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.

• T he 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.

Drugs Involved in Ohio Overdose Deaths, 1999 to 2017 3500 3000 Prescription Opioids 2500 Heroin 2000 Cocaine 1500 Other Synthetic Narcotics (Fentanyl, Carfentanil, etc.) 1000 Methamphetamines 500 0 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

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)

Fraction of Heroin Samples Mixed with Synthetic Opioids 0.6 0.5 0.4 0.3 0.2 0.1 0 2015 2016 2017

Fraction of Meth mixed with Synthetic Opioids or Heroin 0.03 0.025 0.02 0.015 0.01 0.005 0 2015 2016 2017 Meth Mixed with Synthetics Meth Mixed with Heroin

Fraction of Cocaine Mixed with Synthetic Opioids or Heroin 0.12 0.1 0.08 0.06 0.04 0.02 0 2015 2016 2017 Cocaine mixed with Synthetics Cocaine mixed with Heroin

Raw Counts of Non‐Prescription Opioid Samples 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 2015 2016 2017 Heroin Fentanyl Carfentanil Fentanyl Analogs

Composition of Fentanyl Analog Samples 2015‐2017 1 0.8 0.6 0.4 0.2 0 2015 2016 2017

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths 45 40 Total Overdose 35 Deaths Monthly Deaths 30 25 20 15 Synthetic Opioid Overdose 10 Deaths 5 0 January March May July September November January March May July September November January March May July September 2015 2016 2017

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts 45 Monthly Deaths, Number of Positive Drug Total Overdose 40 Deaths 35 30 25 Synthetic Opioid 20 Overdose Deaths Tests 15 10 5 Fentanyl Positive 0 Tests January March May July September November January March May July September November January March May July September 2015 2016 2017

Summit County (Akron): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts Total Overdose 45 Deaths Monthly Deaths, Number of Positive Drug 40 35 Synthetic Opioid 30 Overdose Deaths 25 20 Fentanyl Positive Tests Tests 15 10 5 Carfentanil Positive Tests 0 January March May July September November January March May July September November January March May July September Other Fentanyl Analogs Positive Tests 2015 2016 2017

Butler County (Outside Cincinnati): 3‐Month Smoothed Monthly Overdose Deaths vs Drug Test Counts Total Overdose 30 Monthly Deaths, Number of Positive Drug Deaths 25 Synthetic Opioid Overdose Deaths 20 15 Fentanyl Positive Tests Tests 10 Carfentanil Positive 5 Tests 0 January March May July September November January March May July September November January March May July September Other Fentanyl Analogs Positive Tests 2015 2016 2017

Cuyahoga County (Cleveland): 3‐Month Smoothed Overdose Deaths vs Drug Test Counts/Total Tests 0.2 60 Fentanyl Positive Fraction of Positive Drug Tests 0.18 Tests 50 0.16 Monthly Deaths 0.14 40 Carfentanil Positive 0.12 Tests 0.1 30 0.08 Other Fentanyl 20 0.06 Analogs Positive 0.04 10 Tests 0.02 Total Overdose 0 0 Deaths January March May July September November January March May July September November January March May July September Synthetic Opioid Overdose Deaths 2015 2016 2017

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.