Aaron C Willis PhDc AM LSW Acknowledgements Marion County Coroners Office Alfie Ballew MBA Chief Deputy Coroner Presentation Overview Study Protocol Overall Findings Opiate Overdose Trends from 2007 2014 ID: 1040080
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1. Using Marion County Coroner Data to Inform the Prevention of Opiate Overdose FatalitiesAaron C. Willis, PhD(c), AM, LSW
2. AcknowledgementsMarion County Coroner’s OfficeAlfie Ballew, MBA, Chief Deputy Coroner
3. Presentation OverviewStudy ProtocolOverall FindingsOpiate Overdose Trends from 2007 – 2014Risk FactorsBenzodiazepines“So Whats?”
4.
5. Examining Marion County Coroner’s Office Records~ 1.5 year processGathered data from 2007-2014Included in the study:Cause of Death was listed as an opiateToxicology report found traces of an opiateAccident, Could Not Be Determined, and Suicide
6. Sources of DataDeath CertificateGender, age, address, Veteran status, education, employment, Manner of Death, Place of Death, Cause of DeathAutopsy Report/Toxicology ReportAll substances of misuse, psychotropic, many medicationsDeputy Coroner’s Field ReportNarrative of investigationMedical conditions, mental health history, substance misuse history, previous overdoses, suicide attempts, recent release from incarceration or inpatient setting
7. Overdose Fatalities 2007 - 20141174 peopleGender Male747 (64%) Female427 (36%)Race Caucasian/White1005 (86%) African American/Black149 (13%)Age Average40 years old Range16 – 81 years oldResidence Indianapolis941 (80%) Marion County991 (87%) Indiana1145 (98%)Overdose Fatalities 2007 - 20141174 peopleVeteran Yes100 (9%) Education Some HS281 (24%) HS Grad/GED561 (48%) Some College171 (15%) College Grad and above152 (13%)Manner of Death Accident950 (81%) Not Determined756 (13%) Suicide68 (6%)
8. Gender and Overdose Fatalities
9. Trends in Opiate Overdose Fatalities
10. Proportion Changes in Opiate Overdose Fatalities
11. Trends in Heroin Usep<.003
12. Trends in Fentanyl Usep<.004
13. Trends in Methadone Usep<.05
14. Trends in Oxycodone Use
15. Trends in Hydrocodone Usep<.05
16. Trends in Morphine Usep<.05
17. Trends in All Other Opiate Use
18. Trends in All Prescription Painkiller Usep<.05
19. Recap of OpiatesProportion of useHeroin is trending up since 2010 – last 2 years significant differenceFentanyl was trending down and at 3 year lows until significant spike in 2014Methadone trending down – significant lows last 3 yearsOxycodone trending down past 3 years, but no significant differencesHydrocodone trending down and at lowest significant point last yearMorphine erratic, last 2 years below proportion average, but trending upAll other opiates, trend uncertain, but increase in last 2 years to highest proportion of useAll prescription painkillers, overall trends down, at 2 lowest proportions in last 2 years
20. Risk Factors, Characteristics, Traits of Overdose FatalitiesOverdose Fatalities 2007 – 2014 (N=1174)YesPrevious Suicide Attempts7% (n=84)Previous Overdoses13% (n=156)Injury/Medical Condition57% (n=667)Recent Release from Incarceration8% (n=97)Mental Health History31% (n=362)Substance Misuse History82% (n=960)Intravenous Drug Use15% (n=180)
21. History of Injury, Illness, Disorder, or Diseasep<.05
22. Recent Release from Incarceration or Inpatient Settingp<.01
23. History of Mental Illness
24. History of Substance Misusep<.001
25. History of Injection Drug Usep<.001
26. Polysubstance Use and Benzodiazepines
27. Trends in Benzodiazepine Usep<.001
28. Benzodiazepine Use: Only Heroin, Only Painkiller, Both Heroin & Painkiller
29. Characteristics Among Those Using Benzodiazepines: Mental Health History
30. Characteristics Among Those Using Benzodiazepines: Marijuana Use
31. Characteristics Among Those Using Benzodiazepines: Methadone Use
32. Characteristics Among Those Using Benzodiazepines: Oxycodone Use
33. Characteristics Among Those Using Benzodiazepines: Hydrocodone Use
34. The So What’sMental HealthEnforcementBenzodiazepines/PolysubstanceReal painInjection Drug Use
35. Mental HealthNational Survey on Drug Use and Health – 18.5% prevalence in US31% of total study sampleHigh number of overdoses with mental health history, BUT remains consistent each yearIncrease in overdose fatalities are not explained by mental health
36. EnforcementSimilar to Mental Health, proportion change pretty constant among prescription painkillersHeroin use increasing dramaticallyDramatic increase in FentanylIs enforcement working?
37. Benzodiazepines/Polysubstance UseUse of benzodiazepines continues to be highOnly substance with more “Yes” than “No”Xanax and Clonopin biggest misusersPolysubstance use is the normVery alarming the number of depressants used togetherEducation to patients, clients, inmates, family members
38. Real PainOver half had history of injury/medical concernsTheme in Deputy Coroner Reports – pain, suffering, discomfortMany chronic injuriesWhat about acute flare-ups?Have we abandoned our patients?
39. Injection Drug UseInjection Drug Use 15% (n=180)Entire Sample100% (n=1174)Male71% (n=127)64% (n=747)Mental Health History19% (n=34)31% (n=362)Incarceration History17% (n=30)8% (n=97)Benzodiazepine Use40% (n=72)54% (n=639)Only Heroin Use52% (n=94)28% (n=334)Heroin Use73% (n=131)38% (n=451)Only Painkiller Use27% (n=49)62% (n=723)
40. Thank you!Questions?