OVERDOSE FATALITY REVIEW Review of 2018 Tyra Scherer, MS, Injury - PowerPoint PPT Presentation

OVERDOSE FATALITY REVIEW Review of 2018 Tyra Scherer, MS, Injury Prevention Coordinator Tara Jimison, BSN, RN, Epidemiologist

OVERVIEW This presentation is an overview of unintentional overdose fatalities that THE GOAL OF THIS occurred in Clermont County in 2018. PRESENTATION IS TO PROVIDE A The data in this presentation is SNAPSHOT OF collected in partial fulfillment of the TRENDS RELATED grant requirements of the Injury TO OVERDOSE Prevention grant awarded to Clermont DEATHS IN County Public Health by the Ohio CLERMONT Department of Health. COUNTY.

DATA SOURCES DATA COLLECTION LIMITATIONS AUTOPSY REPORTS INFORMATION PROTECTED BY TOXICOLOGY SCREENS LAW (HEALTH HISTORY) SOME DATA POINTS NOT POLICE REPORTS SPECIFICALLY NOTED IN CLERK OF COURTS REPORTING AND THEREFORE NOT CAPTURED RECORDS LIMITED DATA ON SUBSTANCE ADDITIONAL PUBLIC SOURCES (LEGAL AND ILLEGAL) INFORMATION LIMITED INFORMATION AVAILABLE ONLINE PROVIDED WHEN CASES ARE TRANSPORTED OUT OF COUNTY

OVERDOSE FATALITIES BY YEAR NUMBER OF UNINTENTIONAL DRUG OVERDOSE DEATHS THAT OCCURRED IN CLERMONT COUNTY Source: Clermont County Coroner's Office 2018 68 Unintentional deaths 2017 76 Unintentional deaths 2016 83 Unintentional deaths; 1 Undetermined 2015 93 Unintentional deaths 2014 68 Unintentional deaths

OVERDOSE DEATHS BY MONTH, 2018 10 10 10 9 9 8 7 Number of Deaths 6 6 6 6 5 5 5 4 4 3 3 3 2 1 1 0 Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

OVERDOSE DEATHS BY MONTH, 2017-2018 15 10 Number of Deaths 5 0 Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. 2018 2017 ALTERNATIVELY, THERE WERE IN 2018 THERE WERE 11 FEWER 3 MORE FATALITIES DURING OVERDOSE FATALITIES DURING THE FIRST HALF OF THE YEAR THE SECOND HALF OF THE YEAR. COMPARED TO 2017.

PERCENTAGE OF DEATHS BY MONTH, 2015-2018 20 20 Percentage Percentage 10 11 0 1 J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 2018 2017 2017 2018 20 20 Percentage Percentage 10 10 0 0 J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 2016 2015 2016 2015

DEMOGRAPHICS & SOCIOECONOMICS

AGE SNAPSHOT, 2018 T S E D L O E G A R E V A T S E G 15-24 years (4.41%) 25-34 years (30.88%) 35-44 years (23.53%) N 45-54 years (26.47%) 55-64 years (13.24%) 65-74 years (0%) U 75+ years (1.47%) O (n=68) Y

AGE RANGE BY YEAR 35 30 25 Percentage 20 15 10 5 0 (n=69) (n=94) (n=82) (n=76) (n=68) 2014 2015 2016 2017 2018 <15 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75+ years

GENDER BY YEAR 75% 80 71% 67% 65% 70 59% 35% 60 50 41% Percentage 35% 40 33% 29% APPROXIMATELY 25% 30 1/3 OF THE CASES 20 WERE FEMALES IN 10 2018 (n=24) 0 2014 2015 2016 2017 2018 (n=68) (n=69) (n=94) (n=82) (n=76) Male Female

BREAKDOWN: AGE AND GENDER AVERAGE AGE 25 9 3 20 15 Number of Cases MALES 10 4 6 5 FEMALES 0 15-24.. 25-34.. 35-44.. 45-54.. 55-64.. 65-74.. 75+ yrs Males (n=44) Females (n=24)

MARITAL STATUS SNAPSHOT, 2018 49% 25% 82% 18% 7% OF CASES WERE SINGLE, DIVORCED, 1% SEPARATED, OR WIDOWED Single Married Divorced Widowed Separated (n=68)

EDUCATION SNAPSHOT Less than High School 28% (n=19) High School Graduate or GED 49% (n=33) Some College 9% (n=6) Associate's Degree 6% (n=4) Bachelor's Degree 6% (n=4) Masters's Degree 1% (n=1) Doctorate or Professional Degree 1% (n=1)

OCCUPATION STABLE HOUSING AT TIME OF DEATH 59% CASES HAD A KNOWN OCCUPATION AMONG 2018 CASES WITH A NOTED OCCUPATION 23% WERE FOOD (n=68) HANDLERS (n=9) Stable Housing (52.17%) Not Stable (incl. homeless) (7.61%) Unknown (40.22%) OTHER INDUSTRIES INCLUDED NO STABLE HOUSING INCLUDES CONSTRUCTION, MANUFACTURING, HOMELESS INDIVIDUALS, STAYING LANDSCAPING, SALES, HEALTHCARE, WITH FRIENDS, LIVING IN A CAR, AND COUCH SURFING. SERVICE, AND LAW

CRIMINAL HISTORY 70 THE MOST COMMON CHARGES ARE : 60 DRUG-RELATED (67%*) 50 THEFT OR ROBBERY- RELATED (60%*) Percentage 40 DUI OR OVI (28%*) 30 ASSAULT (22%*) 20 OTHER CHARGES INCLUDED 10 UNDERAGE CONSUMPTION, DRIVING UNDER SUSPENSION, 0 2014 2015 2016 2017 2018 (n=69) (n=94) (n=82) (n=76) (n=68) AND PROSTITUTION. Yes Unknown * Percent of cases with a criminal history (n=45)

HEALTH FACTORS

PHYSICAL ILLNESS 1 IN 4 CASES WERE OBESE (n=17) CASES IDENTIFIED OR 76% REPORTED HAVING A PHYSICAL ILLNESS THE MOST COMMON PHYSICAL ILLNESSES IDENTIFIED: DISEASES OF THE HEART 12% OF CASES REPORTED 47% CASES (n=32) CHRONIC PAIN, INCLUDING PAIN OF THE BACK, RESPIRATORY ILLNESSES SHOULDER, JAW, 31% CASES (n=21) ABDOMEN, AND KNEE (n=8) DISEASES OF THE LIVER 29% CASES (n=20)

MENTAL ILLNESS IS LIKELY MENTAL ILLNESS UNDER REPORTED DUE TO LACK OF ACCESS TO CASES IDENTIFIED OR 31% REPORTED A MENTAL ILLNESS MEDICAL HISTORY (n=21) (INCLUDING SUD DX BY AND LACK OF A PROFESSIONAL ONLY) PHYSICAL EVIDENCE IN AUTOPSY 10% OF CASES HAD A DOCUMENTED HISTORY Anxiety (13) Depression (9) SUD (6) OF SUICIDAL THOUGHTS Bipolar (4) ADHD (1) Other (3) OR ATTEMPTS (n=7) ** Some cases reported multiple mental illnesses.

SUBSTANCE ABUSE HISTORY 9% CASES IDENTIFIED OR 82% REPORTED A HISTORY OF CASES NOTED A HISTORY SUBSTANCE ABUSE (n=56) OF SUBSTANCE ABUSE TREATMENT (n=6) ACCORDING TO SAMHSA, AMONG 2018 CASES WITH A NOTED SUBSTANCE USE DISORDERS HISTORY OF SUBSTANCE ABUSE, OCCUR WHEN THE RECURRENT HEROIN WAS THE SUBSTANCE MOST USE OF ALCOHOL AND/OR REPORTED (71%, n=40) DRUGS CAUSES CLINICALLY AND FUNCTIONALLY SIGNIFICANT IMPAIRMENT, SUCH AS HEALTH 16% CASES REPORTED A HISTORY OF PROBLEMS, DISABILITY, AND FAILURE TO MEET MAJOR METHAMPHETAMINE ABUSE (n=9) RESPONSIBILITIES AT WORK, SCHOOL, OR HOME.

DEATH INVESTIGATION

LOCATION OF OVERDOSE 75% 60 OF DEATHS 51 OCCURRED AT THE 50 CASE'S RESIDENCE 40 OTHER LOCATIONS INCLUDE VARIOUS Number of Cases HOTELS AND A CAMPGROUND 30 20 10 21% OF CASES WERE 7 10 PRONOUNCED DEAD AT A HOSPITAL OR MEDICAL FACILITY 0 Location of Overdose (n=14) (includes DOA) Decendent's Home Friend's Home Other

SCENE OF DEATH ILLICIT DRUGS FOUND AT SCENE RX DRUGS FOUND AT SCENE Yes (51.50%) No (35.30%) Unknown (13.20%) Yes (56%) No (32%) Unknown (12%) 56% CASES WHERE DRUG PARAPHERNALIA WAS FOUND AT THE SCENE (n=38)

LIFE SAVING INTERVENTIONS/ATTEMPTS ALONE AT TIME OF DEATH MORE THAN 1/4 CASES RECEIVED CPR PRIOR TO 20 EMS ARRIVAL (28%) 9 21% CASES NOTED NALOXONE WAS 8 ADMINISTERED EITHER BY EMS, LAW 30 ENFORCEMENT, OR A BYSTANDER** No (13.43%) Yes (29.85%) Found alone (44.78%) Unknown (11.94%) **Naloxone administration data is gleaned from police reports not EMS reports, and therefore is not always noted .

TOXICOLOGY TYPE 100 90 91% 80 70 Percentage OF CASES' 60 50 TOXICOLOGY 40 RESULTS WERE 30 POLYSUBSTANCE 20 IN 2018 (n=62) 10 0 2014 2015 2016 2017 2018 n=94 n=82 n=76 n=22 n=69 Polysubstance Single Drug No Tox Screen

SUBSTANCES PRESENT BY YEAR 100 90 80 70 Percentage 60 50 40 30 20 10 0 (n=45) (n=69) (n=77) (n=64) (n=64) 2014 2015 2016 2017 2018 Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC NOTE: DATA LABELS INDICATE THE PERCENTAGE OF TOTAL CASES THAT WERE POSITIVE FOR EACH SPECIFIC SUBSTANCE

SUBSTANCES PRESENT, 2018 88% 90 80 70 60 Percentage 50 41% 33% 33% 40 30% 23% 30 17% 17% 13% 20 8% 10 0 2018 (n=64) Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC 1 7 % OF CASES' TOXICOLOGY RESULTS WERE POSITIVE FOR NALTREXONE (n=11)

OPIOIDS PRESENT 8 9 % Fentanyl and Related Drugs 78% OF CASES' TOXICOLOGY Heroin 33% RESULTS WERE Morphine/Codeine POSITIVE FOR 13% Oxycodone AT LEAST 8% ONE OPIOID Methadone 2% (n=64) Hydrocodone 5% Hydromorphone IN 2017, 50% OF CASES 3% Oxymorphone TOXICOLOGY RESULTS 3% WERE POSITIVE FOR Tramadol 3% HEROIN, WHEREAS ONLY Buprenorphine 33% WERE POSITIVE IN 2018 2% n=64

TRENDS

PERCENTAGE OF FENTANYL AND HEROIN RELATED DRUG OVERDOSE DEATHS BY YEAR, CLERMONT COUNTY RESIDENTS 80 70 60 50 40 30 20 10 0 2013 2014 2015 2016 2017 2018* Fentanyl Heroin INCLUDES CLERMONT COUNTY RESIDENTS WHO DIED DUE TO UNINTENTIONAL DRUG POISONING WHERE THE HEROIN INDICATOR OR FENTANYL AND ITS ANALOGUES ARE SPECIFICALLY NOTED ON THE DEATH CERTIFICATE *2018 Data is still preliminary and subject to change Source: Ohio Public Health Data Warehouse, 5/30/2019

MERCY HEALTH CLERMONT HOSPITAL EMERGENCY DEPARTMENT ENCOUNTERS DUE TO OPIATE OVERDOSE, BY QUARTER 175 153 Number of Opiate Overdose Encounters 82 78 88 70 62 51 42 39 0 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 Source: Mercy Health Clermont Hospital Emergency Department