Emerging Research: Ohio Drug Markets and Related Overdoses Daniel - - PowerPoint PPT Presentation

Emerging Research: Ohio Drug Markets and Related Overdoses

Daniel Rosenblum Department of Economics Dalhousie University Funded by NIH/NIDA Grant: R01DA037820 Thank you to the Drug Policy Alliance!

• Overdose Deaths in Ohio
• Ohio mostly follows the national pattern: Recent rapid rise in

synthetic opioid related deaths.

• All of the increase in Ohio overdose deaths from mid 2016 to mid

2017 can be attributed to carfentanil and other fentanyl analogs.

• Ohio Drug Lab Test Data
• Drug supply is becoming dominated by synthetic opioids that are

increasingly diversifying and contaminating other drugs.

• Drug Test Data is Strongly Correlated with Deaths
• One additional positive test of carfentanil predicts 0.45 more deaths.
• One additional positive test of fentanyl or fentanyl analogs predicts

0.2 more deaths.

• The major challenge for researchers of the opioid crisis

is a lack of accessible data.

• We don’t know the demand. We don’t know the

supply.

• The more and the better the data we let researchers

have, the more quickly we will identify emerging crises before they get out of control and the more quickly we will be able to direct resources for harm reduction.

• Back when heroin was heroin, you could use the DEA’s

STRIDE data to estimate the price per pure gram of heroin in a city.

• There was wide variation in purity, but the maximum

strength of heroin used to be 100% pure heroin.

• What is the product when it can be laced with carfentanil,

thousands of times more potent than heroin?

• Understanding “heroin” is no longer about the price or purity

going up or down, it’s about what is really in it.

500 1000 1500 2000 2500 3000 3500 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

Drugs Involved in Ohio Overdose Deaths, 1999 to 2017

Prescription Opioids Heroin Cocaine Other Synthetic Narcotics (Fentanyl, Carfentanil, etc.) Methamphetamines

Use drug seizure laboratory test data from the Ohio Bureau of Criminal Investigation

• January 1, 2015 through June 30, 2018
• 6 month time‐lag between seizure and test result
• 2015 through 2017, large sample of tests.
• Some tests from end of 2014 and beginning of 2018.
• 166,165 records. 124,792 with a clear test result.
• Consistent test results for 87 of 88 counties.
• Few tests in Hamilton County (Cincinnati)

0.1 0.2 0.3 0.4 0.5 0.6 2015 2016 2017

Fraction of Heroin Samples Mixed with Synthetic Opioids

0.005 0.01 0.015 0.02 0.025 0.03 2015 2016 2017

Fraction of Meth mixed with Synthetic Opioids or Heroin

Meth Mixed with Synthetics Meth Mixed with Heroin

0.02 0.04 0.06 0.08 0.1 0.12 2015 2016 2017

Fraction of Cocaine Mixed with Synthetic Opioids or Heroin

Cocaine mixed with Synthetics Cocaine mixed with Heroin

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000

2015 2016 2017

Raw Counts of Non‐Prescription Opioid Samples

Heroin Fentanyl Carfentanil Fentanyl Analogs

0.2 0.4 0.6 0.8 1 Composition of Fentanyl Analog Samples 2015‐2017

2015 2016 2017

5 10 15 20 25 30 35 40 45

January March May July September November January March May July September November January March May July September 2015 2016 2017

Monthly Deaths

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths

Total Overdose Deaths Synthetic Opioid Overdose Deaths

5 10 15 20 25 30 35 40 45

January March May July September November January March May July September November January March May July September 2015 2016 2017

Monthly Deaths, Number of Positive Drug Tests

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts

Total Overdose Deaths Synthetic Opioid Overdose Deaths Fentanyl Positive Tests

5 10 15 20 25 30 35 40 45

January March May July September November January March May July September November January March May July September 2015 2016 2017

Monthly Deaths, Number of Positive Drug Tests

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts

Total Overdose Deaths Synthetic Opioid Overdose Deaths Fentanyl Positive Tests Carfentanil Positive Tests Other Fentanyl Analogs Positive Tests

5 10 15 20 25 30

January March May July September November January March May July September November January March May July September 2015 2016 2017

Monthly Deaths, Number of Positive Drug Tests

Butler County (Outside Cincinnati): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts

Total Overdose Deaths Synthetic Opioid Overdose Deaths Fentanyl Positive Tests Carfentanil Positive Tests Other Fentanyl Analogs Positive Tests

10 20 30 40 50 60 0.02 0.04 0.06 0.08 0.1 0.12 0.14 0.16 0.18 0.2 January March May July September November January March May July September November January March May July September 2015 2016 2017 Monthly Deaths Fraction of Positive Drug Tests

Cuyahoga County (Cleveland): 3‐Month Smoothed Overdose Deaths vs Drug Test Counts/Total Tests

Fentanyl Positive Tests Carfentanil Positive Tests Other Fentanyl Analogs Positive Tests Total Overdose Deaths Synthetic Opioid Overdose Deaths

The Value of Timely Data for Researchers and Policy Makers

• Drug test data is strongly correlated with deaths
• It gives us SOME information about what is in the drugs.
• There’s a real possibility of an early warning system to alert

drug consumers, first‐responders, and efficiently mobilize harm reduction services.