Montgomery County, Ohio

OPIATE EPIDEMIC

Board of County Commissioners

City of Dayton Commission

Working Session

April 27, 2016

Overview of opiate epidemic data

Community health improvement plan

PRESENTATION

THE OPIATE EPIDEMIC

4,9515,382 5,118

0

1,000

2,000

3,000

4,000

5,000

6,000

2013 2014 2015

Number of jail bookingsMontgomery County, 2013-2015

7,145

7,862 7,900

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2013 2014 2015

Number of drug chargesMontgomery County, 2013-2015

70.1%

29.1%

0.6%

0.2%

Jail bookings by race Montgomery County, 2013-2015

White

Black

Other*

Unknown

30.8%

69.2%

Jail bookings by sex Montgomery County, 2013-2015

Female

Male

Density of Jail Bookings

by Home Location

Montgomery County, 2013-2015

RESIDENCE MATTERS

Density

low

medium

high

Prescription

Opioids

54%

69%

41% 41%46%

31%

59% 59%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2012 2013 2014 2015

Accidental poisonings by sex

Female Male

4142

111

70

0

20

40

60

80

100

120

2012 2013 2014 2015

Emergency department and inpatient visits Accidental poisoning

by other opiates and

related narcotics

hospital visits

Applies to: codeine, meperidine,

morphine, and opium

Montgomery County,

2012-2015

Rate of Other Opiates and

Related Narcotics

Accidental Poisoning

Hospital Visits

By Patient’s Home Location

Montgomery County, 2015

Rate per 100,000 people

0.0 - 3.3

3.4 - 9.6

9.7 - 22.4

22.5 - 32.6

32.7 - 45.6

45005 4500545066

45309

45315

45322

45325

45327

45337

45342

45344

45345

4535445371

45377

45381

4540245403

45404

45405

45406

45409

45410

4541445415

45416

45417

4541845418

4541945420

45424

45424

45426

45428

45429

45431

45432

45433

45439

45440

45449

45458

45459

Sources: Esri, HERE, DeLorme, TomTom, Intermap, increment P Corp., GEBCO,USGS, FAO, NPS, NRCAN, GeoBase, IGN, Kadaster NL, Ordnance Survey, EsriJapan, METI, Esri China (Hong Kong), swisstopo, MapmyIndia, © OpenStreetMapcontributors, and the GIS User Community

Heroin

Nationally, approximately 435,000

people were regular (past-month)

users of heroin.

Among people between the ages of

12 and 49, the average age of first

use was 28.

HEROIN OVERDOSES

4870

330

293

8 14

4827

0

50

100

150

200

250

300

350

2012 2013 2014 2015

Heroin accidental poisoning by hospital visit type Montgomery County, 2012-2015

Emergency Room Inpatient

HEROIN OVERDOSES

34%

42%39%

41%

66%

58%61%

59%

0%

10%

20%

30%

40%

50%

60%

70%

2012 2013 2014 2015

Hospital visits for heroin accidental poisoning by sex Montgomery County, 2012-2015

Female Male

HEROIN OVERDOSES

0

50

100

150

200

250

0-14 15-19 20-24 25-34 35-44 45-54 55-64 65 +

Ra

te p

er

100

,00

0

Rate of hospital visits for heroin accidental poisoning by age Montgomery County, 2012-2015

2012 2013 2014 2015

Rate per 100.000 people

0.0 - 6.6

6.7 - 33.6

33.7 - 69.7

69.8 - 120.0

120.1 - 193.3

Rate of Heroin Accidental

Poisoning Hospital Visits

By Patient’s Home

Location

Montgomery County, 2015

UNINTENTIONAL DRUG OVERDOSE DEATHS

NATIONAL

In many deaths, multiple drugs are present making

it difficult to identify which drug or drugs caused the death.

UNINTENTIONAL DRUG OVERDOSE DEATHS

OHIO

Lake

Erie Lorain

Ashtabula

Ross

Cuyahoga

Stark

Wood

Knox

Lucas

Darke

Pike

Licking

Scioto

Ottawa

Adams

Allen

Huron

Wayne

Gallia

Butler

Clark

Perry

Brown

Logan

Trumbull

Union

Seneca

Athens

Hardin

Henry

Meigs

Noble

Miami

Mercer

Franklin

Fulton

Belmont

Preble

Portage

Vinton

Putnam

Fairfield

Highland

Hancock

Carroll

Shelby

Monroe

Marion

Muskingum

Clinton

Medina

Richland

Holmes

Summit

Warren

Greene

Morgan

Madison

Morrow

Guernsey

FayetteWashington

Ashland

Pickaway

Coshocton

Geauga

Hocking

Williams

Jackson

Paulding

HarrisonDelaware

Tuscarawas

Defiance

Auglaize

Wyandot

Lawrence

Hamilton

Van WertColumbiana

Jefferson

Crawford

Mahoning

Sandusky

Champaign

Clermont

Montgomery

15.8

Death Rate per 100,000 persons

3.5 - 9.3

9.4 - 13.5

13.6 - 17.8

17.9 - 24.6

24.7 - 35.3

Fewer than 10 deaths

Unintentional Drug Overdose Deaths

2009-2014

UNINTENTIONAL DRUG OVERDOSE DEATHS

Drug overdose deaths have increased 104% from 2010 to 2015

Demographic Characteristics of Overdose Deaths in 2014

Average Age – 41.2 years Sex – Male (62%)

Level of Education – HS Graduate (73%) Race – White (89%)

Marital Status – Singe (44%), Divorced (31%), and Married (21%)

127 130

162

226

264 259

0

50

100

150

200

250

300

2010 2011 2012 2013 2014 2015

Case

s

Accidental Drug Overdose Deaths in Montgomery County 2010-2015

UNINTENTIONAL DRUG OVERDOSE DEATHS2014

Male62%

Female38%

White89%

Black11%

Single45%

Married21%

Divorced32%

Widowed2%

Sex Race

Marital Status

UNINTENTIONAL DRUG OVERDOSE DEATHS

28%26%

3%

58%

9%

44%

27%

52%

29%31%

4%

48%

41%37%

16%

51%

0%

10%

20%

30%

40%

50%

60%

70%

Alcohol Cocaine Methamphetamine Heroin IllicitFentanyl

Prescription Opioids

Anti-Depressants Benzodiazepines

2013 2014

Montgomery County: In 2013 and 2014, benzodiazepines and heroin

were the most commonly identified drugs involved in overdose deaths.

UNINTENTIONAL DRUG OVERDOSE DEATHS

Drug users may not know when illicit

fentanyl has been combined or substituted

with other commonly abused drugs,

such as heroin.

75 84

502

0

100

200

300

400

500

600

2012 2013 2014

Fentanyl-related accidental drug overdose deaths in Ohio, 2012-2014

DAYTON POLICE DEPARTMENTMULTI-YEAR OVERDOSE ANALYSIS

59 104 165 198

730494 369

509

159 462723

782

0

200

400

600

800

1,000

1,200

1,400

1,600

2012 2013 2014 2015

Dayton Police and Fire Departments Overdose Responses 2012-2015

Police Only Fire Only Both

948

1,060

1,257

1,489

UNINTENTIONAL DRUG OVERDOSE DEATHS

In 2015, Narcan was administered 167 times

Demographic Characteristics of Narcan Use

Average Age – 35 years Sex – Male (66%)

Youngest Age – 18 years Race – White (90%)

95% were administered Narcan and survived

3 24

7

19

13

20

15

21

27

21

15

0

5

10

15

20

25

30

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2015

Dayton Police Department Narcan Use by Month, 2015

52% Male

48% Female

93% White

6% Black

1% Asian and Native American

72 Referrals to Drug Treatment

1,334 Total Visits

308 Clients Served

15,202 Needles Exchanged

103 HIV Tests

6 Hepatitis C Test

Referrals offered for: clothing, food, housing, medical & dental

care, mental health, STD clinic, pregnancy

test, and Medicaid enrollment

From April 24, 2015 to March 25, 2016

Visits to Syringe Services Program

April 24, 2015 - March 25, 2016

Visits

1 - 13

14 - 34

35 - 51

52 - 87

88 - 377

CarePoint

Counts include visits by repeat clients

8% of clients live outside

Montgomery County.

31% clients live in zip

code 45403.

53% White

44% Black

3% Other Races

Treatment Services Offered:Screening, Assessment, Non-

Intensive and Intensive Outpatient

Counseling and Family Counseling

1009 Clients Served in FY 2016

Most Common Diagnosis

Alcohol Dependence

Cannabis Dependence

Opioid Dependence

23% of Clients are Opioid

Dependent

27% Female

73% Male

Prevention Services Offered:Classroom and Home Based

Education for Adults and Family

Members.

Accidental

Overdose

Deaths

Involving

Heroin -

from 2007

to 2015

COMMUNITY HEALTH IMPROVEMENT

PLAN

Montgomery County: A healthy, safe, and thriving community!

We believe that all residents of Montgomery County should have:

- equal access to resources that promote a healthy lifestyle

- an environment that promotes health and wellness

- social support and community connections

- knowledge about healthy choices and behaviors

HEALTH PRIORITIES

Priority 1 - Birth Outcomes

Priority 2 - Chronic Disease Prevention

Priority 3 - Behavioral Health

Regardless of the neighborhood or community, all Montgomery County

residents should have access to safe recreational facilities and healthy

food options. New policies and programs emphasizing chronic disease

prevention can “make the healthy choice, the easy choice”.

Integration of partners – mental health, substance

abuse, primary care, public health – is critical to meet the

behavioral health needs and ultimately the overall health

of Montgomery County residents.

Infant Mortality is the key, long-term indicator for birth outcomes as well as

for overall community health and well-being.

Birth Outcomes

Birth Outcomes

Neurodevelopmental Disorders

Infant MortalityMaternal, Infant, and Child Health

Chronic Disease Prevention

Chronic Disease

Chronic Disease

Tobacco Free

Living

Healthy Eating

Active Living

Food Access

Behavioral Health

Brain HealthIntegration of Physical and

Behavioral Health

Mental Health and Mental Disorders

Substance AbuseSubstance Abuse

MONTGOMERY COUNTY CHIP

MONTGOMERY COUNTY STRATEGIC PLAN

ODH STATE HEALTH IMPROVEMENT PLAN

HEALTHY PEOPLE 2020NATIONAL PREVENTION

STRATEGY

BEHAVIORAL HEALTH

Goal 1 - Ensure access to needed behavioral health

services at the right amount, at the right time,

for the right person, and in the appropriate setting.

Goal 2 - Increase integration of physical and

behavioral healthcare services.

Goal 3 - Enhance care coordination and

information sharing across

behavioral health and other

system partners.

BIRTH OUTCOMES

Goal 1 – Reduce preterm births.

Goal 2 – Reduce substance misuse in pregnant women and mothers of infants.

Goal 3 – Reduce the infant mortality racial disparity in zip codes:

45402, 45405, 45406, 45414, 45415, 45416, 45417, and 45426.