OPIOID OVERDOSE RELATED EMERGENCY DEPARTMENT VISITS AT PROVIDENCE EVERETT Quarterly Report Jue August 2017 Xiyao degrauw Sohomish Health District 3020 Rucker Ave., Everett, WA 98201
Opioid Overdose Related ED Visits at Providece Everett Quarterly Report Jue-August 2017 Itroductio I the five year-period betwee 2012 ad 2016, Sohomish Couty had the fourth-highest rate of opioid overdose (OD) death i Washigto State (12.4 per 100,000 populatio) 1. I respose, uder Ceter for Disease ad Prevetio (CDC) Priority Strategy 2 (ehacig ad empowerig commuity-level prevetio), a Opioid Overdose Prevetio project was fuded. The project is to provide commuity ad prescribers opioid overdose iformatio ad educatio to prevet opioid overdose ad improve cliic care for patiets takig opioids for chroic pai ad those with opioid use disorder. Data has bee collected o patiets with OD at Providece Hospital s emergecy departmet (ED) i Everett sice Jue 2017. This report o OD related ED visits will be revisited o a quarterly basis. A total of 100 OD-related ED visits occurred betwee Jue 1 ad August 31 2017. Demographics Figures 1- show demographic ad social iformatio for OD-related ED visits from Jue- August, 2017. Data iclude age, geder, race, ethicity, type of medical isurace, ad employmet. 1 P a g e
Opiod Overdose ED Visits Couts Amog all the OD-related ED visits, more tha oe-third were patiets ages 2 to 30 years (34, 34%). Mea age is 34.6. The yougest patiet was 17, ad the oldest was 61 years old (Figure 1). OD visits occurred more frequet i males tha i females (9, 9%; 40, 40% respectively) (Figure 2). Most of them were o-hispaic (92, 92%), 1 were white, 10 were Native America ad 3 were Africa America (Figure 3). More tha half had Medicaid (64, 64%) or o isurace (17, 17%) (Figure 4). The majority were uemployed (70, 70%), icludig 22 homeless people (Figure ). Figure 1. Opioid Overdose Related ED Visits by Age, 2017 40 3 30 2 20 1 10 0 34 2 22 13 2 4 1-19 ys 20-24 ys 2-30 ys 31-40 ys 41-60 ys 60-70 ys Age of ED patiets 2 P a g e
Figure 2. Opioid Overdose related ED Visits by Sex, 2017 40 9 Male Female Figure 3. Opioid Overdose related ED Visits by Race, 2017 34 1 2 3 10 White Native America Black Other Ukow 3 P a g e
Figure 4. Opioid Overdose related ED Visits by Isurace, 2017 17 4 64 Medicaid Medicare Private Isurace Other No Isurace Ukow Figure. Employmet status of Opioid Overdose related ED Visits, 2017 13 17 Yes 22 No Homeless 48 Ukow Characteristics of OD evets Figures 6-9 show characteristics of the OD evets, icludig the date, time, locatio ad city. Near half (41, 41%) of all visits i the three-moth period occurred i Jue (Figure 6). More tha half (60, 60%) occurred betwee 12pm to midight (Figure 7). OD cases occurred most frequetly i Everett (7, 7%) ad Marysville (23, 23%), with other cases happeig i Arligto, Lake Steves, ad Sohomish, Mukilteo, Mill Creek, Bothell ad Stawood (Figure 8). The most commo locatios where OD cases occurred were i public places (such as 4 P a g e
Opioid Overdose ED Visits Couts restaurats, parks, ad grocery stores) ad private resideces, 36 (36%) ad 41 (41%), respectively, 1 occurred i a car, Oe OD happeed at a Methadoe cliic, oe occurred i a hotel ad two occurred i a camp (Figure 9). Figure 6. Opioid Overdose Related ED Visits, 2017 16 1 1 14 13 13 12 11 10 10 9 9 8 6 4 2 0 Figure 7. Time of Opioid Overdose related ED Visits, 2017 31 16 19 29 0:00-6:00 6:01-12:00 12:01-18:00 18:01-24:00 P a g e
Opioid Overdose ED Visits Couts Opioid Overdose ED Visit Couts 60 Figure 8. Opioid Overdose Ocurred by City, 2017 7 0 40 30 20 23 10 0 4 4 2 2 1 1 1 City of Opioid Overdose Ocurred Figure 9. Opioid Overdose Ocurred by Locatio, 2017 4 40 3 30 2 20 1 10 0 41 Private Residece 1 2 36 1 1 Car Camp Public Place Hotel Other Place of Opioid Overdose Occurred Other: at methadoe cliic Drug usage i OD related ED visits Figures 10-13 show the types of drugs ad practices used by patiets of OD-related ED visits. The most commo opioid drug used was heroi (7, 7%), icludig 46 cases with the patiet usig heroi oly, ad 1 cases usig heroi with methamphetamie (Figure 10). There were 1 cases usig prescribed pai medicie icludig six cases usig medicie prescribed to 6 P a g e
themselves (Figures 10). More tha half the drugs were obtaied illegally o the streets (7, 7%) (Figure 11). Ijectio was the most commo admiistratio method (2, 2%) (Figure 12). Reasos other tha substace use disorder for usig opioid drugs icluded chroic pai (9), cacer (3), depressio (3), ad recreatio (4). Fifty three (3%) people received aloxoe from ED staff, 1 from EMS staff, had it admiistered by a fried /acquaitace or family member, ad 7 were give aloxoe by police (figure 13). Fourtee patiets were experiecig their first overdose ad 33 patiets admitted havig repeated overdose. Figure 10. Opioid Overdose by Substace Used Methadoe oly 2 Rx +Alc/Acetam/Be Rx oly 10 Alo /Be/Mar/ukow 8 Heroi + Metham + MDMA /Mar Heroi + Alc/Coc/Rx/Metha/Be/Mar 9 Heroi + metham 1 Heroi oly 46 0 10 20 30 40 0 Metham=Methamphetamie Alc=Alcohol Coc=Cocaie Rx=Prescribed Pai Medicie Be=Bezos Mar=Marijuaa MADA=3,4-Methyleedioxymethamphetamie Acetam=Acetamiophe 7 P a g e
Figure 11. Source of the Substace used amog Opioid Overdose, 2017 28 1 6 8 7 O Streets From Frieds/Relative Prescribed Other Ukow Figure 12. Opioid Overdose by Route of Admiistratio, 2017 18 9 2 16 Ijectio oral smoke other ukow 8 P a g e
Figure 13. Naloxoe Admiistrated by Persoel amog Opioid OVerdose, 2017 20 2 2 2 1 4 11 1 ED EMS Fried/acquaitace Family member PD EMS +PD EMS +ED Other Not receive Referrals The opioid educatio urse at the Providece ED had limited success i followig up with patiets with 29 patiets cotacted before or after discharge. Amog them, six accepted treatmet referrals, two accepted aloxoe referrals, six accepted treatmet ad aloxoe referrals, eight accepted treatmet, aloxoe ad eedle exchage cliic referrals, oe accepted aloxoe ad eedle exchage cliic referrals, ad six patiets were also iterested i Recovery Café * for support, Sohomish Couty Opioid Outreach Specialist for couselig, ad Commuity Health Ceters of Sohomish Couty for establishig a primary care provider. Coclusios There were 100 OD visits i oe hospital ED i three moths. OD occurred most i people usig heroi. There are ways to reduce heroi-related OD visits ad OD death. Traiigs o how to use aloxoe ad gettig aloxoe kits to those who eed it most are useful as they reduce ot oly OD death but also reduce the burde o ED ad EMS. Icreased access to methadoe would reduce OD deaths ad hospitalizatios as well. Targeted outreach areas would be most successful 9 P a g e
i Everett ad Marysville amog heroi users aged 2-40 years, especially those uemployed or o Medicaid. These efforts could iclude lookig at service orgaizatios such as food baks, shelters, the Everett Gospel Missio, ad others. Oly 29 out of 100 were cotacted successfully, idicatig a eed to chage the strategy of patiet outreach for referrals ad educatio. There is a hope for people with substace use disorder. I respose opioid crisis, the Natioal Istitutes of Health is joiig with private parters to lauch a iitiative i three scietific areas: developig better overdose-reversal ad prevetio itervetios to reduce mortality, savig lives for future treatmet ad recovery; fidig ew, iovative medicatios ad techologies to treat opioid addictio; ad fidig safe, effective, oaddictive itervetios to maage chroic pai. 2 We thak Robi Addiso at Providece Hospital ED departmet for data collectios, ad Holliae Bruce, Gabrielle Fraley ad Carrie McLachla at Sohomish Health District for the iput. Refereces 1. Washigto State Departmet. (2017). Opioid-related Deaths i Washigto State, 2006-2016. http://www.doh.wa.gov/portals/1/documets/pubs/346-083- SummaryOpioidOverdoseData.pdf 2. Volkow, N. D., & Collis, F. S. (2017). The Role of Sciece i Addressig the Opioid Crisis. New Eglad Joural of Medicie. * Recovery Café : offers recovery support for people who have bee traumatized by addictio. https://recoverycafe.org/ 10 P a g e
Appedix Table 1. Opioid Overdose Related ED Visits by Age, 2017 Age (year) 1-19 2 2% 20-24 13 13% 2-30 34 34% 31-40 22 22% 41-60 2 2% 60-70 4 4% Mea age 34.6 Table 2. Opioid Overdose Related ED Visits by Sex, 2017 Sex Male 9 9% Female 40 40% ukow 1 1% Table 3. Opioid Overdose Related ED Visits by Race ad Ethicity, 2017 Ethicity /Race Hispaic 3 3% No-Hispaic White 1 1% No-Hispaic Native America 10 10% No-Hispaic Africa America 3 3% Other 2 2% Ukow 34 34% Table 4. Opioid Overdose Related ED Visits by Type of Isurace, 2017 Isurace Medicaid 64 64% Medicare 4 4% Private Isurace % Other % No Isurace 17 17% Ukow % 11 P a g e
Table. Employmet Status of Opioid Overdose Related ED Visits, 2017 Employmet Yes 17 17% No 48 48% Homeless 22 22% Ukow 13 13% Table 6. Opioid Overdose Related ED Visits, 2017 Moth Early-Jue 13 13% Mid-Jue 13 13% Late-Jue 1 1% Early-July % Mid-July 10 10% Late-July 11 11% Early-Aug. 1 1% Mid-Aug. 9 9% Late-Aug. 9 9% Table 7. Time of Opioid Overdose Related ED Visits, 2017 Time 0:00-6:00 16 16% 6:01-12:00 19 19% 12:01-18:00 29 29% 18:01-24:00 31 31% Ukow % Table 8. Cities where Opioid Overdose Occurred, 2017 City Everett 7 7% Marysville 23 23% Sohomish 4 4% Lake Steves 4 4% Mukilteo 2 2% Mill Creek 2 2% Bothell 1 1% Arligto 1 1% Stawood 1 1% Ukow % 12 P a g e
Table 9. Locatio of Opioid Overdose Occurred, 2017 Locatio Private Residece 41 41% Car 1 1% Camp 2 2% Public Place 36 36% Hotel 1 1% Other* 1 1% Ukow 4 4% *: at methadoe cliic Table 10. Substace Used amog Opioid Overdose, 2017 Substace used Heroi oly 46 46% Heroi + METH 1 1% Heroi + METH+ MDMA+Marijuaa 1 1% Heroi + METH+ Marijuaa 2 2% Heroi + METH+ Alcohol +Bezos 1 1% Heroi + METH+ Cocaie +Bezos +Marijuaa 1 1% Heroi +Methadoe 1 1% Heroi + Alcohol % Heroi +Cocaie 1 1% Heroi +Bezos +Marijuaa 1 1% Heroi +Rx 1 1% Alcohol +Bezos 1 1% Alcohol +Bezos +METH 1 1% Rx oly 10 10% Rx +Alcohol +Acetamiophe 1 1% Rx+Bezos 4 4% Methadoe oly 2 2% Marijuaa oly 1 13% Ukow % METH: Methamphetamie Rx: Prescribed Pai Medicie MDMA: 3,4-Methyleedioxymethamphetamie, commoly kow as ecstasy, 13 P a g e
Table 11. Source of The Substace Used amog Opioid Overdose, 2017 Source of Substace O Streets 7 7% From Frieds/Acquaitace 8 8% Prescribed 6 6% Other 1 1% Ukow 28 28% Table 12. The Admiistratio Route of The Substace used amog Opioid Overdose, 2017 Route of Admiistratio Ijectio 2 2% Oral 16 16% Smoke 9 9% Other % Ukow 18 18% Table 13. Persoel Admiistrated Naloxoe amog Opioid Overdose, 2017 Persoel Emergecy Departmet 1 1% EMS 11 11% Fried/acquaitace 4 4% Family member 1 1% Police % EMS +Police 2 2% EMS +Emergecy Departmet 2 2% Other 2 2% Not receive 20 20% Ukow 2 1% 14 P a g e