overdose fatality review...rev iew of 2017 ty ra sche rer, ms, inj ur y prevention coordin ator ......
TRANSCRIPT
OVERDOSE FATALITY REVIEW Review of 2017
Tyra Scherer, MS, Injury Prevention Coordinator
Tara Jimison, BSN, RN, Epidemiologist
The data in this presentation is collectedin partial fulfillment of the grantrequirements of the Injury Preventiongrant awarded to Clermont County PublicHealth by the Ohio Department of Health.
This presentation is an overview ofunintentional and undetermined overdosefatalities that occurred in ClermontCounty in 2017.
OVERVIEW
THE GOAL OF THISPRESENTATION ISTO PROVIDE ASNAPSHOT OFTRENDS RELATEDTO OVERDOSEDEATHS INCLERMONTCOUNTY.
DATA COLLECTIONLIMITATIONS
DATA SOURCES
LIMITED INFORMATIONPROVIDED WHEN CASES ARETRANSPORTED OUT OF COUNTY
AUTOPSY REPORTS
LIMITED DATA ON SUBSTANCESOURCES (LEGAL AND ILLEGAL)
TOXICOLOGY SCREENS
SOME DATA POINTS NOTSPECIFICALLY NOTED INREPORTING AND THEREFORE
NOT CAPTURED
POLICE REPORTS
INFORMATION PROTECTED BYLAW (HEALTH HISTORY)
CLERK OF COURTSRECORDS
ADDITIONAL PUBLICINFORMATIONAVAILABLE 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 DEATHSTHAT OCCURRED IN CLERMONT COUNTY
OVERDOSE DEATHS BY MONTH, 2017
3 3
6 6
7
9
8
7
6
5
3
13
0
5
10
15
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
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ths
OF 2017 DRUGOVERDOSE DEATHS
OCCURRED INDECEMBER (n=13)
14%
PERCENTAGE OF DEATHS BY MONTH, 2014-2017
2017
J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0
10
20
2016
J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0
10
20
2015
J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0
10
20
2014
J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0
10
20
2017
2016
2014
2015
Per
cen
tage
Per
cen
tage
Per
cen
tage
Per
cen
tage
DEMOGRAPHICS
GENDER BY YEAR
Male Female
75%
67%71%
59%
25%
33%29%
41%
2014 2015 2016 20170
10
20
30
40
50
60
70
80
OVERDOSE DEATHS THAT OCCURRED IN 2017
WERE WOMEN
2/5
HISTORICALLY, THIS IS THECLOSEST GAP BETWEENTHE PERCENTAGES OFMALES AND FEMALES
(n=69)
(n=94)
(n=82)
(n=76)
Per
cen
tage
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
0
5
10
15
20
25
30
35
2014 2015 2016 2017
Per
cen
tage
(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
YOU
NG
EST
O
LDE
ST
AVE
RA
GE
(n=76)
FEMALES
Males (n=45) Females (n=31)
0
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
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MARITAL STATUS SNAPSHOT
Single
Married
Divorced
Widowed
Unknown
47%
29%
18%
4%
1%
80%
OF 2017 CASESWERE SINGLE,DIVORCED, OR
WIDOWED
(n=76)
EDUCATION SNAPSHOT
Unknown 1% (n=1)
College Graduate 3% (n=2)
High School Graduateor GED 74% (n=56)
Less than High School 22% (n=17)
CRIMINAL HISTORY
Yes Unknown
2014 2015 2016 20170
10
20
30
40
50
60
70
THE MOST COMMONCHARGES ARE :
** Percent of cases with acriminal history (n=50)
THEFT ORROBBERY-RELATED
(74%**)
DRUG-RELATED(70%**)
(n=69)
(n=94)
(n=82)
(n=76)
Per
cen
tage
HEALTH FACTORS
1 IN 3 CASES HAD A CHRONICILLNESS OF THE LIVER INCLUDINGHEPATITIS C AND CIRRHOSIS OF
THE LIVER (n=24)
75%
PHYSICAL ILLNESS
CASES IDENTIFIED ORREPORTED HAVING APHYSICAL ILLNESS
THE MOST COMMON PHYSICALILLNESSES 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 ACUTEILLNESS PRIOR TO DEATH (n=10)
THIS IS A 116% INCREASEFROM 2016 (n=12)
16%
MENTAL ILLNESS
CASES IDENTIFIED ORREPORTED 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 THOUGHTSOR ATTEMPTS (n=8)
** Some cases reported multiple mental illnesses.
MENTAL ILLNESS IS LIKELYUNDER REPORTED DUE TO
LACK OF ACCESS TOMEDICAL HISTORY
AND LACK OF PHYSICAL EVIDENCE IN AUTOPSY
84%
SUBSTANCE ABUSE HISTORY
CASES IDENTIFIED ORREPORTED A HISTORY OFSUBSTANCE ABUSE (n=64)
16% CASES NOTED A HISTORY
OF SUBSTANCE ABUSETREATMENT (n=12)
AMONG 2017 CASES WITH A NOTEDHISTORY OF SUBSTANCE ABUSE,
HEROIN WAS THE SUBSTANCE MOSTREPORTED (77%, n=49)
ACCORDING TO SAMHSA,SUBSTANCE USE DISORDERSOCCUR WHEN THE RECURRENTUSE OF ALCOHOL AND/ORDRUGS CAUSES CLINICALLY ANDFUNCTIONALLY SIGNIFICANTIMPAIRMENT, SUCH AS HEALTHPROBLEMS, DISABILITY, ANDFAILURE TO MEET MAJORRESPONSIBILITIES AT WORK,SCHOOL, OR HOME.
14% CASES REPORTED A HISTORY OFPRESCRIPTION DRUG ABUSE (n=11)
DEATH INVESTIGATION
Decendent's Home Friend's Home
Hospital / Nsg Home Car Other
44
9
17
24
0
10
20
30
40
50
2017 (n=76)
OTHER LOCATIONS INCLUDE TWOHOTELS, A HOMELESS SHELTER,
AND A BUSINESS
OF DEATHSOCCURRED AT THECASE'S RESIDENCE
58%
LOCATION OF DEATH
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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 DRUGPARAPHERNALIA WASFOUND 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 TOEMS ARRIVAL (36%)
CASES NOTEDNALOXONE WASADMINISTEREDEITHER BY EMS
OR A BYSTANDER**
18%
**Naloxone administration data is gleaned from police reports notEMS reports, and is not always noted
TOXICOLOGY TYPE
Polysubstance Single Drug No Tox Screen
2014 2015 2016 20170
10
20
30
40
50
60
70
80
90
100
n=69
n=94
n=82
n=76
OF CASES'TOXICOLOGY SCREENRESULTS WEREPOLYSUBSTANCE IN2017** (n=64; 63autopsy, 1 hospital)
100%
**100% of cases where a toxicologyscreen was performed (n=64, 84%of total cases)
Per
cen
tage
SUBSTANCES PRESENT BY YEAR
Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants
Sedatives Other Rx OTC
0
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
Per
cen
tage
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%
0102030405060708090
100
2017 (n=64)
BETWEEN 2016 AND 2017 THERE WAS A 580%INCREASE IN THE PRESENCE OF
METHAMPHETAMINE
OTHER PRESCRIPTIONMEDICATIONS PRESENT INTOXICOLOGY SCREENS WEREGABAPENTIN AND AMPHETAMINE
Per
cen
tage
(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
95% OF CASES' TOXICOLOGY SCREENS
WERE POSITIVE FOR AT LEASTONE OPIOID (n=60)
n=64
OTHER OPIOIDS PRESENT INCASES' TOXICOLOGY SCREENSINCLUDE OXYMORPHONE,DIHYDROCODEINE, ANDNALTREXONE
TRENDS
Fentanyl Heroin
2010 2011 2012 2013 2014 2015 2016 20170
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 UNINTENTIONALDRUG POISONING WHERE THE HEROIN INDICATOR OR FENTANYL AND ITSANALOGUES ARE SPECIFICALLY NOTED ON THE DEATH CERTIFICATE
PERCENTAGE OF FENTANYL AND HEROINRELATED DRUG OVERDOSE DEATHS BY YEAR,
CLERMONT COUNTY RESIDENTS
Per
cen
tage
82
232
195
138
Q1 Q2 Q3 Q40
50
100
150
200
250
78
153
8270
Q1 Q2 Q3 Q40
88
175
MERCY HEALTH CLERMONT HOSPITALEMERGENCY 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 HospitalEmergency Department
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Ad
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iate
Ove
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un
ters
**72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone Administration by Zip Code
NALOXONE ADMINISTRATION BY OHIO EMS PROVIDERSBY ZIP CODE, CLERMONT COUNTY, 2017**
EPICENTER SYNDROMIC SURVEILLANCE
EMERGENCY DEPARTMENT VISITSAMONG CLERMONT COUNTY
RESIDENTS, ALL FACILITIES, 2017
953
INDIVIDUALS PRESENTING TOMERCY CLERMONT HOSPITAL
EMERGENCY DEPARTMENT , 2017
563
EPICENTER COLLECTS EMERGENCY DEPARTMENT CHIEF COMPLAINT DATA FROM 180HOSPITALS AND URGENT CARE FACILITIES ACROSS OHIO IN REAL TIME AND CLASSIFIES
THEM INTO SYMPTOM AND SYNDROME CATEGORIES. CHIEF COMPLAINTS FROM THETRAUMATIC 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 HADCONTACT WITH AMERCY EMERGENCYDEPARTMENT FORPAIN OR ANOVERDOSEWITHIN ONE YEAROF THEIR DEATH
(n=38)
1 CASE VISITED MERCY ED'S 63 TIMES IN THE YEAR PRIOR TODEATH (60 FOR PAIN, 3 OD)
**Data was provided by Mercy Health Clermont Hospital Emergency Department
AMONG THE 2017 CASES, THERE WERE 110 VISITS FOR PAINAND 31 VISITS FOR OVERDOSE AT MERCY EMERGENCYDEPARTMENTS WITHIN ONE YEAR OF DEATH
32 OF THE 76 CASES HAD NO CONTACT WITH MERCYED'S WITHIN ONE YEAR OF THEIR DEATH FOR PAIN OR OD
MERCY ED'S HAD NO RECORD FOR 6 OF THE CASES
MERCY EMERGENCYDEPARTMENT INTERACTIONSWITHIN ONE YEAR OF DEATH
50%
OPIOID PRESCRIPTIONSDISPENSED BY YEAR,CLERMONT COUNTY
268.3261.6
258.2263.2
253.8
2013 2014 2015 2016 2017250
263
275
DOSES PER PATIENT
75.671.0 66.9 62.7 58.4
2013 2014 2015 2016 201740
60
80
DOSES PER CAPITA
**Solid Oral Doses *Population Data from 2010 Ohio Department of Development
BETWEEN 2013-2017 THERE
HAS BEEN A22.79% DECREASEIN TOTAL DOSESDISPENSED INCLERMONT COUNTY.
Do
ses
per
Pat
ien
t**
Do
ses
per
Cap
ita*
*
Source: Ohio Automated RxReporting System
ACCOMPLISHMENTS TO DATE
OUTREACH TO HEALTHCARE PROVIDERS AND NONTRADITIONAL PARTNERS TO HELP EDUCATE THECOMMUNITY ON SUBSTANCE MISUSE PREVENTION
INDIVIDUALSWERE REFERREDTO TREATMENTDURING QRT
RUNS IN 2017
133
QUICK RESPONSE TEAMS FORMED IN UNION TOWNSHIPAND THE CLERMONT COUNTY SHERIFF'S OFFICE IN 2017
MERCY HEALTH CLERMONT HOSPITALREFERRED 239 INDIVIDUALS TOTREATMENT FOR DRUG USE DURINGSBIRT SCREENINGS IN 2017
VOCATIONAL OPPORTUNITIES FORPEOPLE IN RECOVERY INCLUDINGCASC AND GCB VOCATIONAL PROGRAM
ACCOMPLISHMENTS TO DATE
IMPLEMENTATION OF A SYRINGESERVICES PROGRAM INCLERMONT COUNTY
1,381 LBS COLLECTED IN PERMANENT DRUG DROP BOXES IN 2017
FITZGERALD'S PHARMACY(WILLIAMSBURG) ADOPTED APHYSICIAN APPROVED PROTOCOLTO DISPENSE NALOXONE WITHOUTA PRESCRIPTION
PROJECT D.A.W.N.KITS DISTRIBUTED
IN CLERMONTCOUNTY IN 2017
353
PROJECT D.A.W.N.
LIVE STORIES OVERDOSE DATA TOOLPROVIDES NUMBER OF 911 CALLS ANDED VISITS DAILY
INTERVENTIONS TO CONSIDER
WORKING WITH THE FAITH BASED COMMUNITY TO ASSIST WITH PREVENTIONEFFORTS AND CONNECTING INDIVIDUALS TO AVAILABLE RESOURCES
IMPORTANCE OF CALLING 911 IF SOMEONE ISOVERDOSING EVEN IF NARCAN IS BEING ADMINISTERED
INCREASING AWARENESS AND OUTREACH EFFORTS DURINGEND 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 THISREPORT (SOURCES: OBITUARIES, POLICE REPORTS)
QUESTIONS
TARA JIMISON, BSN, RN, EPIDEMIOLOGIST
TYRA SCHERER, MS, INJURY PREVENTION COORDINATOR
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 notnecessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.