1. OVERDOSE SOLUTIONS 2013 OVERDOSE DATA FOR ALLEGHENY COUNTY Jennifer Janssen Manager Toxicology Laboratory Allegheny County Office of the Medical Examiner ACOME

2. The Overdose Problem in Allegheny County 2008-2012 Allegheny County Overdose Prevention Coalition July 24, 2013 Jennifer Janssen, M.S. Allegheny County

3. Scope of the National Problem In 2007, approximately 27,000 unintentional overdose deaths occurred in the U.S., one death every 19 minutes (MMWR, January 13, 2013) Rate of unintentional overdose deaths in the U.S. has been steadily increasing, largely attributed to prescription drug abuse.

4. Rate* of unintentional drug overdose deaths — United States, 1970–2007 * Per 100,000 population

5. Scope of the National Problem Prescription drug abuse is the fastest growing drug problem in the U.S. Since 2003, more overdose deaths have involved opioid analgesics than heroin or cocaine combined

6. Unintentional Drug Overdose Deaths in U.S. during 1999-2007

7. Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women –U.S., 1999-2010 Reported in Morbidity and Mortality Weekly July 5, 2013 Overdose deaths increasing steadily In 2012, total of 15,323 deaths among women were attributed to drug overdoses Opiate pain reliever (OPR) deaths increased five fold between 1999 -2010 for women OPR deaths among men increased 3.6 times Conclusion: More men die from drug overdoses than women, however % increase in deaths since 1999 is greater for women

8. Crude rates for drug overdose deaths and drug misuse-or abuse-related emergency department visit among women by select drug class

9. Scope of Problem in Allegheny County 2012 ACOME Death Investigations: Total Number of cases:1138 Accidental Deaths: 446 (39.1%) Unintentional Drug Deaths: 288 (25.31%) Unintentional Drug Deaths as % of Accidental Deaths: 64.5%

10. ACOME Drug Deaths as % of Morgue Cases

11. ACOME Drug Deaths as % of Accidental Deaths

12. Drug Deaths by Age Group

13. ACOME Drug Deaths by Age Group

16. Drug Deaths by Age Group 2008-2010Median Age of Death: 40 years, Range: 16-88 2011Median Age of Death: 41.5 years, Range: 15-66 2012Median Age of Death: 40 years, Range: 18-75 2011-2012 Percentage of 30-24 year olds increasing Combined the 20-34 year old categories 2007: 27.2% 2008: 24.1% 2009: 25.5% 2010: 28.1% 2011: 30.1% 2012: 40.9%

17. Drug Deaths by Race/Sex

18. ACOME Drug Deaths by Race/Sex

20. Drug Death by Race/Sex in 2012 White males accounted for highest % of deaths (52.4%) White females accounted for 32.2% in 2012 Number of white females increasing:2011:29% 2010: 27% Other races, both M and F accounted for 15.2% of deaths

21. ACOME Drug Deaths Total Single or Combined Case Year Total Drug Deaths 1 Drug2 Drug3 Drug4 Drug5 Drug6 Drug7 Drug 20122881117859271111 2011262897257271223 201022761695228917 2009223525761242036 2008235815658221323

22. ACOME DRUG DEATHS Most drug deaths involve multiple drugs (61%> 1 drug) Single drug deaths in 2008-2010 attributed to cocaine, heroin or alcohol Alcohol listed on death certificate on 18-24% of drug deaths in 2008-2010 Cocaine and heroin common co intoxicants Benzodiazepines often found with opiates

23. ACOME Accidental Overdose Cases

24. 2012 Top 8 Drugs Found Heroin most prevalent, identified in 47.9% of overdose deaths Alcohol: 25.0 % Cocaine: 23.2 % Alprazolam: 12.5 % Oxycodone: 10.7 % Morphine : 10.7 % Oxymorphone: 9.0 % Methadone:7.2 % Hydrocodone (5.2%), Codeine (3.8%), and Fentanyl(4.8%) not as prevalent Low incidence of amphetamine, methamphetamine and other designer drugs (<1%)

25. Misclassification of Morphine Deaths Heroin undergoes rapid breakdown to 6MAM and then to morphine Heroin has a half-life of 9 minutes, and 6 MAM 39 minutes Morphine has a longer half-life (1.3-6.7 hours), and therefore depending on survival time might be the only drug detected In the absence of a drug history, stamp bags, or track marks, some heroin deaths may be classified as morphine deaths

26. Top Eight Drugs Found in Overdose Deaths

27. Heroin: bricks, bundles, stamp bags…

28. Summary Heroin is responsible for greatest percentage of overdose deaths in Allegheny County Oxycodone and oxymorphone identified in 19.7% of overdose deaths The number of overdose deaths in the 20-34 year old age category increasing Pittsburgh has a “traditional pattern” of drug use

29. Acknowledgements Kristen Mertz, MD, MPH – Department of epidemiology/GSPH/University of Pittsburgh Patricia Rekiel – Computer Analyst, ACOME Karl Williams, MD, MPH,Chief Medical Examiner, ACOME