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

OVERVIEW This presentation is an overview of THE GOAL OF THIS unintentional and undetermined overdose PRESENTATION IS fatalities that occurred in Clermont TO PROVIDE A County in 2017. SNAPSHOT OF TRENDS RELATED The data in this presentation is collected TO OVERDOSE in partial fulfillment of the grant requirements of the Injury Prevention DEATHS IN grant awarded to Clermont County Public CLERMONT Health by the Ohio 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 AND UNDETERMINED DRUG OVERDOSE DEATHS THAT OCCURRED IN CLERMONT COUNTY 2014 68 Unintentional deaths 2015 93 Unintentional deaths 2016 83 Unintentional deaths; 1 Undetermined 2017 76 Unintentional deaths Source: Clermont County Coroner's Office

OVERDOSE DEATHS BY MONTH, 2017 14% 15 13 OF 2017 DRUG OVERDOSE DEATHS 10 9 Number of Deaths OCCURRED IN 8 7 7 DECEMBER (n=13) 6 6 6 5 5 3 3 3 0 Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

PERCENTAGE OF DEATHS BY MONTH, 2014-2017 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.. 2017 2016 2016 2017 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.. 2014 2015 2015 2014

DEMOGRAPHICS

GENDER BY YEAR 75% 80 71% 67% 5 2 / 70 59% 60 OVERDOSE DEATHS 50 41% Percentage THAT OCCURRED IN 2017 40 33% WERE WOMEN 29% 25% 30 20 HISTORICALLY, THIS IS THE 10 CLOSEST GAP BETWEEN 0 THE PERCENTAGES OF 2014 2015 2016 2017 (n=76) (n=69) (n=94) (n=82) MALES AND FEMALES Male Female

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

AGE SNAPSHOT, 2017 OLDEST AVERAGE YOUNGEST 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%) (n=76)

BREAKDOWN: AGE AND GENDER AVERAGE AGE 25 20 43 Number of Cases 15 MALES 10 39 5 FEMALES 0 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs Males (n=45) Females (n=31)

MARITAL STATUS SNAPSHOT 47% Single Married Divorced Widowed 29% Unknown (n=76) 18% 80% 4% OF 2017 CASES WERE SINGLE, 1% DIVORCED, OR WIDOWED

EDUCATION SNAPSHOT Less than High School 22% (n=17) High School Graduate or GED 74% (n=56) College Graduate 3% (n=2) Unknown 1% (n=1)

CRIMINAL HISTORY 70 THE MOST COMMON 60 CHARGES ARE : 50 Percentage DRUG-RELATED 40 (70%**) 30 THEFT OR 20 ROBBERY-RELATED (74%**) 10 0 2014 2015 2016 2017 (n=69) (n=94) (n=82) (n=76) Yes Unknown ** Percent of cases with a criminal history (n=50)

HEALTH FACTORS

PHYSICAL ILLNESS CASES IDENTIFIED OR 75% REPORTED HAVING A PHYSICAL ILLNESS 1 IN 3 CASES HAD A CHRONIC ILLNESS OF THE LIVER INCLUDING HEPATITIS C AND CIRRHOSIS OF THE MOST COMMON PHYSICAL THE LIVER (n=24) ILLNESSES IDENTIFIED: THIS IS A 116% INCREASE DISEASES OF THE HEART FROM 2016 (n=12) 47% CASES (n=36) RESPIRATORY ILLNESSES 17% CASES (n=13) 13% OF CASES REPORTED ACUTE DISEASES OF THE LIVER ILLNESS PRIOR TO DEATH (n=10) 32% CASES (n=24)

MENTAL ILLNESS IS LIKELY MENTAL ILLNESS UNDER REPORTED DUE TO LACK OF ACCESS TO 16% CASES IDENTIFIED OR MEDICAL HISTORY REPORTED A MENTAL ILLNESS AND LACK OF (n=12) (NOT INCLUDING SUD) PHYSICAL EVIDENCE IN AUTOPSY 11% OF CASES HAD A HISTORY OF Depression (4) Anxiety (4) Bipolar (5) SUICIDAL THOUGHTS PTSD (2) Other (5) OR ATTEMPTS (n=8) ** Some cases reported multiple mental illnesses.

16% SUBSTANCE ABUSE HISTORY 84% CASES IDENTIFIED OR CASES NOTED A HISTORY OF SUBSTANCE ABUSE REPORTED A HISTORY OF TREATMENT (n=12) SUBSTANCE ABUSE (n=64) ACCORDING TO SAMHSA, AMONG 2017 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 (77%, n=49) DRUGS CAUSES CLINICALLY AND FUNCTIONALLY SIGNIFICANT IMPAIRMENT, SUCH AS HEALTH 14% CASES REPORTED A HISTORY OF PROBLEMS, DISABILITY, AND FAILURE TO MEET MAJOR PRESCRIPTION DRUG ABUSE (n=11) RESPONSIBILITIES AT WORK, SCHOOL, OR HOME.

DEATH INVESTIGATION

LOCATION OF DEATH 58% 50 OF DEATHS 44 OCCURRED AT THE 40 CASE'S RESIDENCE Number of Cases 30 OTHER LOCATIONS INCLUDE TWO HOTELS, A HOMELESS SHELTER, 20 17 AND A BUSINESS 9 10 4 2 0 2017 (n=76) Decendent's Home Friend's Home Hospital / Nsg Home Car Other

ACTIVITY AT TIME OF DEATH ILLICIT DRUGS FOUND AT SCENE Yes (45%) No (38%) Unknown (17%) Sleeping (9%) Driving (1%) Other (65%) Unknown (25%) **Activity at time of death is placed in relation to where the case was found CASES WHERE DRUG 39% PARAPHERNALIA WAS FOUND AT THE SCENE RX DRUGS FOUND AT SCENE Yes (45%) No (31%) Unknown (24%)

LIFE SAVING INTERVENTIONS/ATTEMPTS ALONE AT TIME OF DEATH MORE THAN 1/3 CASES RECEIVED CPR PRIOR TO 61% EMS ARRIVAL (36%) 24% 18% 16% CASES NOTED NALOXONE WAS ADMINISTERED EITHER BY EMS OR A BYSTANDER** No (n=12) Yes (n=46) Unknown (n=18) **Naloxone administration data is gleaned from police reports not EMS reports, and is not always noted

TOXICOLOGY TYPE 100 90 100% 80 70 OF CASES' Percentage 60 TOXICOLOGY SCREEN 50 RESULTS WERE 40 POLYSUBSTANCE IN 30 2017** (n=64; 63 20 10 autopsy, 1 hospital) 0 2014 2015 2016 2017 n=94 n=76 n=82 n=69 Polysubstance Single Drug No Tox Screen **100% of cases where a toxicology screen was performed (n=64, 84% of total cases)

SUBSTANCES PRESENT BY YEAR 100 90 80 70 Percentage 60 50 40 30 20 10 0 (n=77) (n=45) (n=69) (n=64) 2014 2015 2016 2017 Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC 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

SUBSTANCES PRESENT, 2017 95% 100 90 80 Percentage 70 50% 60 50 34% 33% 31% 30% 40 20% 30 17% 13% 20 6% 10 0 2017 (n=64) Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants Sedatives Other Rx OTC OTHER PRESCRIPTION BETWEEN 2016 AND 2017 THERE WAS A 580% MEDICATIONS PRESENT IN INCREASE IN THE PRESENCE OF TOXICOLOGY SCREENS WERE METHAMPHETAMINE GABAPENTIN AND AMPHETAMINE (2017 n=22, 34%; 2016 n=4, 5%)

9 5 % OPIOIDS PRESENT Fentanyl and Related Drugs OF CASES' TOXICOLOGY SCREENS 84% WERE POSITIVE FOR AT LEAST Heroin 50% ONE OPIOID (n=60) Morphine/Codeine 30% Oxycodone 14% OTHER OPIOIDS PRESENT IN Methadone 5% CASES' TOXICOLOGY SCREENS Hydrocodone INCLUDE OXYMORPHONE, 5% DIHYDROCODEINE, AND Buprenorphine 2% NALTREXONE Other 11% n=64

TRENDS

PERCENTAGE OF FENTANYL AND HEROIN RELATED DRUG OVERDOSE DEATHS BY YEAR, CLERMONT COUNTY RESIDENTS 80 70 60 Percentage 50 40 30 20 10 0 2010 2011 2012 2013 2014 2015 2016 2017 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 Source: Ohio Public Health Data Warehouse, 5/17/18

MERCY HEALTH CLERMONT HOSPITAL NALOXONE ADMINISTRATION EMERGENCY DEPARTMENT ENCOUNTERS DUE BY OHIO EMS PROVIDERS, TO OPIATE OVERDOSE, BY QUARTER, 2017 CLERMONT COUNTY, 2017** 232 250 175 153 195 Number of Opiate Overdose Encounters 200 Number of Naloxone Administrations 138 150 82 78 88 70 82 100 50 0 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 **72.6% of Transporting Ohio EMS Agencies Reporting Source: Mercy Health Clermont Hospital Source: Ohio Emergency Medical Services, Naloxone Emergency Department Administration by County

NALOXONE ADMINISTRATION BY OHIO EMS PROVIDERS BY ZIP CODE, CLERMONT COUNTY, 2017** **72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone Administration by Zip Code