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Overdose Solutions 2013

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.

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Overdose Solutions 2013

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  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 County2008-2012 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., 1999-2010Reported 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

  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 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%

  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

  14. ACOME Drug Deaths by Age Group

  15. ACOME Drug Deaths by Age Group

  16. 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 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

  19. 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 TotalSingle or Combined

  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

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