10/25/2016

ARetrospectiveAnalysisof
OverdoseDeathsinAllen
County,20082015
JanaSanders,InformaticsDirector,
FortWayneAllenCountyDepartmentofHealth
FortWayneAllenCountyBoardofHealth
October24,2016

2016ResearchTeam
JanaSanders,M.En.InformaticsDirector
FortWayneAllenCountyDepartmentofHealth

PhilipHuynh,2016MPHintern
FortWayneAllenCountyDepartmentofHealth

Dr.GregoryEigner,MD,AssociateDirector
FortWayneMedicalEducationProgram

Dr.DeborahMcMahan,MD,HealthCommissioner
FortWayneAllenCountyDepartmentofHealth

Dr.DavidMurphy,DO,1st YearResident
FortWayneMedicalEducationProgram

Dr.ChristopherBrubaker,MD,1st YearResident
FortWayneMedicalEducationProgram

2014ResearchTeam
JanaSanders,M.En.InformaticsDirector
FortWayneAllenCountyDepartmentofHealth

DeborahMcMahan,M.D.,HealthCommissioner
FortWayneAllenCountyDepartmentofHealth

SpecialThanksTo:
FortWayneAllenCountyDepartmentofHealth
SarahCastillo,VitalRecordsDirector
KristiGephart,VitalRecordsAsst.Director

KaileyNeff,Intern
FortWayneAllenCountyDepartmentofHealth

BriannaSerbus,M.D.,3rd YearFamilyMedicineResident
FortWayneMedicalEducationProgram

MegWilson,Ph.D.,Director,Research&ScholarlyActivity
FortWayneMedicalEducationProgram

CoronersOffice
MikeBurris,ChiefInvestigator/DeputyCoroner
RebeccaStuttle,Investigator/DeputyCoroner
PatKite,Investigator/DeputyCoroner

GregoryEigner,M.D.,AssociateDirector
FortWayneMedicalEducationProgram

OverdoseEpidemic

PrescriptionOpioids

TheUnitedStatesisinthemidstofanopioidoverdose
epidemic,witha300%increaseintherateofoverdose
deathsinvolvingopioids(opioidpainrelieversandheroin)
since20001,2

In2014,10millionpersonsreportedusingprescription
opioidsfornonmedicalreasons3

In2012,healthcareproviderswroteover250million
prescriptionsforscheduledpainmedicines2

Pastmisuseofprescriptionopioidsisthestrongestrisk
factorforheroininitiationanduse.Infact,75%ofheroin
usershavepreviouslyused,ormisused/abusedprescription
opioids4,5

10/25/2016

IllicitDrugs

StudyDesign

AccordingtoNSDUHdata,morethan900,000peopleinthe
U.S.reportedheroinusein2014,withmortalitydueto
heroinoverdosemorethantriplingintheprior4years2

Retrospectivedescriptivestudy
LutheranIRBapproval
CollaborationwithFortWayneMedicalEducationProgramandAllenCounty
CoronersOffice

Since2014,illicitfentanylhasbeencombinedwithheroin,
increasingitspotencyandthemortalityrisk,whenpresent

Twostudyperiods
20082013
20142015

20082015Demographics

20082015TotalOverdoseDeaths
20082015TotalOverdoseDeaths
80

77

NumberofOverdoseDeaths

75

Gender

Race

70
65

62
White

60
54

55

50

50
45
40

40%

44

46

Females
Males

45

60%

0.7%

0.5%

89%

Black/African
American

10%

Hispanic/Latino

40

Other

35
2008

2009

2010

2011

2012

2013

2014

2015

Year

20082015Demographics
Employment Status

20082015Demographics
CurrentlyEmployed

PlaceofInjury
Residence

CurrentlyUnemployed
0.2%

5%

Workplace

5%

Student
8%

4%

69%

71%

Disabled

Other

4%

Retired

Unknown

20%

14%

Unknown

OtherResidence
0.2%

10/25/2016

20082015AverageAge

20082015AgeBreakdownComparison

AverageAge
OverallAge

Accidental

20082015AgeGroupComparison

Intentional

60

20082013
59.5

41.3

39.9

48.8

41.3

41.6

45.4

2009
15.0
78.0
45.5

44.2

42.9
39.0

2008
19.0
75.0
41.0

49.0

44.7

41.1

40

49.4

2010
21.0
63.0
46.0

2011
17.0
67.0
45.0

46.9
43.7
42.4

40.0

39.3
38.3

2012
16.0
65.0
41.5

2013
24.0
73.0
46.0

2014
18.0
75.0
42.0

2015
19.0
67.0
37.0

PercentageinStudyPopulation

44.1

45

51.9

51.8

32.4%

30%

27.5%

25%

22.9%
19.8%

20%

19.9%

14.3%

15%

26

5%

2.1%

0%

23.7%
20.6%

93
36

10%

30

57

68

27

41

7.7% 7.6%
22

1.5%

10

<20

2029

3039

4049

5059

>=60

AgeGroup

20082015OtherPeoplePresentbyAge
Group
PercentageofAgeGroup

PresenceofOthers

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

20082015OtherPeoplePresentbyAge
Group

62

2029

PercentageofAgeGroup

8
65
62

44

13

5059

60

20082015DrugClassesPresentinatLeast20%oftheStudyPopulation
21.6%

Alcohols

46

3039
4049
AgeGroup

44

20082015DrugClasses
Anticonvulsants

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

65

46

<20

DrugClass

AverageAge

51.9

50

35
Year
Min.
Max.
Median

20142015

35%

55

13

25.2%

Antidepressants

36.4%

IllicitDrugs

42.0%

Benzodiazepines

49.0%

OTCStimulants

73.5%

Opioids
<20

2029

3039
4049
AgeGroup

5059

60

78.9%
0%

10%

20%

30%
40%
50%
60%
PercentageofStudyPopulation

70%

80%

90%

10/25/2016

20082015PresenceofHeroin

20082015DrugClassesbyYear
Benzodiazepines

20082015HeroinPresent

Fentanyl
35%

90%

PercetnageofStudyPopulation

Percent Present in Study Population

Opioids*
100%
80%
70%
60%
50%
40%
30%
20%
10%

30.3%
30%

2008

2009

2010

2011

2012

2013

2014

18.0%

20%
15%
10.6%
10%
4.5%

5%
0%

0%

24.1%

25%

0.0%
2008

2015

2009

2.2%

2.2%

2010

2011

20082013
100%

90%

PercentageinStudyPopulation

6
14%

5
4
3
2

86%

80%

20142015

86.2%
75.5%

70%
60%

55.4%

40%

49.3%

112

50%
213

37.6%

30%

139

20%

48.5%

35.8%

101

72

33.8%

26.2%

22.3%
21.3%

23.1%

63
106

44

74

30

60

29

0%
Opioids*

IllicitDrugs

0
HeroinExclusively

2014

2015

Benzodiazepines
Antidepressants
DrugClass

Volatiles/alcohols

Anticonvulsants

*Opioidsincludefentanyl,methadone,andweakopioids

MedicalConditionsbyMannerofDeath,
20142015 Accidental (n=111)
Intentional (n=20)
Percent Present in Study Population

2015

n=130

n=282

10%

FentanylCombination

2014

ComparisonofDrugClassesPresentwithat20%oftheStudyPopulation

Heroin,20082015
n=56

2013

ComparisonofDrugClassesbyStudyPeriod

Heroin/FentanylCombination
n=8

HeroinandFentanyl

2012
Year

Year

Conclusions

70%

OverdosedeathsinAllenCountyincreased93%from2008
2015.

60%

60%
50%

43.2%

40%

Mostdeathswereaccidental,involvedmultiplesubstances
andoccurredataplaceofresidence.Deathrateswere
higherformales,whites,andemployedindividuals

35%

30%
20%

20%
10%

15%

10%
9.0%

7.2%

14.4%
9.0%

7.2%
0%

0%
COPD

Hepatitis C

Depression

Chronic pain

Prior suicide Substance abuse

attempt

Opioidswerepresentin79%ofoverdosedeaths,most
frequentlycombinedwithbenzodiazepinesand/orillicit
drugs
Presenceofopioidsincreasedto90%in2015

Medical Condition

10/25/2016

Conclusions

FutureDirections

Heroinrelateddeathshaveincreasedsteadilysince2011

HistoricalreviewofINSPECTdata

Overdosedeathsduetofentanylhavetripledsince2013

Continuedcollectionofrealtimeoverdosedeathdata

Depressionscreeningissupported,giventheassociation
betweendepressionandintentionaloverdosedeaths

Collaboratewithcommunitypartnerstogathernaloxone
administrationdataandinformationonoverdosesnotresulting
indeath

Naloxoneaccessispotentiallylifesavingas57%ofdeaths
occurredinaresidencewhereotherswerepresentatthe
timeofoverdose

Indepthanalysisofdrugcombinations

References
1. CDC. IncreasesinDrugandOpioidOverdoseDeaths UnitedStates,
20002014.MMWR2015;64;15.
2. OpioidPainkillerPrescribing.(2014).
From:http://www.cdc.gov/vitalsigns/opioidprescribing/
3.CDC.Widerangingonlinedataforepidemiologicresearch(WONDER).
Atlanta,GA:CDC,NationalCenterforHealthStatistics;2015.
Availableathttp://wonder.cdc.gov
4. JonesCM,LoganJ,GladdenRM,BohmMK.Vitalsigns:demographic
andsubstanceabusetrendsamongheroinusers UnitedStates,2002
2013.MMWR2015;64:71925
5. CiceroTJetal.ThechangingfaceofheroinuseintheUnitedStates:A
retrospectiveanalysisofthepast50years.JAMAPsych2014;71:82126

Thankyou
jana.sanders@allencounty.us