, 5.0% 9, 3.58% 8,.76% 8,.76% 8,.76% 54, 43.90% 47, 38.% 46, 37.40% 44, 35.77% 75, 60.98% 0% 0% 0% 30% 40% 50% 60% 70% METHAMPHETAMINE (n=) AMPHETAMINE MORPHINE THC-COOH GABAPENTIN ALPRAZOLAM HEROIN CODEINE BUPRENORPHINE OXAZEPAM TEMAZEPAM HYDROMORPHONE 33, 9.46% 33, 9.46% 3, 8.57% 8, 5.00% 7, 4.% 4,.43% 4,.43% 50, 44.64% 48, 4.86% 47, 4.96% 7, 63.39% 0% 0% 0% 30% 40% 50% 60% 70% 6 Buprenorphine identified by buprenorphine. and/or norbuprenorphine. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 5

16 METHADONE (n=9) GABAPENTIN CLONAZEPAM ALPRAZOLAM OXYCODONE OXYMORPHONE THC-COOH DIAZEPAM MORPHINE OXAZEPAM TEMAZEPAM 34, 36.96% 3, 33.70% 30, 3.6% 7, 9.35% 3, 5.00%, 3.9%, 3.9% 0,.74% 9, 0.65% 50, 54.35% 0% 0% 0% 30% 40% 50% 60% 7 Methadone identified by methadone and/or EDDP. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 6

17 Table 3. Most Common Two-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, 05 Two-Drug Combination - Count Percentage 3 Heroin 4 and Morphine % Codeine and Morphine % Codeine and Heroin % Fentanyl 5 and Morphine % Gabapentin and Morphine % Morphine and THC-COOH % Gabapentin and Oxycodone 5.74% Alprazolam 6 and Gabapentin 5.74% Alprazolam 6 and Morphine 44.% Clonazepam 7 and Gabapentin % Drug testing of blood, urine, and/or vitreous fluids. Decedents may have had more than one drug combination detected. 3 Percentage is based on total number of DOFSS drug overdose fatalities, n=,95. 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Fentanyl identified by fentanyl. and/or norfentanyl. 6 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 7 Clonazepam identified by clonazepam. and/or 7-aminoclonazepam. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Postmortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 7

18 Table 4. Most Common Three-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, 05 Three-Drug Combination - Count Percentage 3 Codeine, Heroin 4, and Morphine % Heroin 4, Morphine, and THC-COOH % Fentanyl 5, Heroin 4, and Morphine 9.34% Gabapentin, Oxycodone, and Oxymorphone % Alprazolam 6, Heroin 4, and Morphine % Codeine, Morphine, and THC-COOH % Alprazolam 6, Oxycodone, and Oxymorphone % Gabapentin, Heroin 4, and Morphine % Ethanol, Heroin 4, and Morphine % Codeine, Gabapentin, and Morphine % Drug testing of blood, urine, and/or vitreous fluids. Decedents may have had more than one drug combination detected. 3 Percentage is based on total number of DOFSS drug overdose fatalities, n=,95. 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Fentanyl identified by fentanyl. and/or norfentanyl. 6 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Postmortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 8

19 Table 5. Most Common Four-Drug Combinations Detected Among Drug Overdose Decedents in Kentucky, 05 Four-Drug Combination - Count Percentage 3 Codeine, Heroin 4, Morphine, and THC-COOH % Alprazolam 5, Codeine, Heroin 4, and Morphine % Codeine, Heroin 4, Hydromorphone, and Morphine % Codeine, Gabapentin, Heroin 4, and Morphine % Codeine, Morphine, THC, and THC-COOH % Codeine, Fentanyl 6, Heroin 4, and Morphine % Codeine, Ethanol, Heroin 4, and Morphine % Alprazolam 5, Gabapentin, Oxycodone, and Oxymorphone % Fentanyl 6, Heroin 4, Morphine, and THC-COOH % Cocaine 7, Codeine, Heroin 4, and Morphine % Drug testing of blood, urine, and/or vitreous fluids. Decedents may have had more than one drug combination detected. 3 Percentage is based on total number of DOFSS drug overdose fatalities, n=,95. 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 6 Fentanyl identified by fentanyl. and/or norfentanyl. 7 Cocaine identified by cocaine., cocaethylene, and/or benzoylecgonine. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 9

20 DRUG OVERDOSE FATALITY DEMOGRAPHICS Table 6. Most Common Drugs Identified Among Drug Overdose Decedents in Kentucky by Gender, 05 Drug - Female (N=50) Male (N=785) P-value 3 MORPHINE 83 (35.9%) 39 (49.8%) <0.00 GABAPENTIN 8 (44.7%) 38 (30.3%) <0.00 HEROIN 4 95 (8.6%) 7 (34.5%) <0.00 ALPRAZOLAM 5 55 (30.4%) 96 (5.0%) 0.03 FENTANYL 6 08 (.0%) 6 (8.8%) 0.00 CODEINE 89 (7.5%) 0 (8.0%) <0.00 THC-COOH 05 (0.6%) 96 (5.0%) 0.07 OXYCODONE 6 (4.7%) 65 (.0%) 0. OXYMORPHONE 97 (9.0%) 45 (8.4%) 0.80 HYDROCODONE 0 (.6%) 34 (7.0%) 0.04 HYDROMORPHONE 83 (6.3%) 47 (8.7%) 0.6 COCAINE 7 6 (.0%) 03 (3.%) 0.54 Drug testing of blood, urine, and/or vitreous fluids. Drugs are not mutually exclusive; decedents may have more than one drug detected. 3 p-value from chi-square test of independence. 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 6 Fentanyl identified by fentanyl. and/or norfentanyl. 7 Cocaine identified by cocaine., cocaethylene, and/or benzoylecgonine. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 0

21 Table 7. Most Common Drugs Identified Among Drug Overdose Decedents in Kentucky by Age Group, 05 Drug years (N=79) 5-34 years (N=30) years (N=349) years (N=349) 55+ years (N=6) MORPHINE 5 (64.6%) 8 (59.9%) 43 (4.0%) 30 (37.%) 69 (3.9%) GABAPENTIN 9 (.4%) 7 (3.5%) 34 (38.4%) 67 (47.9%) 85 (39.4%) HEROIN 3 40 (50.6%) 5 (4.4%) 87 (4.9%) 75 (.5%) 39 (8.%) ALPRAZOLAM 4 9 (4.%) 7 (3.8%) 93 (6.6%) 09 (3.%) 58 (6.9%) FENTANYL 5 8 (35.4%) 3 (37.4%) 96 (7.5%) 70 (0.%) 7 (.5%) CODEINE 3 (40.5%) 0 (36.4%) 63 (8.%) 70 (0.%) 34 (5.7%) THC-COOH 34 (43.0%) 89 (9.5%) 74 (.%) 79 (.6%) 5 (.6%) OXYCODONE 5 (6.3%) 43 (4.%) 78 (.3%) 04 (9.8%) 6 (8.%) OXYMORPHONE 5 (6.3%) 39 (.9%) 76 (.8%) 77 (.%) 45 (0.8%) HYDROCODONE 5 (6.3%) 33 (0.9%) 6 (7.8%) 86 (4.6%) 58 (6.9%) HYDROMORPHONE 4 (7.7%) 49 (6.%) 50 (4.3%) 7 (0.6%) 45 (0.8%) COCAINE 6 5 (6.3%) 4 (3.%) 5 (4.9%) 46 (3.%) 9 (8.8%) Drug testing of blood, urine, and/or vitreous fluids. Drugs are not mutually exclusive; decedents may have more than one drug detected. 3 Heroin identified by metabolite 6-monoacetylmorphine. 4 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 5 Fentanyl identified by fentanyl. and/or norfentanyl. 6 Cocaine identified by cocaine., cocaethylene, and/or benzoylecgonine. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change.

22 Table 8. Top Drugs Identified Among Drug Overdose Decedents in Kentucky by Race, 05 Drugs -3 Black (N=54) White (N=3) MORPHINE 3 (4.6%) 545 (44.3%) GABAPENTIN 5 (7.8%) 449 (36.5%) HEROIN 4 5 (7.8%) 346 (8.%) ALPRAZOLAM 5 6 (.%) 343 (7.9%) FENTANYL 6 7 (3.5%) 3 (5.3%) CODEINE (.%) 93 (3.8%) THC-COOH 7 (3.5%) 83 (3.0%) OXYCODONE 6 (.%) 83 (3.0%) OXYMORPHONE 6 (.%) 35 (9.%) HYDROCODONE 5 (9.3%) 39 (9.4%) HYDROMORPHONE 5 (9.3%) 5 (8.3%) COCAINE 7 3 (4.6%) 40 (.4%) Asian/PI, Indian, Other, and Unknown Race were excluded from this analyses due to low counts. Drug testing of blood, urine, and/or vitreous fluids. 3 Drugs are not mutually exclusive; decedents may have more than one drug detected. 4 Heroin identified by metabolite 6-monoacetylmorphine. 5 Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 6 Fentanyl identified by fentanyl. and/or norfentanyl. 7 Cocaine identified by cocaine., cocaethylene, and/or benzoylecgonine. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change.

23 Figure. Most Common Prescription Drugs Identified Among Drug Overdose Decedents in Kentucky by Median Blood Concentration and Therapeutic Range, 05-6 A therapeutic range for buprenorphine has not been clearly established ( Alprazolam identified by alprazolam. and/or a-oh-alprazolam. 3 Buprenorphine identified by buprenorphine. and/or norbuprenorphine. 4 Clonazepam identified by clonazepam. and/or 7-aminoclonazepam. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 3

24 5 Fentanyl identified by fentanyl. and/or norfentanyl. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 4

25 6 Methadone identified by methadone and/or EDDP. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Postmortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 5

26 Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 6

27 Table 9. Most Common Drug Classes Identified Among Drug Overdose Decedents in Kentucky by Suicide and Accidental Manners of Death, 05 Drug Class -3 Suicide, n=5 (%) Accident, n=64 (%) Chi-Square p- value 4 Fischer s Exact p-value 5 OPIOIDS 6 5 (49.0%) 976 (83.85%) < BENZODIAZEPINES 9 (37.5%) 563 (48.37%) ANTICONVULSANTS 3 (5.49% 49 (36.86%) CANNABINOIDS 8 (5.69%) 79 (3.97%) 0. - ALCOHOL 6 (.76%) (8.%) COCAINE <5 49 (.80%) AMPHETAMINES 5 (9.80%) 4 (.0%) STIMULANTS 7 (33.33%) 45 (3.87%) <0.00 <0.00 ANTIDEPRESSANTS 7 (33.33%) 3 (.66%) <0.00 <0.00 NON-OPIOID ANALGESICS 0 (9.6%) 4 (.06%) <0.00 <0.00 BARBITURATES <5 4 (.06%) CARDIOVASCULAR AGENTS 8 (5.69%) (.03%) <0.00 <0.00 ANTIHISTAMINES 8 (5.69%) (.03%) <0.00 <0.00 SEDATIVES/HYPNOTICS 5 (9.80%) 7 (0.60%) <0.00 <0.00 ANTIPSYCHOTICS <5 7 (0.60%) <0.00 <0.00 NARCOTICS <5 < ANTIBIOTICS 0 < ANESTHETICS 0 < GASTROINTESTINAL AGENTS 0 < BATH SALTS 0 < NEUROLOGICAL AGENTS 0 < Undetermined, Homicide, and Natural Manners of Death were excluded from this analysis. Drug testing of blood, urine, and/or vitreous fluids. 3 Drugs are not mutually exclusive; decedents may have more than one drug detected. 4 p-value from chi-square test of independence. 5 p-value from Fisher-exact test for instances where chi-square assumptions may be violated. 6 Opioids includes all opium-like substances (including natural opiates and synthetic opioids). Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 7

28 Table 0. Kentucky Resident Drug Overdose Fatality Counts and Rates, 05 County Count Rate (per 00,000 population) -3 Adair <5 * Allen <5 * Anderson 7 * Ballard <5 * Barren 5 * Bath <5 * Bell Boone Bourbon 5 * Boyd 4.93 Boyle 9 * Bracken 5 * Breathitt <5 * Breckinridge <5 * Bullitt Butler Caldwell <5 * Calloway 5 * Campbell Carlisle 0 * Carroll <5 * Carter 9 * Casey 5 * Christian <5 * Clark Clay 6 * Clinton 6 * Crittenden <5 * Cumberland <5 * Daviess Edmonson 7 * Elliott <5 * Estill 6 * Fayette Fleming 6 * Floyd Franklin 4. Fulton 0 * 8

29 Gallatin 8 * Garrard <5 * Grant 8 * Graves 5 * Grayson 6 * Green <5 * Greenup Hancock <5 * Hardin 9 * Harlan 9 * Harrison 8 * Hart <5 * Henderson <5 * Henry 7 * Hickman <5 * Hopkins 6 * Jackson <5 * Jefferson 7.9 Jessamine Johnson 6 * Kenton 68.0 Knott <5 * Knox Larue 0 * Laurel 0.08 Lawrence <5 * Lee 6 * Leslie <5 * Letcher 7 * Lewis 6 * Lincoln <5 * Livingston <5 * Logan <5 * Lyon <5 * Madison Magoffin <5 * Marion <5 * Marshall <5 * Martin 9 * Mason <5 * 9

30 McCracken 7 * McCreary <5 * McLean 0 * Meade 5 * Menifee 0 * Mercer 5 * Metcalfe <5 * Monroe <5 * Montgomery 9 * Morgan 0 * Muhlenberg <5 * Nelson 7 * Nicholas <5 * Ohio 8 * Oldham Owen <5 * Owsley <5 * Pendleton 5 * Perry 39.3 Pike 33. Powell 6 * Pulaski 7.9 Robertson 0 * Rockcastle <5 * Rowan 5 * Russell 7 * Scott Shelby Simpson 7 * Spencer 6 * Taylor 5 * Todd <5 * Trigg 5 * Trimble <5 * Union 5 * Warren 5.6 Washington <5 * Wayne <5 * Webster <5 * Whitley

31 Wolfe <5 * Woodford 9 * Counts less than 5 were suppressed according to state data release policy. Rates based on Counts less than 0 were suppressed according to the state data release policy. 3 Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 3

32 Figure 3. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population, 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 3

33 Table. Kentucky Resident Drug Overdose Fatality Counts and Rates by Kentucky Area Development District (ADD), 05 ADD District Count Rate (Number of Drug Overdose Deaths per 00,000 population) Barren River Big Sandy Bluegrass Buffalo Trace 37.3 Cumberland Valley FIVCO Gateway 8.8 Green River Kentucky River KIPDA Lake Cumberland Lincoln Trail Northern Kentucky Pennyrile Purchase 4. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 33

34 Table. Kentucky Resident Drug Overdose Fatality Counts Involving Scheduled and Non-Scheduled Drugs by Kentucky Area Development District (ADD), 05 - ADD District Schedule I Schedule II Schedule III Schedule IV Non-Scheduled Barren River 4 49 < Big Sandy Bluegrass Buffalo Trace 8 6 <5 5 <5 Cumberland Valley Fivco Gateway <5 5 <5 9 8 Green River 6 7 <5 8 0 Kentucky River KIPDA Lake Cumberland Lincoln Trail 30 <5 0 6 Northern Kentucky Pennyrile Purchase <5 <5 0 0 Schedule V drugs were not included due to a low count Counts less than 5 were suppressed according to state data release policy. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 34

35 Table 3. Kentucky Resident Drug Overdose Fatality Counts Involving Specific Drugs by Kentucky Area Development District (ADD), 05 ADD District Heroin Fentanyl Fentanyl Heroin with Methamphetamine Barren River <5 6 <5 <5 Big Sandy <5 <5 0 <5 Bluegrass Buffalo Trace 5 6 <5 0 Cumberland Valley < Fivco 5 <5 Gateway <5 5 0 <5 Green River <5 <5 0 <5 Kentucky River <5 <5 0 <5 KIPDA Lake Cumberland 5 5 <5 9 Lincoln Trail 5 <5 <5 8 Northern Kentucky 0 55 Pennyrile 0 <5 0 6 Purchase <5 <5 0 0 Counts less than 5 were suppressed according to state data release policy. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 35

36 Figure 4. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population by Area Development District, 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 36

37 Figure 5. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule I Drugs by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 37

38 Figure 6. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule II Drugs by Area Development District (ADD), 05 Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 38

39 Figure 7. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule III Drugs by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 39

40 Figure 8. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Schedule IV Drugs by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 40

41 Figure 9. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Non- Scheduled Drugs by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 4

42 Figure 0. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Heroin by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 4

43 Figure. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Fentanyl by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 43

44 Figure. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Heroin and Fentanyl by Area Development Districts (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 44

45 Figure 3. Kentucky Resident Drug Overdose Fatality Rates per 00,000 Population Involving Methamphetamine by Area Development District (ADD), 05 - Rates based on Counts less than 0 were suppressed according to Kentucky data release policy. Rates based on counts less than 0 are unreliable, and should be interpreted with caution. Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 45

46 Figure 4. Other Significant Conditions Contributing to Death for Drug Overdose Decedents in Kentucky, 05-4 Other significant conditions contributing to death are not mutually exclusive, death may be counted in more than one applicable category. Of 95 Kentucky drug overdose decedents, 383 decedents had a listed other significant condition contributing to death on death certificate and/or autopsy report. 3 Mechanisms of death recorded on death certificate as a significant condition contributing to death were not included. 4 Other categories refer to all low count significant condition contributing to death Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Postmortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 46

47 Percent Drug Overdose Fatality Surveillance System (DOFSS) 05 Annual Report Figure 5. Body Mass Index (BMI) Range for Drug Overdose Decedents in Kentucky, 05-0% 9% 8% 7% 6% 5% 4% 3% % % 0% BMI BMI information was available for 53.36% of total drug overdose decedent cases (69/,95). Percentages based on total number of drug overdose decedents with BMI information (n=69). Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. Table 4. Drug Overdose Decedent Body Mass Index Percentile Median Determination BMI Percentile Median Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 47

48 Figure 6. Morphine-Codeine Ratio (MCR) in Drug Overdose Decedents in Kentucky with Negative Heroin Post-mortem Toxicology Results and Scene Indication of Possible Heroin, 05 MCR in Cases negative for Heroin Scene Evidence Indicates Possible Heroin Involvement in Cases with MCR > 6, 59.6%, 40.74% 6, 54.54% 5, 45.45% Blood Morphine/Codeine Ratio < Blood Morphine/Codeine Ratio > Scene Indicates Probable Heroin No Scene Indication of Heroin MCR calculated ) if blood post-mortem toxicology was positive for both morphine and codeine and ) blood, urine, or vitreous were negative for 6-monoacetylmorphine (n=7). Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. October 07. Kentucky data sources: Death Certificates, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services; Post-mortem Toxicology Records, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Autopsy Reports, Kentucky State Medical Examiner s Office, Cabinet for Justice and Public Safety; Kentucky All Schedule Prescription Electronic Reporting, Office of Inspector General, Cabinet for Healthy and Family Services; and Kentucky Coroner Investigation Reports, County Coroners Offices. Data outputs draw from selected DOFSS data sources. Data are provisional and subject to change. 48