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Putting the Pieces Together: Strengthening Data to Combat the Drug Overdose Crisis in Kansas

Learn how data surveillance & prevention strategies are combating drug overdose crisis in Kansas, with focus on partnerships & funding opportunities. Explore overdose data trends & CDC's strategies.

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Putting the Pieces Together: Strengthening Data to Combat the Drug Overdose Crisis in Kansas

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  1. Putting the Pieces Together:Strengthening Data to Combat the Drug Overdose Crisis in Kansas Photo Source: http://elvocerous.com/images/M_images/aNewsimagen/Michigan2/Opioides.jpg Jennifer Donnelly, MPH Drug Overdose and Prescription Drug Monitoring Program Epidemiologist Kansas State Board of Pharmacy 2019 Coroner’s Conference July 17, 2019 Wichita, Kansas

  2. CDC’s Drug Overdose Strategy Learning Objectives Overdose Data to Action Funding Drug Overdose Trends Nationally and in Kansas Data Linkages: K-TRACS and Death Certificates Photo Source: https://static1.squarespace.com/static/590b8e4086e6c0b867364a35/t/5bc90009b208fcae3202e269/1539899423113/Dumped+Out+Puzzle+Pieces?format=1000w

  3. CDC’s Drug Overdose Strategy Source: https://www.cdc.gov/opioids/pdf/Strategic-Framework-Factsheet_Jan2019_508.pdf

  4. Data on Deaths attributed to: • Heroin • Natural/semi-synthetic opioids • Methadone • Synthetic Opioids other than Methadone • Any Opioid related overdose • Prescription Opioid • Cocaine • Psychostimulants such as methamphetamine Toxicology screening may be critical to understanding cause of death in overdose fatalities. CDC Strategy Conduct Surveillance & Research Source: https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf

  5. CDC - Overdose Data to Action (OD2A) • Surveillance - • Collecting and disseminating timely emergency department data on suspected all drug, all opioid, heroin, and all stimulant overdoses • Collecting and disseminating descriptions of drug overdose death circumstances using death certificates and medical examiner / coroner data (enhanced use of toxicology) • Implementing innovative surveillance activities to support interventions (also applicable to local and territory applicants), including data linkages Prevention – • Strengthening prescription drug monitoring programs • Improving state-local integration • Establishing linkages to care • Improving provider and health system support New 3-year funding opportunity Incorporates surveillance and prevention strategies into a multi-year workplan Focuses on partnerships: State and Local Public Health Community Photo Sources: https://www.cdc.gov

  6. Drug Overdose Trends in the United States Photo Credits: http://www.drugsdb.com/blog/most-abused-prescription-drugs.html https://www.istockphoto.com/thinkstock

  7. People Died every day in 2016 and 2017 from an Opioid Related Overdose People used Heroin for the First time in 2016 People Misused Prescription Opioids in 2016 130 + Drug Overdose Trends in the United States 81,000 11.4 million Increase in overdose Death involving Psychostimulants (such as methamphetamine) between 2016 & 2017 37 % Photo Credit: Gregory Reid (https://www.aarp.org/health/drugs-supplements/info-2017/opiates-prescription-pain-medication-information.html Data Source: https://www.hhs.gov/opi1oids/about-the-epidemic/index.html

  8. Age Adjusted Overdose Death Rates (per 100,000 population) Involving Opioids, by Type, United States, 2000 -2017

  9. Age-Adjusted Rates(per 100,000 population) of Drug Overdoses by State: United States, 2017 Source: https://www.cdc.gov/nchs/products/databriefs/db329.htm

  10. United States Prescribing Rate of Opioids per 100 Persons 2012 2006 2017 Kansas Rate 90.3 Opioid Prescriptions per 100 persons Kansas Rate 77.5 Opioid Prescriptions per 100 persons Kansas Rate 69.8 Opioid Prescriptions per 100 persons Technical Note – CDC prescription data is not from K-TRACS. It comes from IQVIA Xponent 2006–2017. IQVIA Xponent is based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the United States. Data Source: - https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

  11. Number of Drug Overdose Deaths by Age, All Races, Both Sexes, United States – 2017 (N=70,237) Data Source: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/ Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug-poisoning deaths are defined as having ICD–10 underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent).

  12. Number of Drug Overdose Deaths by Sex, All Races, All Ages, United States – 2017 Males accounted for 46,552 or 66.3% of all drug overdose deaths in 2017 In 2017, a total of 70,237 drug overdose deaths were reported to CDC Females accounted for 23,685 or 33.7 % of all drug overdose deaths in 2017 Data Source: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/

  13. Age-Adjusted Rate (per 100,000 population) of Drug Overdose Deaths by Race/Ethnicity, All Ages, both Sexes, United States: 2000 - 2017 Non-Hispanic Whites Non-Hispanic Blacks Hispanic/Latino Data Source: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/

  14. Rates of deaths due to Heroin and Prescription Drugs appear to have stabilized from 2016 to 2017 but still remain high. United States Drug Overdose Trends, Key Points Deaths involving synthetic opioids (Fentanyl) continue to drive increases in overdose deaths. Polysubstance use including increases in stimulant abuse is now considered to be the 4th wave of the drug crisis in the US. Overdose deaths attributed to cocaine and psychostimulants increased by 34.4% and 37.0% between 2016 and 2017. Data Sources: https://www.cdc.gov/drugoverdose/data/index.html Photo Source: https://static1.squarespace.com/static/590b8e4086e6c0b867364a35/t/5bc90009b208fcae3202e269/1539899423113/Dumped+Out+Puzzle+Pieces?format=1000w

  15. Drug Overdose Trends in Kansas Photos Sources: https://www.collegechoice.net/rankings/best-colleges-in-kansas/ https://www.therecoveryvillage.com/opiate-addiction/opiates-change-personality/#gref

  16. Age Adjusted Overdose Death Rates (per 100,000 population), by Drug Type, Kansas, 2005 -2017 Unknown (R99) Any Opioid Commonly Prescribed Opioids Psychostimulants (including methamphetamine) Other Synthetic Opioids (e.g., fentanyl, tramadol) Heroin Note: Rate based are small cell counts are generally thought to be unstable. The Kansas Department of Public Health and Environment define small numbers are less than 6. These rates are suppressed in this graphic.

  17. 10 Year Average Age-Adjusted Rate (per 100,000 population) for All Drug Overdose Deaths by County, Kansas (2007-2017) This map displays age-adjusted rates for deaths attributed to any drug overdose per 100,000 Kansas residents for counties with at least 5 overdose events. The reference population used is the 2000 census estimates for Kansas by county.

  18. Prescriptions per Capita by Patient County Kansas Prescribing Rate of Opioids per 100 Residents 2016 2015 2017 2,555,858 Opioid Prescriptions were dispensed to Kansas Residents in 2015 (89.6 per 100 population) 2,396,957 Opioid Prescriptions were dispensed to Kansas Residents in 2017 (84.0 per 100 population) 2,604,203 Opioid Prescriptions were dispensed to Kansas Residents in 2016 (91.3 per 100 population) Technical Note – These maps display opioid prescription dispensations as reported to K-TRACS. Reporting to K-TRACS is voluntary. Rates are calculated using 2000 US census standard population. Data Source: -APPRISS Health Data Dashboard – Dispensations by County

  19. Number of Drug Overdose Deaths by Type and Age Group for All Races and Both Sexes, Kansas - 2017 Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug-poisoning deaths are defined as having ICD–10 underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent).

  20. 5 Year Average Age-Average Adjusted Rate (per 100,000 population) of Drug Overdose Deaths by Sex, All Races, All Ages, Kansas, 2012-2017 12.4 per 100,000 males died on a drug overdose in Kansas From 2012 to 2017, a total of 1,908 drug overdose deaths were reported in Kansas 10.3 per 100,000 females died of a drug overdose in Kansas

  21. 5 Year Average Age-Adjusted Rate (per 100,000 population) for Drug Overdose Deaths by Race/Ethnicity, All Ages, both Sexes, Kansas: 2012-2017 *Data with counts less than 6 are not displayed per KDHE suppression rules

  22. Age-adjusted rates of deaths due to prescriptions opioids continue to be higher than other types of overdose deaths. Kansas Drug Overdose Trends, Key Points Deaths involving psychostimulants have increased by 130% from 2014 (n=33) and 2017 (n=76). Individuals considered to be white have higher rates of drug overdose deaths across all categories, except heroin. Opioid prescriptions registered in K-TRACS suggest a gradual decline in the number of opioid prescriptions dispensed from 2015 – 2017. Photo Source: https://static1.squarespace.com/static/590b8e4086e6c0b867364a35/t/5bc90009b208fcae3202e269/1539899423113/Dumped+Out+Puzzle+Pieces?format=1000w

  23. Data Linkages – What can we learn about Drug Overdose Deaths from K-TRACS?

  24. Prescription Drug Monitoring Program K-TRACS is a voluntary controlled substance registry that is available 24/7 through a web based portal Primary goals are: • Provide education and information to prescribers and pharmacies • Monitor trends and address controlled substance prescribing and utilization for public health • Prevent misuse, abuse and diversion of controlled substances • Give prescribers and pharmacies access to controlled substance history at the patient level • Alert prescribers to patients that may benefit from a referral to treatment for substance abuse disorders

  25. Data Linkage : K-TRACS and 2018 and Mid-Year 2019 Death Certificates • Methodology • Deaths occurring in Kansas among Kansas residents • All Drug Overdose Deaths must have one of these underlying cause of death codes • X40–44 (unintentional) • X60–64 (suicide) • X85 (homicide) • Y10–Y14 (undetermined intent) •  Contributing Cause of Death due to Prescription Opioid • Deaths involving a prescription opioid (T40.2) • Natural and semi-synthetic opioids and (T40.3) • Natural/semisynthetic opioids (T40.2), • Synthetic opioids other than methadone (T40.4)

  26. Data Linkage : K-TRACS and 2018 and Mid-Year 2019 Death Certificates • Cohort Characteristics • Total Deaths included (N= 158) • Time Frame: January 1, 2018 – May 1, 2019 • Median age of decedents is 44 years with a range of 16 to 70 • Gender and Race/Ethnicity were not included in the dataset

  27. Decedents had a record in K-TRACS (144 out of 158 records) 91.1% Who was in K-TRACS? Descendants had an overlapping Benzodiazepine and Opioid Prescription 45.5% Descendants had an overlapping Benzodiazepine, Muscle Relaxer and Opioid Prescription 3

  28. 31 out of 144 or 21.5% of decedents had greater than 5 providers in 2 years • 13 out of 144 or 9.0 % had prescriptions dispensed at 4 or more pharmacies in 90 days K-TRACS - High Risk Behavior Indicators The average number of prescribers was 3with a range of 1 to 35 The average number of prescriptions was almost 22 with a range of 1 to 106 The average days to death from last fill date was 186 with a range of -122 to 2,333 Photo Source: PIcasa

  29. Decedents ages 34 years and younger had a 3.9 greater odds (95% CI = 1.88 – 7.91) of having Fentanyl listed as a cause of death compared to those 35 years and older. • Considerations: Wide confidence intervals suggest that a larger sample size in needed. However the large odds ratio is statistically significant at the 0.05 alpha level. Future analyses including multiple years may be warranted.

  30. 40.7 % of descendants did not have K-TRACS prescriptions listed as a contributing cause of death Future analyses need to be conducted to understand prescribing patterns of Benzodiazepines and Opioids K-TRACS Death Certificate Linkage K-TRACS can be used by Death Investigators to help determine cause of death on a case by case basis Future analyses can help understand the impact of declining opioid prescribingand increase deaths due to illicitopioid use Photo Source: https://static1.squarespace.com/static/590b8e4086e6c0b867364a35/t/5bc90009b208fcae3202e269/1539899423113/Dumped+Out+Puzzle+Pieces?format=1000w

  31. Acknowledgements Farah Ahmed, MPH, Ph. D.– Environmental Health Officer and State Epidemiologist Lou Saadi, Ph.D. – State Registrar and Director, Bureau of Epidemiology and Public Health Informatics Greg Crawford – Director, Vital and Health Statistics Data Analysis Section Nirmala Gunashekaran - Opioid Surveillance Coordinator Ahmed Ismail, MB, BCh, Ph.D. – Cancer Program Advanced Epidemiologist David Oakley, MA – Health Data Analyst Adrienne Hearrell, MPH, CPTA – Opioid/Drug Overdose Program Manager Reyne Kenton – K-TRACS Program Manager

  32. Questions & Discussion Photo Source: https://static1.squarespace.com/static/590b8e4086e6c0b867364a35/t/5bc90009b208fcae3202e269/1539899423113/Dumped+Out+Puzzle+Pieces?format=1000w

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