Opioid-related Overdose in Allegheny County: 2015-16 March 2018 Eric Hulsey, DrPH, MA Manager, Behavioral Health Analytics Office of Data Analysis, Research and Evaluation Allegheny County Dept of Human Services

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Overview Share with you what we’ve learned about accidental opioid-related overdose deaths in Allegheny County Share with you our recommendations to reduce deaths based on available data Engage you in a discussion about what you can do to reduce overdoses

Opioid-related Overdose Fatalities in Allegheny County 2015-16 About DHS

Analytic and Data Publications Opioid-related Overdose Fatalities in Allegheny County 2015-16 Analytic and Data Publications Overdose Dashboard Our DARE office and its analytic teams publish on this site. Sample publications about behavioral health topics are highlighted. Note that images are hyperlinked. www.alleghenycountyanalytics.us

Allegheny County Data Warehouse Opioid-related Overdose Fatalities in Allegheny County 2015-16 Allegheny County Data Warehouse

Data Integrated at Individual Levels and Other Spatial Information Opioid-related Overdose Fatalities in Allegheny County 2015-16 Data Integrated at Individual Levels and Other Spatial Information Self Explanatory

Drug Overdose Rates Throughout U.S. 2003-2014 Opioid-related Overdose Fatalities in Allegheny County 2015-16 Drug Overdose Rates Throughout U.S. 2003-2014 Take-away – there have been increasing OD deaths around the country for the past 10+ years – largely driven by opiates and heroin in recent years. Source: NY Times, January 2016

Increasing Overdose Deaths in Allegheny County Opioid-related Overdose Fatalities in Allegheny County 2015-16 Increasing Overdose Deaths in Allegheny County Self Explanatory

Age-adjusted opioid-related overdose death rate: Opioid-related Overdose Fatalities in Allegheny County 2015-16 Age-adjusted opioid-related overdose death rate: Allegheny County in Comparison to Pennsylvania and US Opioid-related overdose deaths in Allegheny County compared to PA and US

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Opioid-related overdose deaths by age, sex and race (n=910)

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Opioid-related overdose death rates by age, sex, and race (n=903) Crude death rates per 100,000 for Allegheny County are presented. Highest death rates, respectively, include black males aged 45–64 and white males 25–44 years old. Seven OD victims had a race other than black or white and rates could not be calculated – therefore, n=903

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Fentanyl, fentanyl analogues, cocaine and benzodiazepines among opioid-related overdose deaths (n=910) Self-explanatory

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Heroin vs prescription opioid medications among opioid-related overdose deaths (2008-14) The new "abuse-deterrent" version of Oxycontin was approved in 2010; Purdue Pharma stopped shipments of the older version of Oxycontin to pharmacies in August 2010. Heroin-only overdose deaths increasing. Following the formulation change of Oxycontin Allegheny County followed suit with other places around the US that observed increased rates of overdose primarily due to heroin.

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Opioid-related overdose deaths by municipality (n=586)

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Top 10 municipalities by number of opioid-related overdose deaths (n=910)

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Opioid-related overdose deaths by Pittsburgh neighborhood (n= 324)

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Top 10 city neighborhoods by number of opioid-related overdose deaths (n=910)

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Heatmap of opioid-related overdose deaths: 2015-16

Opioid-related Overdose Fatalities in Allegheny County 2015-16 EMS Dispatches when naloxone was administered by zipcode: 2015-16 Take-away – while we didn’t perform significant analysis, we’ve demonstrated that we have the capacity and will monitor ODs in the future using 911 and EMS dispatch data.

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Emergency dept visit with chief complaint of overdose by hospital Take-away – while we didn’t perform significant analysis, we’ve demonstrated that we have the capacity and will monitor ED admissions in the future using this data Source: EpiInfo from state DOH

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Prior health and human service involvement In the year prior to the death of these 910 individuals: 164 (18%) had been released from jail 388 (43%) had received a publicly funded behavioral health service 257 (28%) had received a substance use disorder service 313 (34%) had received a mental health service 182 (20%) had received both 27 (3%) were listed as a parent on an open child welfare case 87 children were potentially affected by the person’s death 68 were <18 at the time of the death 45 (5%) had some contact with homeless and housing services

Top five MH services (n=140) Top five SUD services (n=97) Opioid-related Overdose Fatalities in Allegheny County 2015-16 Time (in days) between last public system encounter and fatal overdose: 2015-16 Top five MH services (n=140) Top five SUD services (n=97) …………………………………….

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Homelessness and Housing Services Encounters in the Year and 30 Days Prior to Fatal Overdose: 2015–2016

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Prescribed medications filled within 90 days of fatal overdose Just over half of the opioid-related deaths (463, or 51%) involved individuals who were actively enrolled HealthChoices members (i.e., insured through Medicaid) 90 days prior to their death. 309 filled one or more prescriptions 90 days prior to their death, some of which have dangerous combination or interaction effects with concurrent opioid use that further depress respiration and increase sedation, increasing the risk of overdose. Just over half of the opioid-related deaths (463, or 51%) involved individuals who were actively enrolled HealthChoices members (i.e., insured through Medicaid) 90 days prior to their death. This was an increase from 45 percent during the previous period. Of these members, 309 filled one or more prescriptions 90 days prior to their death, some of which have dangerous combination or interaction effects with concurrent opioid use that further depress respiration and increase sedation, increasing the risk of overdose.

Key Take-Aways and Recommendations

Opiate-related Overdose Fatalities in Allegheny County 2008-14 Recommendations Consider interventions that are targeted toward specific populations Black males 45-64 White males 25-34 Improve screening for opioid use and overdose risk, overdose education, and naloxone distribution among individuals in mental health treatment Almost 1/3 of all deaths in the County encountered the publicly funded MH system Many of the people who died had filled prescriptions for psychotherapeutic medications There were 350 people (25%) who received a publicly funded SUD treatment service in the year prior to death. Results suggest that opiate-related fatalities occurred most frequently (38% or 134 of 350) within 30 days of a recent SUD treatment service; “rehab” and methadone maintenance were the two most common services received.

Opiate-related Overdose Fatalities in Allegheny County 2008-14 Recommendations Improve identification of opioid use and overdose risk among the growing number of HealthChoices (i.e., Medicaid) members Many enrolling through contact with health system Improve targeted interventions to County jail inmates at risk of overdose following release Increased offering of medication-assisted treatment Distribute naloxone upon release Focus overdose prevention efforts in the areas of the County where the deaths are occurring Reconsider the evidence base for current priority interventions to reduce death Prescription opioids alone contributed to only 9% of overdose deaths and, in combination with heroin and fentanyl, 17%

Overdose Dashboard: 2010 - present Opioid-related Overdose Fatalities in Allegheny County 2015-16 Overdose Dashboard: 2010 - present Our DARE office and its analytic teams publish on this site. Sample publications about behavioral health topics are highlighted. Note that images are hyperlinked. www.alleghenycountyanalytics.us

Opioid-related Overdose Fatalities in Allegheny County 2015-16 Animated Overdose Heat Map (ArcGIS Online)

Overdose Risk Prediction Opioid-related Overdose Fatalities in Allegheny County 2015-16 Overdose Risk Prediction The purpose of this effort is to integrate a variety of data sources and represent the complex dynamics of factors known to be related to fatal overdose in a mathematical model. This model will be used to create a risk prediction tool allowing local decision-makers (i.e. DHS and ACHD) to: rapidly identify approaching periods of increased risk for OD fatalities in the County prioritize targeted intervention strategies aimed to reduce incidence of opioid overdose and the resulting fatalities.

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