OVERDOSE FATALITY REVIEW Review of 2017 Tyra Scherer, MS, Injury - - PowerPoint PPT Presentation

OVERDOSE FATALITY REVIEW

Review of 2017 Tyra Scherer, MS, Injury Prevention Coordinator Tara Jimison, BSN, RN, Epidemiologist

The data in this presentation is collected in partial fulfillment of the grant requirements of the Injury Prevention grant awarded to Clermont County Public Health by the Ohio Department of Health. This presentation is an overview of unintentional and undetermined overdose fatalities that occurred in Clermont County in 2017.

OVERVIEW

THE GOAL OF THIS PRESENTATION IS TO PROVIDE A SNAPSHOT OF TRENDS RELATED TO OVERDOSE DEATHS IN CLERMONT COUNTY.

DATA COLLECTION LIMITATIONS

DATA SOURCES

LIMITED INFORMATION PROVIDED WHEN CASES ARE TRANSPORTED OUT OF COUNTY

AUTOPSY REPORTS

LIMITED DATA ON SUBSTANCE SOURCES (LEGAL AND ILLEGAL)

TOXICOLOGY SCREENS

SOME DATA POINTS NOT SPECIFICALLY NOTED IN REPORTING AND THEREFORE NOT CAPTURED

POLICE REPORTS

INFORMATION PROTECTED BY LAW (HEALTH HISTORY)

CLERK OF COURTS RECORDS ADDITIONAL PUBLIC INFORMATION AVAILABLE ONLINE

OVERDOSE FATALITIES BY YEAR

2014 2015 2016 2017

68 Unintentional deaths 93 Unintentional deaths 83 Unintentional deaths; 1 Undetermined 76 Unintentional deaths

Source: Clermont County Coroner's Office

NUMBER OF UNINTENTIONAL AND UNDETERMINED DRUG OVERDOSE DEATHS THAT OCCURRED IN CLERMONT COUNTY

OVERDOSE DEATHS BY MONTH, 2017

3 3 6 6 7 9 8 7 6 5 3 13 5 10 15 Jan. Feb. Mar. Apr. May June July

• Aug. Sept. Oct.
• Nov. Dec.

Number of Deaths

OF 2017 DRUG OVERDOSE DEATHS OCCURRED IN DECEMBER (n=13)

14%

PERCENTAGE OF DEATHS BY MONTH, 2014-2017

2017

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 10 20

2016

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 10 20

2015

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 10 20

2014

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D.. 10 20

2017 2016 2014 2015

Percentage Percentage Percentage Percentage

DEMOGRAPHICS

GENDER BY YEAR

Male Female

75% 67% 71% 59% 25% 33% 29% 41% 2014 2015 2016 2017 10 20 30 40 50 60 70 80

OVERDOSE DEATHS THAT OCCURRED IN 2017 WERE WOMEN

2 / 5

HISTORICALLY, THIS IS THE CLOSEST GAP BETWEEN THE PERCENTAGES OF MALES AND FEMALES

(n=69) (n=94) (n=82) (n=76) Percentage

AGE RANGE BY YEAR

<15 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75+ years

5 10 15 20 25 30 35 2014 2015 2016 2017

Percentage (n=69) (n=94) (n=82) (n=76)

15-24 years (5.26%) 25-34 years (26.32%) 35-44 years (31.58%) 45-54 years (18.42%) 55-64 years (18.42%)

AGE SNAPSHOT, 2017

YOUNGEST OLDEST AVERAGE

(n=76)

FEMALES

Males (n=45) Females (n=31)

5 10 15 20 25 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs

BREAKDOWN: AGE AND GENDER

AVERAGE AGE

MALES

43 39

Number of Cases

MARITAL STATUS SNAPSHOT

Single Married Divorced Widowed Unknown

47% 29% 18% 4% 1%

80%

OF 2017 CASES WERE SINGLE, DIVORCED, OR WIDOWED

(n=76)

EDUCATION SNAPSHOT

Unknown 1% (n=1) College Graduate 3% (n=2) High School Graduate

• r GED 74% (n=56)

Less than High School 22% (n=17)

CRIMINAL HISTORY

Yes Unknown

2014 2015 2016 2017 10 20 30 40 50 60 70

THE MOST COMMON CHARGES ARE :

** Percent of cases with a criminal history (n=50)

THEFT OR ROBBERY-RELATED (74%**) DRUG-RELATED (70%**)

(n=69) (n=94) (n=82) (n=76) Percentage

HEALTH FACTORS

1 IN 3 CASES HAD A CHRONIC ILLNESS OF THE LIVER INCLUDING HEPATITIS C AND CIRRHOSIS OF THE LIVER (n=24)

75%

PHYSICAL ILLNESS

CASES IDENTIFIED OR REPORTED HAVING A PHYSICAL ILLNESS THE MOST COMMON PHYSICAL ILLNESSES IDENTIFIED: DISEASES OF THE HEART 47% CASES (n=36) RESPIRATORY ILLNESSES 17% CASES (n=13) DISEASES OF THE LIVER 32% CASES (n=24) 13% OF CASES REPORTED ACUTE ILLNESS PRIOR TO DEATH (n=10) THIS IS A 116% INCREASE FROM 2016 (n=12)

16%

MENTAL ILLNESS

CASES IDENTIFIED OR REPORTED A MENTAL ILLNESS (n=12) (NOT INCLUDING SUD)

Depression (4) Anxiety (4) Bipolar (5) PTSD (2) Other (5)

11% OF CASES HAD A HISTORY OF SUICIDAL THOUGHTS OR ATTEMPTS (n=8)

** Some cases reported multiple mental illnesses.

MENTAL ILLNESS IS LIKELY UNDER REPORTED DUE TO LACK OF ACCESS TO MEDICAL HISTORY AND LACK OF PHYSICAL EVIDENCE IN AUTOPSY

84%

SUBSTANCE ABUSE HISTORY

CASES IDENTIFIED OR REPORTED A HISTORY OF SUBSTANCE ABUSE (n=64)

16%

CASES NOTED A HISTORY OF SUBSTANCE ABUSE TREATMENT (n=12)

AMONG 2017 CASES WITH A NOTED HISTORY OF SUBSTANCE ABUSE, HEROIN WAS THE SUBSTANCE MOST REPORTED (77%, n=49)

ACCORDING TO SAMHSA, SUBSTANCE USE DISORDERS OCCUR WHEN THE RECURRENT USE OF ALCOHOL AND/OR DRUGS CAUSES CLINICALLY AND FUNCTIONALLY SIGNIFICANT IMPAIRMENT, SUCH AS HEALTH PROBLEMS, DISABILITY, AND FAILURE TO MEET MAJOR RESPONSIBILITIES AT WORK, SCHOOL, OR HOME.

14% CASES REPORTED A HISTORY OF PRESCRIPTION DRUG ABUSE (n=11)

DEATH INVESTIGATION

Decendent's Home Friend's Home Hospital / Nsg Home Car Other

44 9 17 2 4 10 20 30 40 50 2017 (n=76)

OTHER LOCATIONS INCLUDE TWO HOTELS, A HOMELESS SHELTER, AND A BUSINESS

OF DEATHS OCCURRED AT THE CASE'S RESIDENCE

58%

LOCATION OF DEATH

Number of Cases

Sleeping (9%) Driving (1%) Other (65%) Unknown (25%)

ACTIVITY AT TIME OF DEATH

Yes (45%) No (38%) Unknown (17%)

ILLICIT DRUGS FOUND AT SCENE

Yes (45%) No (31%) Unknown (24%)

RX DRUGS FOUND AT SCENE

39%

CASES WHERE DRUG PARAPHERNALIA WAS FOUND AT THE SCENE

**Activity at time of death is placed in relation to where the case was found

No (n=12) Yes (n=46) Unknown (n=18)

61% 24% 16%

LIFE SAVING INTERVENTIONS/ATTEMPTS

ALONE AT TIME OF DEATH MORE THAN 1/3 CASES RECEIVED CPR PRIOR TO EMS ARRIVAL (36%)

CASES NOTED NALOXONE WAS ADMINISTERED EITHER BY EMS OR A BYSTANDER**

18%

**Naloxone administration data is gleaned from police reports not EMS reports, and is not always noted

TOXICOLOGY TYPE

Polysubstance Single Drug No Tox Screen

2014 2015 2016 2017 10 20 30 40 50 60 70 80 90 100

n=69 n=94 n=82 n=76

OF CASES' TOXICOLOGY SCREEN RESULTS WERE POLYSUBSTANCE IN 2017** (n=64; 63 autopsy, 1 hospital)

100%

**100% of cases where a toxicology screen was performed (n=64, 84%

• f total cases)

Percentage

SUBSTANCES PRESENT BY YEAR

Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC

10 20 30 40 50 60 70 80 90 100 2014 2015 2016 2017

(n=45) (n=69) (n=77) (n=64)

NOTE: DATA LABELS INDICATE THE NUMBER OF CASES WHERE SUBSTANCE WAS PRESENT, THEREFORE NUMBERS MAY ADD UP TO MORE THAN THE TOTAL NUMBER OF CASES

Percentage

SUBSTANCES PRESENT, 2017

Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC

17% 31% 30% 34% 50% 95% 6% 33% 20% 13% 10 20 30 40 50 60 70 80 90 100 2017 (n=64)

BETWEEN 2016 AND 2017 THERE WAS A 580% INCREASE IN THE PRESENCE OF METHAMPHETAMINE OTHER PRESCRIPTION MEDICATIONS PRESENT IN TOXICOLOGY SCREENS WERE GABAPENTIN AND AMPHETAMINE

Percentage

(2017 n=22, 34%; 2016 n=4, 5%)

OPIOIDS PRESENT

84% Fentanyl and Related Drugs 50% Heroin 30% Morphine/Codeine 14% Oxycodone 5% Methadone 5% Hydrocodone 2% Buprenorphine 11% Other

9 5 %

OF CASES' TOXICOLOGY SCREENS WERE POSITIVE FOR AT LEAST ONE OPIOID (n=60)

n=64

OTHER OPIOIDS PRESENT IN CASES' TOXICOLOGY SCREENS INCLUDE OXYMORPHONE, DIHYDROCODEINE, AND NALTREXONE

TRENDS

Fentanyl Heroin

2010 2011 2012 2013 2014 2015 2016 2017 10 20 30 40 50 60 70 80

Source: Ohio Public Health Data Warehouse, 5/17/18

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

PERCENTAGE OF FENTANYL AND HEROIN RELATED DRUG OVERDOSE DEATHS BY YEAR, CLERMONT COUNTY RESIDENTS

Percentage

82 232 195 138 Q1 Q2 Q3 Q4 50 100 150 200 250 78 153 82 70 Q1 Q2 Q3 Q4 88 175

MERCY HEALTH CLERMONT HOSPITAL EMERGENCY DEPARTMENT ENCOUNTERS DUE TO OPIATE OVERDOSE, BY QUARTER, 2017 NALOXONE ADMINISTRATION BY OHIO EMS PROVIDERS, CLERMONT COUNTY, 2017**

**72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone Administration by County Source: Mercy Health Clermont Hospital Emergency Department

Number of Naloxone Administrations Number of Opiate Overdose Encounters

**72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone Administration by Zip Code

NALOXONE ADMINISTRATION BY OHIO EMS PROVIDERS BY ZIP CODE, CLERMONT COUNTY, 2017**

EPICENTER SYNDROMIC SURVEILLANCE

EMERGENCY DEPARTMENT VISITS AMONG CLERMONT COUNTY RESIDENTS, ALL FACILITIES, 2017

953

INDIVIDUALS PRESENTING TO MERCY CLERMONT HOSPITAL EMERGENCY DEPARTMENT , 2017

563

EPICENTER COLLECTS EMERGENCY DEPARTMENT CHIEF COMPLAINT DATA FROM 180 HOSPITALS AND URGENT CARE FACILITIES ACROSS OHIO IN REAL TIME AND CLASSIFIES THEM INTO SYMPTOM AND SYNDROME CATEGORIES. CHIEF COMPLAINTS FROM THE TRAUMATIC INJURY - DRUGS CLASSIFIER ARE ANALYZED FOR OVERDOSE SURVEILLANCE.

**Data was analyzed and excludes overdose encounters with mention of Tylenol, insulin, ibuprofen, etc. Suicides or intentional injuries are also excluded.

EMERGENCY DEPARTMENT VISITS DUE TO DRUG OVERDOSE , 2017**

OF CASES HAD CONTACT WITH A MERCY EMERGENCY DEPARTMENT FOR PAIN OR AN OVERDOSE WITHIN ONE YEAR OF THEIR DEATH (n=38)

1 CASE VISITED MERCY ED'S 63 TIMES IN THE YEAR PRIOR TO DEATH (60 FOR PAIN, 3 OD)

**Data was provided by Mercy Health Clermont Hospital Emergency Department

AMONG THE 2017 CASES, THERE WERE 110 VISITS FOR PAIN AND 31 VISITS FOR OVERDOSE AT MERCY EMERGENCY DEPARTMENTS WITHIN ONE YEAR OF DEATH 32 OF THE 76 CASES HAD NO CONTACT WITH MERCY ED'S WITHIN ONE YEAR OF THEIR DEATH FOR PAIN OR OD MERCY ED'S HAD NO RECORD FOR 6 OF THE CASES

MERCY EMERGENCY DEPARTMENT INTERACTIONS WITHIN ONE YEAR OF DEATH

5 %

OPIOID PRESCRIPTIONS DISPENSED BY YEAR, CLERMONT COUNTY

268.3 261.6 258.2 263.2 253.8 2013 2014 2015 2016 2017 250 263 275

DOSES PER PATIENT

75.6 71.0 66.9 62.7 58.4 2013 2014 2015 2016 2017 40 60 80

DOSES PER CAPITA

**Solid Oral Doses *Population Data from 2010 Ohio Department of Development

BETWEEN 2013-2017 THERE HAS BEEN A 22.79% DECREASE IN TOTAL DOSES DISPENSED IN CLERMONT COUNTY.

Doses per Patient** Doses per Capita**

Source: Ohio Automated Rx Reporting System

ACCOMPLISHMENTS TO DATE

OUTREACH TO HEALTHCARE PROVIDERS AND NON TRADITIONAL PARTNERS TO HELP EDUCATE THE COMMUNITY ON SUBSTANCE MISUSE PREVENTION INDIVIDUALS WERE REFERRED TO TREATMENT DURING QRT RUNS IN 2017

133

QUICK RESPONSE TEAMS FORMED IN UNION TOWNSHIP AND THE CLERMONT COUNTY SHERIFF'S OFFICE IN 2017 MERCY HEALTH CLERMONT HOSPITAL REFERRED 239 INDIVIDUALS TO TREATMENT FOR DRUG USE DURING SBIRT SCREENINGS IN 2017 VOCATIONAL OPPORTUNITIES FOR PEOPLE IN RECOVERY INCLUDING CASC AND GCB VOCATIONAL PROGRAM

ACCOMPLISHMENTS TO DATE

IMPLEMENTATION OF A SYRINGE SERVICES PROGRAM IN CLERMONT COUNTY 1,381 LBS COLLECTED IN PERMANENT DRUG DROP BOXES IN 2017 FITZGERALD'S PHARMACY (WILLIAMSBURG) ADOPTED A PHYSICIAN APPROVED PROTOCOL TO DISPENSE NALOXONE WITHOUT A PRESCRIPTION PROJECT D.A.W.N. KITS DISTRIBUTED IN CLERMONT COUNTY IN 2017

353

P R O J E C T D . A . W . N .

LIVE STORIES OVERDOSE DATA TOOL PROVIDES NUMBER OF 911 CALLS AND ED VISITS DAILY

INTERVENTIONS TO CONSIDER

WORKING WITH THE FAITH BASED COMMUNITY TO ASSIST WITH PREVENTION EFFORTS AND CONNECTING INDIVIDUALS TO AVAILABLE RESOURCES IMPORTANCE OF CALLING 911 IF SOMEONE IS OVERDOSING EVEN IF NARCAN IS BEING ADMINISTERED INCREASING AWARENESS AND OUTREACH EFFORTS DURING END OF THE YEAR AND HOLIDAY SEASON OTHER SUGGESTIONS FOR INTERVENTIONS OR EFFORTS ALREADY IN PLACE? ADDRESSING CHILDHOOD TRAUMA DUE TO SUBSTANCE USE DISORDER; 28 CHILDREN LOST A MOTHER OR FATHER WHO IS INCLUDED IN THIS REPORT (SOURCES: OBITUARIES, POLICE REPORTS)

QUESTIONS

TARA JIMISON, BSN, RN, EPIDEMIOLOGIST TYRA SCHERER, MS, INJURY PREVENTION COORDINATOR

TJIMISON@CLERMONTCOUNTYOHIO.GOV TSCHERER@CLERMONTCOUNTYOHIO.GOV

This work was supported by the Cooperative Agreement number, 6 NB01OT009137-01-02, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.