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Overdose Solutions 2013. Overdose Data for Allegheny County Jennifer Janssen Manager Toxicology Laboratory Allegheny County Office of the Medical Examiner ACOME. The Overdose Problem in Allegheny County 2008-2012. Allegheny County Overdose Prevention Coalition July 24, 2013. - PowerPoint PPT Presentation
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OVERDOSE SOLUTIONS 2013
OVERDOSE DATA FOR ALLEGHENY COUNTY
Jennifer JanssenManager Toxicology Laboratory
Allegheny County Office of the Medical ExaminerACOME
The Overdose Problem in Allegheny County2008-2012
Allegheny CountyOverdose Prevention
Coalition
July 24, 2013
Jennifer Janssen, M.S.Allegheny County
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.
Rate* of unintentional drug overdose deaths — United States, 1970–2007
* Per 100,000 population
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
Unintentional Drug Overdose Deaths in U.S. during 1999-2007
Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women –U.S., 1999-2010Reported 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
Crude rates for drug overdose deaths and drug misuse-or abuse-related emergency department visit among women by select drug class
Scope of Problem in Allegheny County2012
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%
ACOME Drug Deaths as % of Morgue Cases
2012 2011 2010 2009 2008 20070.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
25.31%
22.18%
19.62% 18.99%20.80%
18.70%
Drug Deaths as % of Morgue Cases
Drug Death as % All Morgue Cases
ACOME Drug Deaths as % of Accidental Deaths
2012 2011 2010 2009 2008 20070.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%64.43%
60.37%58.06% 57.77% 56.63%
49.89%
Drug Deaths as % of Accidental Deaths
Drug Death as % Accidental Deaths
Drug Deaths by Age Group
ACOME Drug Deaths by Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%20.00%
0.69%
8.33%
15.97% 16.67%
7.64% 7.29%
11.81%
17.71%
8.33%
5.21%
0.35%
2012 % of Drug Deaths per Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%
2.29%
6.11%
11.45%12.60% 12.21%
13.36%
16.79%
13.74%
7.25%
4.20%
2011 % of Drug Deaths per Age Group
ACOME Drug Deaths by Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%20.00%
1.76%
6.61%
11.01% 10.57%8.81%
12.78%14.10%
17.18%
11.01%
4.41%1.76%
2010 % of Drug Deaths per Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%
3.14%
5.83%
11.66%
8.07%10.31%
13.45%15.25%
17.04%
10.31%
4.04%
0.90%
2009 % of Drug Deaths per Age Group
ACOME Drug Deaths by Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%20.00%
2.97%
9.75% 9.32%
5.08%
8.90%
16.10%18.64%
15.68%
9.32%
2.54% 1.69%
2008 % of Drug Deaths per Age Group
0 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60 thru 69 70 or >0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
3.13%6.25%
10.27% 10.71% 9.38%11.16%
16.07%19.20%
9.38%
3.57%0.89%
2007 % of Drug Deaths per Age Group
Drug Deaths by Age Group• 2008-2010 Median Age of Death: 40 years, Range: 16-88• 2011 Median Age of Death: 41.5 years, Range: 15-66• 2012 Median Age of Death: 40 years, Range: 18-75• 2011-2012 Percentage of 30-24 year olds increasingCombined the 20-34 year old categories
2007: 27.2%2008: 24.1%
2009: 25.5%2010: 28.1%2011: 30.1%2012: 40.9%
Drug Deaths by Race/Sex
ACOME Drug Deaths by Race/Sex
White Black Other0
20406080
100120140160 151
264
93
131
2012 Drug Deaths by Race / SexMale Female
White Black Other0
20406080
100120140160 152
201
76
13
2011 Drug Deaths by Race / SexMale Female
ACOME Drug Deaths by Race/Sex
White Black Other0
20406080
100120140 131
28
2
57
5
2009 Drug Deaths by Race / SexMale Female
White Black Other0
20406080
100120140 124
28
1
63
11
2010 Drug Deaths by Race / SexMale Female
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
ACOME Drug Deaths TotalSingle or Combined
Case Year
Total Drug Deaths
1 Drug 2 Drug 3 Drug 4 Drug 5 Drug 6 Drug 7 Drug
2012 288 111 78 59 27 11 1 1
2011 262 89 72 57 27 12 2 3
2010 227 61 69 52 28 9 1 7
2009 223 52 57 61 24 20 3 6
2008 235 81 56 58 22 13 2 3
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
ACOME Accidental Overdose Cases
Heroin; 138
Alcohol; 72Cocaine; 67
Alprazolam; 36
Morphine; 31
Oxycodone; 31
Oxymorphone; 26Methadone; 21
2012 Top 8 Drugs FoundSingle or Combined OD
HeroinAlcoholCocaineAlprazolamMorphineOxycodoneOxymorphoneMethadone
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%)
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
Top Eight Drugs Found in Overdose Deaths
Cocaine; 86
Alcohol; 56
Heroin; 50Morphine; 48
Oxycodone; 40
Alprazolam; 39
Methadone; 32
Diazepam; 20
2010 Top 8 Drugs FoundSingle or Combined OD
CocaineAlcoholHeroinMorphineOxycodoneAlprazolamMethadoneDiazepam
Cocaine; 76
Heroin; 63
Alcohol; 61Morphine;
40
Alprazo-lam; 39
Methadone; 38
Oxy-codone; 33Hydrocodone; 25
2009 Top 8 Drugs FoundSingle or Combined OD
CocaineHeroinAlcoholMorphineAlprazolamMethadoneOxycodoneHydrocodone
Heroin; 138
Alcohol; 72Cocaine; 67
Alprazo-lam; 36
Morphine; 31
Oxy-codone; 31
Oxymor-phone; 26Methadone; 21
2012 Top 8 Drugs FoundSingle or Combined OD
HeroinAlcoholCocaineAlprazolamMorphineOxycodoneOxymorphoneMethadone
Heroin; 95
Cocaine; 83
Alcohol; 60
Oxycodone; 51
Alprazolam; 42
Methadone; 26
Diazepam; 25
Morphine; 24
2011 Top 8 Drugs FoundSingle or Combined OD
HeroinCocaineAlcoholOxycodoneAlprazolamMethadoneDiazepamMorphine
Heroin: bricks, bundles, stamp bags…
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
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