Bronx Community Health Dashboard: Drug Abuse and Opioids Created: 5/18/2017 Last Updated: 10/23/2017 See last slide for more information about this project.

USA Opioid-Related Mortality Rate Men in the USA are 3 times more likely to die from opioids than men in other World Bank high income countries 250% increase USA Opioid-Related Mortality Rate Data source: Institute for Health Metrics and Evaluation. GBD Compare Data Visualization. abuse of opioid analgesics = over $72 billion in medical costs alone each year. This is comparable to costs related to other chronic diseases such as asthma and HIV Other studies estimate the cost of opioid abuse to be between $53-$56 billion annually, accounting for medical and substance abuse treatment costs, lost work productivity, and criminal justice costs https://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf 4 Average number of daily drug overdoses in NYC, 2016 80% Percent of overdose deaths involved opioids Data source: Healing NYC: Preventing Overdoses, Saving Lives 2017

Youth Behavior

Youth in Staten Island were more likely to report taking benzodiazepines and other Rxs without a doctor’s prescription one ore more times in the last year such as Xanax, Valium, Klonopin, or Ativan Data source: NYC Youth Risky Behavior Study, 2015. Analysis by Montefiore OCPH. Data for benzodiazepine and Rx use not collected before 2015.

Youth in Staten Island were most likely to report using heroin at least one or more times in their lifetime Data source: NYC Youth Risky Behavior Study, 2003-2015. Analysis by Montefiore OCPH. Data collected every two years.

Drug-related hospitalizations

6 of 10 districts with highest drug-related hospitalizations are in the Bronx 201 Mott Haven & Melrose 202 Hunts Point & Longwood 203 Morrisania & Crotona 204 Highbridge & Concourse 205 Fordham & University Heights 206 Belmont & East Tremont 207 Kingsbridge Heights & Bedford 208 Riverdale & Fieldston 209 Parkchester & Soundview 210 Throgs Neck & Co-op City 211 Morris Park & Bronxdale 212 Williamsbridge & Baychester 201 202 203 204 206 207 208 209 210 211 212 205 NYC 907 Data source: NYC Community Health Profiles.

Opioid-Related Mortality Including suicide, intentional CDC ICD Codes used for this category: F11.0-F11.5, F11.7-F11.9, F12.0-F12.5, F12.7-F12.9, F13.0-F13.5, F13.7-F13.9, F14.0-F14.5, F14.7-F14.9, F15.0-F15.5, F15.7-F15.9, F16.0-F16.5, F16.7-F16.9, F17.0, F17.3-F17.5, F17.7-F17.9, F18.0-F18.5, F18.7- F18.9, F19.0-F19.5, F19.7-F19.9, X40-X44, X60-X64, X85, Y10-Y14

When compared to similar counties, the Bronx has nearly double the rate of opioid-related mortality rates Opioid-Related Mortality includes suicides, unintentional and intentional mortality Data source: National Vital Statistics Surveillance System, Underlying Cause of Death, 2000-2015. Analysis by Montefiore OCPH.

Drug related mortality rates are increasing at a higher rate in the Bronx than the rest of NYC Opioid-Related Mortality includes suicides, unintentional and intentional mortality Data source: National Vital Statistics Surveillance System, Underlying Cause of Death, 2000-2015. Analysis by Montefiore OCPH.

Males and those 45-54 have the highest drug related mortality rates in the Bronx Data source: Underlying Cause of Death, 2000-2015. Analysis by Montefiore OCPH. Age-specific rates are not age-adjusted. 25-34 year data unstable 2004-2005, 2009. 55-64 year data unstable 2000, 2002-2003.

Non-Hispanic White populations have the highest rates of drug related mortality in the Bronx Data source: National Vital Statistics Surveillance System, Underlying Cause of Death, 2000-2015. Analysis by Montefiore OCPH.

4 of 5 districts with highest drug-related mortality rate are in the Bronx NYC 8.6 201 Mott Haven & Melrose 202 Hunts Point & Longwood 203 Morrisania & Crotona 204 Highbridge & Concourse 205 Fordham & University Heights 206 Belmont & East Tremont 207 Kingsbridge Heights & Bedford 208 Riverdale & Fieldston 209 Parkchester & Soundview 210 Throgs Neck & Co-op City 211 Morris Park & Bronxdale 212 Williamsbridge & Baychester 201 202 203 204 206 207 208 209 210 211 212 205 Data source: NYC Community Health Profiles. 25 community districts, including 2 in the Bronx, did not have stable data to report drug-related age-adjusted death rates

Overdose Mortality unintentional

The Bronx has higher outpatient emergency department visits and hospitalization overdose rates than the rest of NYC Overdose Mortality refers to unintentional deaths Reported overdoses in Hospitalizations Reported overdoses in outpatient emergency department visits Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Bronx and NYC Excluding Bronx data are not age-adjusted

Staten Island has the highest rate of all opioid overdoses occurring in outpatient emergency departments while the Bronx has the highest rate of hospitalization opioid overdoses Reported overdoses in Hospitalizations Reported overdoses in outpatient emergency department visits **work the wording on this slide Outpatient – not actually admitted to a hospital, hospitalization data = admitted to a hospital and overdose occurred there Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Data are not age adjusted

Staten Island has higher rates of OED heroin overdoses and the Bronx has higher rates of Hospitalization heroin overdoses Reported overdoses in outpatient emergency department visits Reported overdoses in Hospitalizations SPARCS collects information about ED visits through the patient discharge data system. Outpatient ED visits are events that did not result in admission to the hospital. Each outpatient emergency department (ED) visit receives an ICD-9-CM code (ICD-10-CM codes beginning Oct. 1, 2015) at discharge that indicates the primary reason for the occurrence. There are also a first-listed cause, external cause of injury, and up to 24 other diagnosis codes recorded to further describe the ED visits. Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Hospitalization overdose data for Staten Island not stable after Jan-Mar, 2016; Data are not age adjusted

Staten island has the highest OED based opioid overdoses (excluding heroin) while the Bronx and Brooklyn have the highest opioid overdoses (excluding heroin) in hospitalizations Reported overdoses in outpatient emergency department visits Reported overdoses in Hospitalizations Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Data are not age adjusted

Brooklyn and the Bronx have the highest Naloxone administration numbers reported by emergency medical services (EMS) Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Numbers represent naloxone administration events reported electronically, actual number of events may be higher

The Bronx has the highest Naloxone administration rate reported by emergency medical services (EMS) per 100,000 Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Numbers represent naloxone administration events reported electronically, actual number of events may be higher

The Bronx has the highest rate of unique clients admitted for heroin and all opioids per 100,000 persons Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. Individual clients can be admitted to treatment in more than one quarter during the year

Bronx non-heroin overdoses Non-heroin overdoses in the Bronx and NYC are contributing to a lower percentage of total overdoses 15% decrease Bronx non-heroin overdoses Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. .

Bronx heroin overdose mortality Heroin overdoses are contributing to a growing percentage of all overdose mortality in NYC 15% increase Bronx heroin overdose mortality Data source: New York State: County Opioid Quarterly Report, 2015-2016. Analysis by Montefiore OCPH. .

About the Community Health Dashboard Project The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e.g., by age, sex, race/ethnicity, etc.) and sub-county/neighborhood level data Data will be periodically updated as new data becomes available. Produced by Montefiore’s Office of Community & Population Health using publicly-available data sources For more information please contact Colin Rehm, PhD, Manager of Research & Evaluation (crehm@montefiore.org).