1. 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

2. 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

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

4. Analytic and Data Publications
Opioid-related Overdose Fatalities in Allegheny County
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.

5. Allegheny County Data Warehouse
Opioid-related Overdose Fatalities in Allegheny County
Allegheny County Data Warehouse

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

7. Drug Overdose Rates Throughout U.S. 2003-2014
Opioid-related Overdose Fatalities in Allegheny County
Drug Overdose Rates Throughout U.S
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

8. Increasing Overdose Deaths in Allegheny County
Opioid-related Overdose Fatalities in Allegheny County
Increasing Overdose Deaths in Allegheny County
Self Explanatory

9. Age-adjusted opioid-related overdose death rate:
Opioid-related Overdose Fatalities in Allegheny County
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

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

11. 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

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

13. Opioid-related Overdose Fatalities in Allegheny County 2015-16
Heroin vs prescription opioid medications among opioid-related overdose deaths ( )
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.

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

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

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

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

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

19. Opioid-related Overdose Fatalities in Allegheny County 2015-16
EMS Dispatches when naloxone was administered by zipcode:
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.

20. 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

21. 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

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

23. 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

24. 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.

25. Key Take-Aways and Recommendations

26. 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.

27. 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%

28. Overdose Dashboard: 2010 - present
Opioid-related Overdose Fatalities in Allegheny County
Overdose Dashboard: 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.

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

30. Overdose Risk Prediction
Opioid-related Overdose Fatalities in Allegheny County
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.

31. Thank you!

33. Client View: Client Search

34. Client View: Summary

35. Client View: Timeline View

36. Client View: Timeline Expanded View

37. Client View: Service Involvement

38. Client View: Provider Involvement