28 Unintentional Drug Overdose Data Review Public Health - Dayton & Montgomery County Epidemiology Section May 2016
Page 1 of 26 Prepared by: Epidemiology Section of Public Health - Dayton & Montgomery County Dawn L. Ebron, MS, MPH, CPH For comments and information requests: Public Health - Dayton & Montgomery County Epidemiology Section 117 South Main Street Dayton, OH 45422-1280 Phone: (937) 496-6533 Email: epi@phdmc.org
Page 2 of 26 Table of Contents Introduction...3 Terminology...4 Abbreviations...5 Drug Related Jail Bookings...6 Hospital Inpatient and Emergency Department...10 Accidental poisoning by heroin...10 Accidental poisoning by other opiates and related narcotics...13 Dayton Police and Fire Department Drug Overdose Response...15 Unintentional Drug Overdose Deaths...17 State-wide Overdose Death Rates...17 Montgomery County Overdose Deaths...18 Sources and Additional Resources...25
Page 3 of 26 Introduction Unintentional drug overdose deaths in the United States reached record numbers in 2014. According to the Centers for Disease Control and Prevention (CDC), nearly half a million people died from drug overdoses from 2000 to 2014. More than 60% of these deaths involved an opioid. It is estimated that 79 Americans die every day from an opioid overdose. The state of Ohio is also struggling to combat an escalating drug overdose death epidemic. In 2014, Ohio had the 5 th highest drug overdose death rate in the nation (24.6 per 100,000), a statistically significant increase from the year prior. At the county-level, drug overdose deaths in Montgomery County contributed to the steady rise in overdose deaths in Ohio. With 953 deaths from 2009 to 2014, the County has the second highest drug overdose rate in the state (31.1 per 100,000). In an effort to understand the current drug epidemic, this report was created to summarize drug related data that is collected by several different organizations into one formal data report. This report contains drug related criminal justice data, inpatient and emergency department accidental overdose records, drug overdose responses by City of Dayton first responders, and unintentional drug overdose death reports. The information presented in this report can be used to inform the general public, organizations, as well the leadership within the County as to the severity of the drug overdose problem. Additionally, this report is available to provide data needed for the development of new programs, inform policy decisions, or apply for grants pertaining to this epidemic.
Page 4 of 26 Terminology Benzodiazepine Psychoactive drug that proves useful in the treatment of anxiety, insomnia, agitation, seizures, and muscle spasms. The potential of a fatal overdose increases when these drugs are taken in combination with other central nervous system depressants such as ethanol and opioids. Common benzodiazepines are Alprazolam (Xanax), Diazepam (Valium), and Clonazepam (Klonopin). Drug mention A specific drug is found in the bodily system of decedent, not that the drug was necessarily the sole cause of death. The presence of more than one drug can result in more than one mention. Educational attainment The highest degree of education an individual has completed. Epidemic A widespread occurrence of a disease in a community at a particular time Heroin An opioid drug synthesized from morphine. It usually appears as a white or brown powder or a black sticky substance and can be injected, smoked, or inhaled by snorting or sniffing. ICD code A classification code used to classify mortality data from death certificates and morbidity data from inpatient and outpatient records, physician offices, and most National Center for Health Statistics (NCHS) surveys. Illicit fentanyl A synthetic opiate that is similar to, but more powerful, than morphine. It is made illegally and mixed with (or substituted for) heroin. This amplifies its potency and potential dangers. Jail booking After an arrest, a criminal suspect is taken into police custody and processed. The process of being booked usually includes recording personal information, taking fingerprints and photographs, and collecting any personal property. Naloxone (Narcan ) An Opioid Antagonist It blocks or reverses the effects of opioid medications used to treat a narcotic overdose in an emergency. Narcotic A drug or substance that affects mood or behavior, dulls senses, relieves pain, and causes sleepiness. It is often used to refer to any illegal drug, especially one that is addictive. Opiate A medication or illegal drug derived from opium or mimics the effect of an opiate (synthetic opiate). A sedative that depresses activity of the central nervous system, reduces pain, and causes sleepiness. Overdose (accidental/unintentional) A toxic amount of a drug or combination of drugs overwhelms the body. Prescription Opioids Medications prescribed by a physician used to relieve pain by reducing the intensity of pain signals read by the brain. Medications that fall in this class include: hydrocodone, oxycodone, morphine, and codeine.
Page 5 of 26 Abbreviations WSU CITAR Wright State University s Center for Interventions, Treatment, and Addictions Research ED Emergency Department ICD International Classification of Diseases
Number Page 6 of 26 Drug Related Jail Bookings Jail bookings Montgomery County, 2013-2015 6,000 5,000 4,951 5,382 5,118 4,000 3,000 2,000 1,000 0 2013 2014 2015 Source: Justice Web Over the past 3 years (2013-2015), there was an average of 5,150 jail bookings per year for drug related offenses.
Page 7 of 26 Jail bookings by race Montgomery County, 2013-2015 0.2% 0.6% 29.1% 70.1% White Black Other* Unknown *Other includes those coded as Asian (0.1%), Indian (0.0%), Hispanic (0.5%) and other (0.0%). Source: Justice Web More Whites were arrested for drug related charges than Blacks (70% vs. 29%). Jail bookings by sex Montgomery County, 2013-2015 30.8% Female Male 69.2% Source: Justice Web Males are much more likely than women to be arrested for a drug related offense (69% vs. 31%).
Density calculations performed by ArcGIS 10.3.1 Page 8 of 26
Page 9 of 26 Jail Bookings by Arresting Agency, Montgomery County, 2013-2015 Arresting Agency 2013 2014 2015 Total Adult Parole Authority 8 0.2% 12 0.2% 5 0.1% 25 0.2% Airport 1 0.0% 0 0.0% 1 0.0% 2 0.0% Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) 1 0.0% 0 0.0% 0 0.0% 1 0.0% Brookville Police 27 0.5% 22 0.4% 34 0.7% 83 0.5% Butler Township Police 48 1.0% 76 1.4% 79 1.5% 203 1.3% Centerville Police 18 0.4% 14 0.3% 16 0.3% 48 0.3% Clay Township Police 9 0.2% 4 0.1% 8 0.2% 21 0.1% Clayton Police 29 0.6% 52 1.0% 38 0.7% 119 0.8% Dayton Police 2,182 44.1% 2,166 40.2% 1,964 38.4% 6,312 40.9% Drug Enforcement Agency (DEA) 0 0.0% 2 0.0% 0 0.0% 2 0.0% Deputy United States Marshal (DUSM) 0 0.0% 0 0.0% 1 0.0% 1 0.0% Englewood Police 31 0.6% 54 1.0% 44 0.9% 129 0.8% Federal Bureau of Investigation (FBI) 3 0.1% 0 0.0% 0 0.0% 3 0.0% Federal (FED) 4 0.1% 1 0.0% 1 0.0% 6 0.0% German Township Police 1 0.0% 5 0.1% 5 0.1% 11 0.1% Germantown Police 2 0.0% 9 0.2% 12 0.2% 23 0.1% Grandview Medical Center 19 0.4% 23 0.4% 24 0.5% 66 0.4% Huber Heights Police 84 1.7% 102 1.9% 134 2.6% 320 2.1% Jackson Township 2 0.0% 7 0.1% 4 0.1% 13 0.1% Kettering Police 66 1.3% 96 1.8% 137 2.7% 299 1.9% Miami Township Police 110 2.2% 103 1.9% 99 1.9% 312 2.0% Miamisburg Police 84 1.7% 107 2.0% 134 2.6% 325 2.1% Montgomery County Adult Probation 378 7.6% 266 4.9% 300 5.9% 944 6.1% Montgomery County Sherriff 1,311 26.5% 1,541 28.6% 1,341 26.2% 4,193 27.1% Moraine Police 75 1.5% 133 2.5% 179 3.5% 387 2.5% New Lebanon Police 20 0.4% 29 0.5% 21 0.4% 70 0.5% Oakwood Police 8 0.2% 5 0.1% 12 0.2% 25 0.2% Ohio State Patrol 79 1.6% 225 4.2% 149 2.9% 453 2.9% Park Police 18 0.4% 17 0.3% 29 0.6% 64 0.4% Perry Township Police 7 0.1% 1 0.0% 2 0.0% 10 0.1% Riverside Police 82 1.7% 54 1.0% 85 1.7% 221 1.4% Sinclair Community College 18 0.4% 27 0.5% 9 0.2% 54 0.3% Trotwood Police 132 2.7% 101 1.9% 126 2.5% 359 2.3% University of Dayton Police 9 0.2% 8 0.1% 8 0.2% 25 0.2% Union Police 4 0.1% 5 0.1% 2 0.0% 11 0.1% United States Military (USM) 9 0.2% 7 0.1% 6 0.1% 22 0.1% Vandalia Police 19 0.4% 23 0.4% 25 0.5% 67 0.4% West Carrollton Police 27 0.5% 46 0.9% 64 1.3% 137 0.9% Wright Patterson Police 0 0.0% 1 0.0% 2 0.0% 3 0.0% Other 11 0.2% 12 0.2% 8 0.2% 31 0.2% Unknown 15 0.3% 26 0.5% 10 0.2% 51 0.3% TOTAL 4,951 5,382 5,118 15,451 Source: Justice Web
Number Page 10 of 26 Hospital Inpatient and Emergency Department (ED) Data ICD E850.0 Accidental poisoning by heroin 350 300 250 200 150 100 50 0 48 Heroin accidental poisoning by hospital visit type Montgomery County, 2012-2015 70 8 14 330 48 293 2012 2013 2014 2015 Emergency Department Inpatient 27 Source: OHA Insight, Greater Dayton Hospital Association Visits to the emergency department (ED) for accidental poisoning by heroin were higher than inpatient stays. In 2015, the number of ED visits for heroin overdoses was more than 6 times higher than in 2012. 70% 60% 50% 40% 30% 20% 10% 0% Hospital visits (inpatient and ED) for heroin accidental poisoning by sex Montgomery County, 2012-2015 66% 34% 58% 42% Source: OHA Insight, Greater Dayton Hospital Association 61% 39% 59% 41% 2012 2013 2014 2015 Female Male Men were more likely to visit the hospital (ED or inpatient) for a heroin overdose than women. The percent of female heroin overdose related hospital visits increased 21% from 2012 to 2015.
Rate per 100,000 Page 11 of 26 250 Rate of hospital visits (inpatient and ED) for heroin accidental poisoning by age Montgomery County, 2012-2015 200 150 100 50 0 0-14 15-19 20-24 25-34 35-44 45-54 55-64 65 + Source: OHA Insight, Greater Dayton Hospital Association 2012 2013 2014 2015 The rate of hospital visits was greatest among 25 to 34 year olds for all years.
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Number Page 13 of 26 ICD E850.2 Accidental poisoning by other opiates and related narcotics Applies to: codeine, meperidine, morphine, and opium 60 50 Other opiates and related narcotics accidental poisoning by hospital visit Montgomery County, 2012-2015 57 54 51 40 30 20 24 17 28 14 19 10 0 2012 2013 2014 2015 Emergency Department Inpatient Source: OHA Insight, Greater Dayton Hospital Association In 2014, the number of ED visits and inpatient stays for accidental poisoning for other opiates and related narcotics were almost equal (57 vs. 54). But in 2015, there were more than 2.5 times more ED visits than inpatient stays. 80% 70% 60% 50% 40% 30% 20% 10% 0% Hospital vists (inpatient and ED) for accidental poisoning by other opiates and related narcotics by sex Montgomery County, 2012-2015 54% 46% 69% 31% Source: OHA Insight, Greater Dayton Hospital Association 59% 59% 41% 41% 2012 2013 2014 2015 Female Male In 2012 and 2013, a higher percentage of hospital visits (inpatient and ED) for accidental poisonings by other opiates and related narcotics was by females, but in 2014 and 2015, a higher percentage was by males.
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Number Page 15 of 26 Dayton Police and Fire Department Drug Overdose Response 30 Dayton Police Department narcan useage by Month in 2015 27 25 20 15 10 5 0 3 2 Source: Dayton Police Department 4 Narcan Uses by the Dayton Police Department in 2015 Number of Uses 167 Recovery Sex Race 7 Age Range Youngest Age Oldest Age Average Age 19 13 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 20 Number 15 Percent Successful 158 95% Unsuccessful 9 5% Male 111 66% Female 56 34% White 150 90% Black 17 10% 12-17 0 0% 18-24 18 11% 25-34 72 43% 35-44 50 30% 45-54 22 13% 55-64 5 3% 65+ 0 0% 18 years 64 years 21 34.7 years 95% of overdose victims that were administered Narcan were successfully revived. 21 15
Number Page 16 of 26 1,600 1,400 1,200 1,000 800 Dayton Police and Fire Departments' overdose calls 2012-2015 948 1,060 159 462 1,257 723 1,489 782 600 400 200 730 509 494 369 59 104 165 198 0 2012 2013 2014 2015 Police Only Fire Only Both Source: Dayton Police Department From 2012 to 2015, the number of both solo and dual assist police calls for service in which the call type was an overdose increased 350% within the city of Dayton. Overall, the number of times police and/or fire responded to an overdose within the city of Dayton increased 57% from 2012 to 2015.
Page 17 of 26 Montgomery County has the 2 nd highest unintentional drug overdose death rate in Ohio. 1. Brown County - 35.8 2. Montgomery County - 31.1 2. Adams County - 31.0 4. Jefferson County - 30.2 5. Scioto County - 29.4
Number Number Page 18 of 26 Unintentional drug overdose deaths in Montgomery County 2010-2015 300 264 259 250 226 200 150 127 130 162 100 50 0 2010 2011 2012 2013 2014 2015 Source: Poisoning Death Review, WSU CITAR Unintentional drug overdose deaths have increased 104% since 2010. Unintentional Overdose Deaths in Montgomery County by Month, 2015 40 35 30 25 20 15 13 12 12 16 26 21 34 19 23 29 30 24 10 5 0 Source: Poisoning Death Review, WSU CITAR
Page 19 of 26 Unintentional drug overdose death mentions in Montgomery County, OH 2013-2015 Benzodiazepines 43% 52% 51% Anti-Depressants 6% 16% 27% Prescription Opioids 31% 37% 44% Illicit Fentanyl 9% 41% 41% Heroin 48% 45% 58% Methamphetamine 3% 4% 5% Cocaine 26% 31% 36% Alcohol 26% 28% 29% 0% 10% 20% 30% 40% 50% 60% 70% 2013 2014 2015 Source: Poisoning Death Review, WSU CITAR In 2015, heroin was the most frequently mentioned drug and were found in 45% of the 259 overdose deaths. This is a slight decrease from the percent of mentions in 2014 (48%) and a 22% decrease from 2013. In 2014, the most frequently mentioned type of drug was benzodiazepines. From 2013 to 2014, the percent of overdose deaths with mentions of illicit fentanyl increased 355%. In 2014 and 2015, 41% of overdose toxicology reports mentioned illicit fentanyl.
Page 20 of 26 Unintentional drug overdose deaths - Demographics Unintentional drug overdose deaths in Montgomery County, OH by sex, 2015 32.4% Male Female 67.6% Source: Poisoning Death Review, WSU CITAR Unintentional drug overdose deaths in Montgomery County, OH by race, 2015 0.8% 13.5% 85.7% White Black Other Source: Poisoning Death Review, WSU CITAR
Page 21 of 26 Unintentional drug overdose deaths in Montgomery County, OH by educational attainment, 2015 5.8% 0.8% < High School 67.2% HS graduate 26.3% College graduate Post-graduate Unknown Source: Poisoning Death Review, WSU CITAR 35% Unintentional drug overdose deaths in Montgomery County, OH by age group, 2015 30% 25% 20% 26.3% 29.0% 22.0% 15% 13.9% 10% 5% 0% 7.3% 0% 1.5% 0% <15 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65-74 yrs 75+ yrs Source: Poisoning Death Review, WSU CITAR
Page 22 of 26 Unintentional drug overdose deaths in Montgomery County, OH by maritial status, 2015 25.9% 2.0% 20.0% 52.2% Single Married Divorced Widowed Source: Poisoning Death Review, WSU CITAR The majority of unintentional drug overdose fatalities in 2015 were male (68%), White (86%), have at least a high school diploma (67%), 35 to 44 years of age (29%), and are single (51%).
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Page 26 of 26 Sources and Additional Resources Centers for Disease Control and Prevention (CDC). Fentanyl. http://www.cdc.gov/drugoverdose/opioids/fentanyl.html Centers for Disease Control and Prevention (CDC). Injury Prevention & Control: Opioid Overdose. http://www.cdc.gov/drugoverdose/index.html Centers for Disease Control and Prevention (CDC). Today s Heroin Epidemic. http://www.cdc.gov/drugoverdose/opioids/heroin.html Hedegaard H, Chen LH, Warner M. Drug poisoning deaths involving heroin: United States, 2000 2013. NCHS data brief, no 190. Hyattsville, MD: National Center for Health Statistics. 2015. http://www.cdc.gov/nchs/data/databriefs/db190.pdf Ohio Department of Health, Drug Overdose Data and Publications. http://www.healthy.ohio.gov/vipp/data/rxdata.aspx