The Opioid Epidemic: Overdose Data in NYC Sindhu Shamasunder, MPH Bureau of Alcohol and Drug Use Prevention, Care and Treatment NYC Department of Health and Mental Hygiene
The burden of drug overdose Nationally, drug poisoning (overdose) deaths surpass those due to motor vehicle accidents More New Yorkers die from overdose than homicides, suicides, and motor vehicle crashes combined Drug overdose is a leading cause of premature death among NYC residents Overdose is the top cause of death for NYC residents age 25 to 34 80% of overdoses in NYC involve an opioid; opioidinvolved overdoses are preventable Source: Li W, Huynh M, Lee E, Lasner-Frater L, Castro A, Kelley D, Kennedy J, Maduro G, Sebek K, Sun Y, Van Wye G. Summary of Vital Statistics, 2014. New York, NY: New York City Department of Health and Mental Hygiene, Office of Vital Statistics, 2016.
Number Age-adjusted mortality rate per 100,000 Unintentional drug poisoning deaths, NYC, 2000-2016* 1400 1200 19.9 20 1000 800 600 10.2 12.2 11.5 12.2 11.5 12.5 13.3 10.9 9.6 9.1 8.2 9.4 10.9 11.6 11.7 13.6 15 10 400 5 200 0 638 792 723 769 722 796 838 695 618 593 541 630 730 788 800 937 1374 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Number of unintentional drug poisoning deaths Age-adjusted rate per 100,000 0 Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2000-2016* *Data for 2015 and 2016 are provisional and subject to change (Published June 13, 2017)
Rate of drug overdoses Rate of unintentional drug poisoning (overdose), by demographics, 2016* 35 32.1 30 25 20 19.6 22.1 25.8 28.4 18.4 15 14.1 10 8.9 5 0 Male Female Black Hispanic White 15-34 35-54 55-84 Gender Race Age Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2016* *Data for 2016 are provisional and subject to change. (June 13, 2017)
Age group Large increases among age groups with high rates Age-specific rate of overdose death, 2015 and 2016 15-24 6.5 9.0 25-34 12.9 17.8 35-44 15.4 23.0 45-54 24.8 34.0 55-64 18.2 29.9 65-84 3.7 6.7 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Rate of overdose death Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2015-2016* *Data for 2015 and 2016 are provisional and subject to change (Published June 13, 2017)
Rate of overdoses, by neighborhood of residence, 2016 Rate of unintentional drug poisoning (overdose) deaths (per 100,000 residents), New York City, 2016 Bronx 5.8 10.0 10.1 15.0 15.1 22.0 22.1 30.0 30.1 39.0 Manhattan Queens Top 5 neighborhoods Staten Island Brooklyn Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2016* *Data for 2016 are provisional and subject to change (June 13, 2017)
Rate of overdoses, by neighborhood of residence, 2016 Rate of unintentional drug poisoning (overdose) deaths (per 100,000 residents), New York City, 2016 5.8 10.0 10.1 15.0 South Bronx 15.1 22.0 22.1 30.0 30.1 39.0 Top 5 neighborhoods South Beach Tottenville (Staten Island) Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2016* *Data for 2016 are provisional and subject to change (June 13, 2017)
Large increases from 2015 to 2016 among neighborhoods with endemically high rates Neighborhoods with five highest overdose rates, 2015-2016 Neighborhoods with five lowest overdose rates, 2015-2016 Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2015-2016* *Data for 2015 and 2016 are provisional and subject to change (Published June 13, 2017)
FENTANYL IN NEW YORK CITY
Fentanyl in NYC drug supply Fentanyl: potent synthetic opioid analgesic that is short acting Potency 50-100 times greater than morphine Non-pharmaceutical fentanyl Not patches or lollipops Produced in illicit laboratories Showing up in heroin, as well as cocaine, and street pills (e.g., marked as Xanax or opioid analgesics) Cut in and/or pressed prior to purchase Persons who use typically cannot detect it by sight, taste, or smell
Number of overdoses Percent involving fentanyl Increase in fentanyl driving increases in overdose deaths 350 300 250 200 150 100 50 0 Number of unintentional drug poisoning deaths (overdoses), by quarter, New York City, 2015-2016 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Confirmed drug overdoses Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2015-2016* *Data for 2015 and 2016 are provisional and subject to change (June 13, 2017) Percent involving fentanyl
Heroin or fentanyl involved in nearly all opioid overdoses in 2016 Any Opioid 82% Heroin or Fentanyl 72% Cocaine 46% Benzodiazepines 33% Opioid Analgesics 18% Methadone 14% Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2015-2016* *Data for 2015 and 2016 are provisional and subject to change (Published June 13, 2017)
Demographic profiles of decedents with fentanyl the same as heroin w/o fentanyl Any Fentanyl Heroin, no fentanyl Male Female 80% 20% 21% 79% Black Latino White 45% 32% 23% 20% 36% 44% 15-34 35-54 55-84 49% 31% 20% 27% 30% 44% Bronx Brooklyn Manhattan Queens Staten Island 28% 23% 20% 18% 11% 8% 28% 28% 17% 18% 100% 80% 60% 40% 20% 0% 20% 40% 60% 80% 100% Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2016* *Data for 2016 are provisional and subject to change (Published June 13, 2017)
INCREASE IN COCAINE- INVOLVED OVERDOSES
Age-Adjusted Rate per 100,000 Rate of unintentional drug poisoning deaths by drug type, NYC 2000-2016* (Drugs not mutually exclusive) 12 10 8 Heroin Cocaine 6 4 2 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2000-2016* *Data for 2015 and 2016 are provisional and subject to change (June 13, 2017)
Age-Adjusted Rate per 100,000 Rate of unintentional drug poisoning deaths by drug type, NYC 2000-2016* (Drugs not mutually exclusive) 12 10 8 Heroin Cocaine 6 4 2 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene, 2000-2016* *Data for 2015 and 2016 are provisional and subject to change (June 13, 2017)
Number of overdoses Percent involving fentanyl Fentanyl increasingly present in cocaineinvolved overdoses 100 90 80 70 60 50 40 30 20 10 0 Number of unintentional drug poisoning deaths (overdoses) involving cocaine without heroin, by quarter, New York City, 2015-2016 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Overdose deaths involving cocaine, no heroin Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene 2015-2016* *Data for 2015 and 2016 are provisional and subject to change (June 13, 2017) Percent involving fentanyl
Thank you! Questions?
The Opioid Epidemic: Responses to Overdose in NYC Jonathan McAteer, MPH Bureau of Alcohol and Drug Use Prevention, Care and Treatment NYC Department of Health and Mental Hygiene
New York City s response: HealingNYC $38M per year investment announced by the Mayor in March 2017 Goal: decrease opioid overdose deaths by 35 percent over 5 years 12 overall strategies Collaborative effort among multiple agencies
DOHMH-led strategies 1. Naloxone expansion 2. Rapid Assessment and Response (RAR) 3. Relay: Non-fatal overdose response system 4. Public awareness campaigns 5. Judicious opioid prescribing 6. Buprenorphine access
Naloxone expansion Reach high risk populations Equip more public safety officers Encourage organizations to register as opioid overdose prevention programs Raise public awareness Goal: Distribute 100,000 naloxone kits annually
Naloxone expansion Naloxone available via standing order (no prescription needed) NYC Health Commissioner provides standing order to pharmacist to dispense naloxone All major chain pharmacies carry naloxone Goal: Expand the number of independent pharmacies participating in the standing order
Rapid Assessment and Response (RAR) Method of quickly gathering data and information from stakeholders in response to a time-sensitive problem Informed by infectious disease/outbreak investigation models Investigations targeted to specific geographies and/or demographic groups Process includes: mapping, interviews, surveys, observation, site visits, and canvassing Disseminate findings to key stakeholders and coordinate response strategies with public safety and other partners
Examples of public health rapid response Health alert flyering in targeted communities Targeted distribution of naloxone In-person visits to service providers Provide data on fentanyl and mortality Distribute fentanyl awareness materials Encourage non-registered community based organizations to enroll as opioid overdose prevention programs
Relay: NYC DOHMH nonfatal overdose response system The occasion of a nonfatal overdose is an opportunity for intervention Relay program model based on pilot program in Rhode Island Partner with emergency departments (ED) in NYC hospitals located in high-risk neighborhoods 10 hospitals over 3 years Launched in June of 2017
Relay: NYC DOHMH nonfatal overdose response system Wellness Advocates (trained peer workers) dispatched to partner EDs 24/7 to engage individuals after a non-fatal overdose Participants will be offered Overdose risk reduction counseling Opioid overdose rescue training and naloxone Follow-up, referrals, and navigation to harm reduction, drug treatment, or other services Provide follow-up engagement for up to 90 days More than 91 participants engaged to date
Raise public awareness I saved a life campaign launched in May 2017
Thank you! Questions? To request copies of our educational material, posters, or ads, please contact Cindy Moy at cmoy2@health.nyc.gov