OVERDOSE FATALITY REVIEW - ccphohio.org
Transcript of OVERDOSE FATALITY REVIEW - ccphohio.org
OVERDOSE FATALITY REVIEWReview of 2020
Megan Davish, MPH, Injury Prevention CoordinatorTyra Scherer, MS, Epidemiologist
This presentation is an overview ofunintentional overdose fatalities thatoccurred in Clermont County in 2020.
The data in this presentation iscollected in partial fulfillment of thegrant requirements of the InjuryPrevention grant awarded to theClermont County Public Health by theOhio Department of Health.
The goal of thispresentation is toprovide asnapshot oftrends related tooverdose deathsin ClermontCounty.
OVERVIEW
Autopsy reports
Toxicology screens
Police reports
Clerk of Courts records
Additional public information available online
Information protected by law(Health History)
Some data points notspecifically noted in reportingand therefore not captured
Limited data on substancesources (legal and illegal)
Limited information providedwhen cases are transportedout of the county.
DATA SOURCES DATA COLLECTIONLIMITATIONS
OVERDOSE FATALITIES BY YEAR Number of unintentional drug overdose deaths that occurred in Clermont County.
Source: Clermont County Coroner's Office
2020 63 Unintentional Deaths
2017 76 Unintentional Deaths
2019 54 Unintentional Deaths
2018 68 Unintentional Deaths
2016 83 Unintentional Deaths; 1 Undetermined
Jan.Feb.
Mar.
Apr.M
ayJune
JulyAug.
Sept.O
ct.Nov.
Dec.
8
6
4
2
0
OVERDOSE DEATHS BY MONTH, 2020 N
umbe
r of D
eath
s
4
34
3
66
7
6 6 6 6
5 5
In 2020 there were 29 overdosefatalities during the first half ofthe year, identical to 2019.
However, there were 9more fatalities during the
second half of the year.
OVERDOSE DEATHS BY MONTH, 2019-2020
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
8
6
4
2
0
Num
ber
of D
eath
s
2019 2020
PERCENTAGE OF DEATHS BY MONTH, 2017-2020
20182017
2019 2020
Perc
enta
gePe
rcen
tage
Perc
enta
gePe
rcen
tage
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
15%
10%
5%
0%
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
20%
15%
10%
5%
0% Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
15%
10%
5%
0%
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
15%
10%
5%
0%
DEMOGRAPHICS &SOCIOECONOMICS
AGE SNAPSHOT, 2020
19
40
69O
LDES
TAV
ERAG
EYO
UN
GES
T
45-5427%
25-3425.4%
35-4425.4%
55-6411.1%
15-249.5%
65-741.6%
n=(63)
AGE RANGE BY YEAR
2017 2018 2019 2020
40%
30%
20%
10%
0%
Perc
enta
ge
n= (63) n= (54) n= (68) n= (76)25-34 years 45-54 years 55-64 years 65-74 years15-24 years 35-44 years 75+ years
2017 (n=76) 2018 (n=68) 2019 (n=54) 2020 (n=63)
100
75
50
25
0
GENDER BY YEAR
30%
Less than 1/3 ofthe cases were
females in 2020.(n=19)
30%35%41%
65%65%59%
Perc
enta
ge35%
70%
Male Female
BREAKDOWN: AGE AND GENDER
15-24 25-34 35-44 45-54 55-64 65-74
20
15
10
5
0
Num
ber
of C
ases
Males (n=44) Females (n=19)
AVERAGE AGE
MALES
FEMALES
37
39
MARITAL STATUS SNAPSHOT, 2020
Single
47.6%
Married
23.8%
Divorced
20.6%
Widowed
6.3%
74%OF CASES WERE
SINGLE,DIVORCED,
WIDOWED, ORUNKNOWN.
EDUCATION SNAPSHOT Less than HighSchool 15.87% (n=10)High School Graduate or GED 57.14% (n=36)
Some College9.52% (n=6)
Associate's Degree6.35% (n=4)
Bachelor's Degree1.58% (n=1)
Master's Degree1.58% (n=1)
Doctorate or Professional Degree
1.58% (n=1)Unknown
6.35% (n=4)
OCCUPATION
27%OF CASES HAD AKNOWN OCCUPATION.
AMONG 2020 CASESWITH A NOTEDOCCUPATION, 52%WORKED LABORINTENSIVE JOBS.* (N=9)
INDUSTRIES INCLUDED:CONSTRUCTION, LANDSCAPING,
HEALTHCARE, SERVICE, ANDAUTOMOTIVE OPERATIONS.
*Labor intensive is defined as positions with a largephysical component.
STABLE HOUSING AT TIMEOF DEATH
Stable Housing (79.36%)Not Stable (incl. Homeless) (14.28%)
Unknown (6.35%)
NO STABLE HOUSING INCLUDES HOMELESSINDIVIDUALS, STAYING WITH FRIENDS, LIVING
IN A CAR, AND COUCH SURFING.
THE MOST COMMON CHARGES ARE:
DRUG-RELATED (68.75%)
DRIVING UNDER THE INFLUENCE OR
DUI/OVI (47.91%)
ASSAULT (37.5%)
THEFT OR ROBBERY-RELATED
(31.25%)
CRIMINAL HISTORY
OTHER CHARGES INCLUDED UNDERAGECONSUMPTION, DRIVING UNDERSUSPENSION, ENDANGERING CHILDREN,AND MORE.
*Percent of cases with a criminal history (n-48)
2016 2017 2018 2020
125
100
75
50
25
0
66%
34%
65%
35%
64%
33%
76%
23%
(n=76) (n=82) (n=68) (n=63) P
erce
nta
ge
Unknown Yes
HEALTH FACTORS
THE MOST COMMON PHYSICAL ILLNESSIDENTIFIED:
OF CASES IDENTIFIEDOR REPORTED HAVINGA PHYSICAL ILLNESS.
PHYSICAL ILLNESS
66%
DISEASES OF THE HEART 30% OF CASES (N=44)
RESPIRATORY ILLNESS 14% OF CASES (N=21)
DISEASES OF THE LIVER 8.84% OF CASES (N=13)
1 IN 4 CASES WEREOBESE.(N=17)*
7% OF CASES REPORTEDDIGESTIVE ILLNESSES SUCHAS DIVERTICULUTIS,ULCERS, ORHEMORRHAGIC GASTRITIS.
*Cases were identified as obese or BMI wascalculated. *Many cases had multiple comorbidities.
OF CASES IDENTIFIED ORREPORTED A MENTAL ILLNESS.(N=12) (INCLUDING SUD DX BYA PROFESSIONAL ONLY.)
DEPRESSION (5)ANXIETY (2)BIPOLAR (2)PTSD (1)ADHD (1)SUD (1)
MENTAL ILLNESS IS LIKELYUNDER REPORTED DUE TO
LACK OF ACCESS TO MEDICALHISTORY AND LACK OFPHYSICAL EVIDENCE IN
AUTOPSY.
3% OF CASES HAD ADOCUMENTED HISTORY OFSUCIDAL THOUGHTS ORATTEMPTS. (N=2).
MENTAL ILLNESS
19%
*Some cases reported multiple mental illnesses.
AMONG 2020 CASES WITH A NOTEDHISTORY OF SUBSTANCE ABUSE,HEROIN WAS THE SUBSTANCE MOSTREPORTED. (33.3%, N=15).
According to SAMHSA, substanceabuse disorders occur when therecurrent use of alcohol and/ordrugs causes clinically andfunctionally significantimpairment, such as healthproblems, disability, and failureto meet major responsibilities atwork, school, or home.
SUBSTANCE ABUSE HISTORY
71%
8.8% OF CASES REPORTED A HISTORYOF FENTANYL ABUSE (N=4).
OF CASES IDENTIFIED ORREPORTED A HISTORY OFSUBSTANCE ABUSE. (N=45)
11%OF CASES NOTED A
HISTORY OF SUBSTANCEABUSE TREATMENT.
(N=7)
DEATH INVESTIGATION
50
40
30
20
10
0
LOCATION OF OVERDOSE
Decedent's Home Friend's Home Other
76%OF DEATHS
OCCURRED AT THECASE'S RESIDENCE.
OTHER LOCATIONS INCLUDE VARIOUSHOTELS, BUSINESSES AND PROPERTIES.
12.6% OF CASES WERE PRONOUNCEDDEAD AT THE HOSPITAL OR MEDICALFACILITY.(N=8) (INCLUDES DOA).
Location of Overdose
48
4
11
SCENE OF DEATH
RX DRUGS FOUND AT SCENEYes (19%) No (73%) Unknown (8%)
ILLICIT DRUGS FOUND AT SCENEYes (38%) No (54%) Unknown (8%)
57% OF CASES WHERE DRUG PARAPHERNALIAWAS FOUND AT THE SCENE. (n=36)
Yes (27%) No (58%) Unknown (11%)
CASES NOTED NALOXONE WASADMINISTERED EITHER BY EMS,LAW
ENFORCEMENT OR A BYSTANDER.** (N=11).
LIFE SAVING INTERVENTIONS/ATTEMPTS
ALONE AT TIME OF DEATH
17%
MORE THAN 1/4 OFCASES RECEIVED CPR
(38%) (N=24).
**Naloxone administration data is gleaned from police reports not EMS reports, and therefore is not always noted.
2016 2017 2018 2020
100%
75%
50%
25%
0%
TOXICOLOGY TYPE
OF CASES'TOXICOLOGYRESULTS WEREPOLYSUBSTANCEIN 2020.
(N=52)
96%
**96% of cases were a toxicology screen was performed(n=54, 85.7% of total cases).
Polysubstance Single Drug No Tox Screen
SUBSTANCES PRESENT BY YEAR
NOTE: DATA LABELS INDICATE THE PERCENTAGE OF TOTAL CASES THAT WERE POSITIVE FOR EACH SPECIFIC SUBSTANCE
2016 2017 2018 2020
100%
75%
50%
25%
0%
(n=54) (n=77) (n=64) (n=62)
Perc
enta
ge
Marijuana Cocaine Methamphetamine Heroin Other opioidsAlcohol Sedatives
Other RX OTC Anti-Depressants
SUBSTANCES PRESENT, 2020
100%
75%
50%
25%
0%
22%
42%26%
18% 24%
89%
39% 35%28%
1.8%
Perc
enta
ge
2020 (n=54) Marijuana Cocaine Methamphetamine Heroin Fentanyl Other opioidsAlcohol Sedatives
Other RX OTC
OF CASES TOXICOLOGY RESULTS WERE POSITIVEFOR NALTREXONE (N= 10)18%
3.7%
Anti-Depressants
SUBSTANCES PRESENT BASED ON LOCATIONOPIOIDS STIMULANTS SEDATIVES
OPIOIDS PRESENT
OF CASES'TOXICOLOGY RESULTSWERE POSITIVE FORAT LEAST ONEOPIOID.(N=54)
89%
IN 2019, 90% OFCASES TOXICOLOGY
RESULTS WEREPOSITIVE FOR
FENTANYL, SIMILARTO THE 89% IN 2020.
Fentanyl
Heroin
Codeine
Oxycodone
Methadone
Hydrodone
Oxymorphone
Tramadol
Buprenorphine
89%
24%
1.8%
1.8%
3.7%
3.7%
1.8%
5.5%
9%
n=54
TRENDS
CLERMONT COUNTY ISRANKED 11TH IN THESTATE OF OHIO FOR UNINTENTIONALDRUG OVERDOSEDEATHS FROM 2010-2019.
11TH
*Source Ohio Department of Health, 2019 Drug Overdose Data:General Findings
UNINTENTIONAL OVERDOSE DEATH RATE BYCOUNTY, ADJUSTED BY AGE 2014-2019
Source: Ohio Department of Health, Bureau of Vital Statistics, U.S. Census Bureau (Vintage 2019 population estimates). Analysis: ODH Violence and Injury Prevention Section.Includes Ohio residents who died due to unintentional drug poisoning (underlying cause of death ICD-10 codes x40-X44). County is based on county of residence.
2015 2016 2017 2018 2019 2020**
100%
75%
50%
25%
0%
PERCENTAGE OF FENTANYL AND HEROIN RELATED DRUG OVERDOSE DEATHSBY YEAR,
CLERMONT COUNTY RESIDENTS
INCLUDES CLERMONT COUNTY RESIDENTS WHO DIED DUE TO UNINTENTIONAL DRUG POISONINGWHERE THE HEROIN IDICATOR OR FENTANYL AND ITS ANALOGUES ARE SPECIFCIALLY NOTED ONTHE DEATH CERTIFICATE.
*2020 Data is still preliminary and subject to change Source Ohio Public Health Data Warehouse, 5/21/2020
Fentanyl Heroin
Q1 2020 Q2 2020 Q3 2020 Q4 2020 Q1 2021 Q2 2021
150
100
50
0
91
134
120108
91
55
Num
ber o
f Nal
oxon
e Ad
min
istr
atio
nsNALOXONE ADMINISTRATIONS BY OHIO EMS PROVIDERS,
CLERMONT COUNTY
** 83.4% of Transporting Ohio EMS Agencies Reporting.Source: Ohio Emergency Medical Services, Naloxone Administration by County.
NALOXONE ADMINISTRATIONRATE BY ZIP CODE,
CLERMONT COUNTY 2020
**85.5% of Transporting Ohio EMSAgencies Reporting
Source: Ohio Emergency Medical Services, Naloxone Administration by County.
NALOXONEADMINISTRATIONRATE BY ZIP CODE,
CLERMONT COUNTY2020
**85.5% of TransportingOhio EMS Agencies
Reporting
Source: Ohio Emergency Medical Services,Naloxone Administration by County.
Rates were calucated with the population
estimated in 2019. If this data was not available,the 2010 US Census Demographic profile was
used.
NALOXONE ADMINISTRATION RATE COMPARED TO INCIDENCE OF OVERDOSEFATALITIES BY ZIP CODE, CLERMONT COUNTY 2020
Naloxone Administration Rates Overdose Fatality Rates Overdose Fatality and Naloxone
Administration Rates
2015 2016 2017 2018 2019 2020
300
200
100
0
OPIOID PRESCRIPTIONS DISPENSEDBY YEAR, CLERMONT COUNTY
2015 2016 2017 2018 2019 2020
75
50
25
0
THE TOTAL NUMBER OFPRESCRIBED OPIOID DOSESDISPENSED IN CLERMONTCOUNTY CONTINUES TODECREASE, WITH A 4.6%DECREASE BETWEEN 2015AND 2019.
DURING THE SAME TIMEFRAME, THERE WAS A 43%
INCREASE IN THE TOTALNUMBER OF STIMULANT
DOSES DISPENSED.
258.2 263.2 253.8 254.6 246.1
136.3
Dos
es p
er p
atie
nt**
DOSES PER PATIENT
DOSES PER CAPITA
Dos
es p
er C
apita
**
***2020 Reporting the first quarter** Solid Oral Doses*Population Data from 2010 Ohio Department of DevelopmenttSource: Ohio Automated Rx Reporting System
66.9 62.7 58.4
50.5 45.3
9.6
THE SYRINGE SERVICES PROGRAM CONTINUED TO SERVE CLERMONT COUNTY RESIDENTS.
2020 ACCOMPLISHMENTS
DESPITE THE COVID-19 PANDEMIC, SERVICESACROSS THE SPECTRUM OF TREATMENTCONTINUED TO SERVE CLIENTS ACROSS THECOUNTY.
PROJECT D.A.W.NKITS DISTRIBUTED
IN CLERMONTCOUNTY IN 2020
15,653 SYRINGES EXCHANGED351 VISITS BY CLERMONT COUNTY RESIDENTS254 DOSES OF NALOXONE DISTRIBUTED
407
PROJECTD.A.W.N.
CLERMONT COUNTY RECOVERY CENTER AND CHILD PROTECTIVE SERVICES BEGAN COORDINATING CARE FOR HIGH-RISK FAMILIES.
INTERVENTIONS TO CONSIDER
QUESTIONS
TYRA SCHERER, MS, [email protected]
MEGAN DAVISH, MPH, INJURY PREVENTION [email protected]
This work is funded either in whole or in part by a grand awared by the Ohio Department of Health, Office of Health Improvement and Wellness, Violence and Injury Prevention Section and as a subaward of a grant issued by Preventative Health and Health Services BLock Grant under the Injury Prevention Program Grant. Grant award number r 6NBO1OT009137-01-03, and CFDA number 93.758