OVERDOSE FATALITY REVIEWReview of 2020

Megan Davish, MPH, Injury Prevention CoordinatorTyra Scherer, MS, Epidemiologist

This presentation is an overview ofunintentional overdose fatalities thatoccurred in Clermont County in 2020.

The data in this presentation iscollected in partial fulfillment of thegrant requirements of the InjuryPrevention grant awarded to theClermont County Public Health by theOhio Department of Health.

The goal of thispresentation is toprovide asnapshot oftrends related tooverdose deathsin ClermontCounty.

OVERVIEW

Autopsy reports

Toxicology screens

Police reports

Clerk of Courts records

Additional public information available online

Information protected by law(Health History)

Some data points notspecifically noted in reportingand therefore not captured

Limited data on substancesources (legal and illegal)

Limited information providedwhen cases are transportedout of the county.

DATA SOURCES DATA COLLECTIONLIMITATIONS

OVERDOSE FATALITIES BY YEAR Number of unintentional drug overdose deaths that occurred in Clermont County.

Source: Clermont County Coroner's Office

2020 63 Unintentional Deaths

2017 76 Unintentional Deaths

2019 54 Unintentional Deaths

2018 68 Unintentional Deaths

2016 83 Unintentional Deaths; 1 Undetermined

Jan.Feb.

Mar.

Apr.M

ayJune

JulyAug.

Sept.O

ct.Nov.

Dec.

8

6

4

2

0

OVERDOSE DEATHS BY MONTH, 2020 N

umbe

r of D

eath

s

4

34

3

66

7

6 6 6 6

5 5

In 2020 there were 29 overdosefatalities during the first half ofthe year, identical to 2019.

However, there were 9more fatalities during the

second half of the year.

OVERDOSE DEATHS BY MONTH, 2019-2020

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

8

6

4

2

0

Num

ber

of D

eath

s

2019 2020

PERCENTAGE OF DEATHS BY MONTH, 2017-2020

20182017

2019 2020

Perc

enta

gePe

rcen

tage

Perc

enta

gePe

rcen

tage

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

15%

10%

5%

0%

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

20%

15%

10%

5%

0% Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

15%

10%

5%

0%

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

15%

10%

5%

0%

DEMOGRAPHICS &SOCIOECONOMICS

AGE SNAPSHOT, 2020

19

40

69O

LDES

TAV

ERAG

EYO

UN

GES

T

45-5427%

25-3425.4%

35-4425.4%

55-6411.1%

15-249.5%

65-741.6%

n=(63)

AGE RANGE BY YEAR

2017 2018 2019 2020

40%

30%

20%

10%

0%

Perc

enta

ge

n= (63) n= (54) n= (68) n= (76)25-34 years 45-54 years 55-64 years 65-74 years15-24 years 35-44 years 75+ years

2017 (n=76) 2018 (n=68) 2019 (n=54) 2020 (n=63)

100

75

50

25

0

GENDER BY YEAR

30%

Less than 1/3 ofthe cases were

females in 2020.(n=19)

30%35%41%

65%65%59%

Perc

enta

ge35%

70%

Male Female

BREAKDOWN: AGE AND GENDER

15-24 25-34 35-44 45-54 55-64 65-74

20

15

10

5

0

Num

ber

of C

ases

Males (n=44) Females (n=19)

AVERAGE AGE

MALES

FEMALES

37

39

MARITAL STATUS SNAPSHOT, 2020

Single

47.6%

Married

23.8%

Divorced

20.6%

Widowed

6.3%

74%OF CASES WERE

SINGLE,DIVORCED,

WIDOWED, ORUNKNOWN.

EDUCATION SNAPSHOT Less than HighSchool 15.87% (n=10)High School Graduate or GED 57.14% (n=36)

Some College9.52% (n=6)

Associate's Degree6.35% (n=4)

Bachelor's Degree1.58% (n=1)

Master's Degree1.58% (n=1)

Doctorate or Professional Degree

1.58% (n=1)Unknown

6.35% (n=4)

OCCUPATION

27%OF CASES HAD AKNOWN OCCUPATION.

AMONG 2020 CASESWITH A NOTEDOCCUPATION, 52%WORKED LABORINTENSIVE JOBS.* (N=9)

INDUSTRIES INCLUDED:CONSTRUCTION, LANDSCAPING,

HEALTHCARE, SERVICE, ANDAUTOMOTIVE OPERATIONS.

*Labor intensive is defined as positions with a largephysical component.

STABLE HOUSING AT TIMEOF DEATH

Stable Housing (79.36%)Not Stable (incl. Homeless) (14.28%)

Unknown (6.35%)

NO STABLE HOUSING INCLUDES HOMELESSINDIVIDUALS, STAYING WITH FRIENDS, LIVING

IN A CAR, AND COUCH SURFING.

THE MOST COMMON CHARGES ARE:

DRUG-RELATED (68.75%)

DRIVING UNDER THE INFLUENCE OR

DUI/OVI (47.91%)

ASSAULT (37.5%)

THEFT OR ROBBERY-RELATED

(31.25%)

CRIMINAL HISTORY

OTHER CHARGES INCLUDED UNDERAGECONSUMPTION, DRIVING UNDERSUSPENSION, ENDANGERING CHILDREN,AND MORE.

*Percent of cases with a criminal history (n-48)

2016 2017 2018 2020

125

100

75

50

25

0

66%

34%

65%

35%

64%

33%

76%

23%

(n=76) (n=82) (n=68) (n=63) P

erce

nta

ge

Unknown Yes

HEALTH FACTORS

THE MOST COMMON PHYSICAL ILLNESSIDENTIFIED:

OF CASES IDENTIFIEDOR REPORTED HAVINGA PHYSICAL ILLNESS.

PHYSICAL ILLNESS

66%

DISEASES OF THE HEART 30% OF CASES (N=44)

RESPIRATORY ILLNESS 14% OF CASES (N=21)

DISEASES OF THE LIVER 8.84% OF CASES (N=13)

1 IN 4 CASES WEREOBESE.(N=17)*

7% OF CASES REPORTEDDIGESTIVE ILLNESSES SUCHAS DIVERTICULUTIS,ULCERS, ORHEMORRHAGIC GASTRITIS.

*Cases were identified as obese or BMI wascalculated. *Many cases had multiple comorbidities.

OF CASES IDENTIFIED ORREPORTED A MENTAL ILLNESS.(N=12) (INCLUDING SUD DX BYA PROFESSIONAL ONLY.)

DEPRESSION (5)ANXIETY (2)BIPOLAR (2)PTSD (1)ADHD (1)SUD (1)

MENTAL ILLNESS IS LIKELYUNDER REPORTED DUE TO

LACK OF ACCESS TO MEDICALHISTORY AND LACK OFPHYSICAL EVIDENCE IN

AUTOPSY.

3% OF CASES HAD ADOCUMENTED HISTORY OFSUCIDAL THOUGHTS ORATTEMPTS. (N=2).

MENTAL ILLNESS

19%

*Some cases reported multiple mental illnesses.

AMONG 2020 CASES WITH A NOTEDHISTORY OF SUBSTANCE ABUSE,HEROIN WAS THE SUBSTANCE MOSTREPORTED. (33.3%, N=15).

According to SAMHSA, substanceabuse disorders occur when therecurrent use of alcohol and/ordrugs causes clinically andfunctionally significantimpairment, such as healthproblems, disability, and failureto meet major responsibilities atwork, school, or home.

SUBSTANCE ABUSE HISTORY

71%

8.8% OF CASES REPORTED A HISTORYOF FENTANYL ABUSE (N=4).

OF CASES IDENTIFIED ORREPORTED A HISTORY OFSUBSTANCE ABUSE. (N=45)

11%OF CASES NOTED A

HISTORY OF SUBSTANCEABUSE TREATMENT.

(N=7)

DEATH INVESTIGATION

50

40

30

20

10

0

LOCATION OF OVERDOSE

Decedent's Home Friend's Home Other

76%OF DEATHS

OCCURRED AT THECASE'S RESIDENCE.

OTHER LOCATIONS INCLUDE VARIOUSHOTELS, BUSINESSES AND PROPERTIES.

12.6% OF CASES WERE PRONOUNCEDDEAD AT THE HOSPITAL OR MEDICALFACILITY.(N=8) (INCLUDES DOA).

Location of Overdose

48

4

11

SCENE OF DEATH

RX DRUGS FOUND AT SCENEYes (19%) No (73%) Unknown (8%)

ILLICIT DRUGS FOUND AT SCENEYes (38%) No (54%) Unknown (8%)

57% OF CASES WHERE DRUG PARAPHERNALIAWAS FOUND AT THE SCENE. (n=36)

Yes (27%) No (58%) Unknown (11%)

CASES NOTED NALOXONE WASADMINISTERED EITHER BY EMS,LAW

ENFORCEMENT OR A BYSTANDER.** (N=11).

LIFE SAVING INTERVENTIONS/ATTEMPTS

ALONE AT TIME OF DEATH

17%

MORE THAN 1/4 OFCASES RECEIVED CPR

(38%) (N=24).

**Naloxone administration data is gleaned from police reports not EMS reports, and therefore is not always noted.

2016 2017 2018 2020

100%

75%

50%

25%

0%

TOXICOLOGY TYPE

OF CASES'TOXICOLOGYRESULTS WEREPOLYSUBSTANCEIN 2020.

(N=52)

96%

**96% of cases were a toxicology screen was performed(n=54, 85.7% of total cases).

Polysubstance Single Drug No Tox Screen

SUBSTANCES PRESENT BY YEAR

NOTE: DATA LABELS INDICATE THE PERCENTAGE OF TOTAL CASES THAT WERE POSITIVE FOR EACH SPECIFIC SUBSTANCE

2016 2017 2018 2020

100%

75%

50%

25%

0%

(n=54) (n=77) (n=64) (n=62)

Perc

enta

ge

Marijuana Cocaine Methamphetamine Heroin Other opioidsAlcohol Sedatives

Other RX OTC Anti-Depressants

SUBSTANCES PRESENT, 2020

100%

75%

50%

25%

0%

22%

42%26%

18% 24%

89%

39% 35%28%

1.8%

Perc

enta

ge

2020 (n=54) Marijuana Cocaine Methamphetamine Heroin Fentanyl Other opioidsAlcohol Sedatives

Other RX OTC

OF CASES TOXICOLOGY RESULTS WERE POSITIVEFOR NALTREXONE (N= 10)18%

3.7%

Anti-Depressants

SUBSTANCES PRESENT BASED ON LOCATIONOPIOIDS STIMULANTS SEDATIVES

OPIOIDS PRESENT

OF CASES'TOXICOLOGY RESULTSWERE POSITIVE FORAT LEAST ONEOPIOID.(N=54)

89%

IN 2019, 90% OFCASES TOXICOLOGY

RESULTS WEREPOSITIVE FOR

FENTANYL, SIMILARTO THE 89% IN 2020.

Fentanyl

Heroin

Codeine

Oxycodone

Methadone

Hydrodone

Oxymorphone

Tramadol

Buprenorphine

89%

24%

1.8%

1.8%

3.7%

3.7%

1.8%

5.5%

9%

n=54

TRENDS

CLERMONT COUNTY ISRANKED 11TH IN THESTATE OF OHIO FOR UNINTENTIONALDRUG OVERDOSEDEATHS FROM 2010-2019.

11TH

*Source Ohio Department of Health, 2019 Drug Overdose Data:General Findings

UNINTENTIONAL OVERDOSE DEATH RATE BYCOUNTY, ADJUSTED BY AGE 2014-2019

Source: Ohio Department of Health, Bureau of Vital Statistics, U.S. Census Bureau (Vintage 2019 population estimates). Analysis: ODH Violence and Injury Prevention Section.Includes Ohio residents who died due to unintentional drug poisoning (underlying cause of death ICD-10 codes x40-X44). County is based on county of residence.

2015 2016 2017 2018 2019 2020**

100%

75%

50%

25%

0%

PERCENTAGE OF FENTANYL AND HEROIN RELATED DRUG OVERDOSE DEATHSBY YEAR,

CLERMONT COUNTY RESIDENTS

INCLUDES CLERMONT COUNTY RESIDENTS WHO DIED DUE TO UNINTENTIONAL DRUG POISONINGWHERE THE HEROIN IDICATOR OR FENTANYL AND ITS ANALOGUES ARE SPECIFCIALLY NOTED ONTHE DEATH CERTIFICATE.

*2020 Data is still preliminary and subject to change Source Ohio Public Health Data Warehouse, 5/21/2020

Fentanyl Heroin

Q1 2020 Q2 2020 Q3 2020 Q4 2020 Q1 2021 Q2 2021

150

100

50

0

91

134

120108

91

55

Num

ber o

f Nal

oxon

e Ad

min

istr

atio

nsNALOXONE ADMINISTRATIONS BY OHIO EMS PROVIDERS,

CLERMONT COUNTY

** 83.4% of Transporting Ohio EMS Agencies Reporting.Source: Ohio Emergency Medical Services, Naloxone Administration by County.

NALOXONE ADMINISTRATIONRATE BY ZIP CODE,

CLERMONT COUNTY 2020

**85.5% of Transporting Ohio EMSAgencies Reporting

Source: Ohio Emergency Medical Services, Naloxone Administration by County.

NALOXONEADMINISTRATIONRATE BY ZIP CODE,

CLERMONT COUNTY2020

**85.5% of TransportingOhio EMS Agencies

Reporting

Source: Ohio Emergency Medical Services,Naloxone Administration by County.

Rates were calucated with the population

estimated in 2019. If this data was not available,the 2010 US Census Demographic profile was

used.

NALOXONE ADMINISTRATION RATE COMPARED TO INCIDENCE OF OVERDOSEFATALITIES BY ZIP CODE, CLERMONT COUNTY 2020

Naloxone Administration Rates Overdose Fatality Rates Overdose Fatality and Naloxone

Administration Rates

2015 2016 2017 2018 2019 2020

300

200

100

0

OPIOID PRESCRIPTIONS DISPENSEDBY YEAR, CLERMONT COUNTY

2015 2016 2017 2018 2019 2020

75

50

25

0

THE TOTAL NUMBER OFPRESCRIBED OPIOID DOSESDISPENSED IN CLERMONTCOUNTY CONTINUES TODECREASE, WITH A 4.6%DECREASE BETWEEN 2015AND 2019.

DURING THE SAME TIMEFRAME, THERE WAS A 43%

INCREASE IN THE TOTALNUMBER OF STIMULANT

DOSES DISPENSED.

258.2 263.2 253.8 254.6 246.1

136.3

Dos

es p

er p

atie

nt**

DOSES PER PATIENT

DOSES PER CAPITA

Dos

es p

er C

apita

**

***2020 Reporting the first quarter** Solid Oral Doses*Population Data from 2010 Ohio Department of DevelopmenttSource: Ohio Automated Rx Reporting System

66.9 62.7 58.4

50.5 45.3

9.6

THE SYRINGE SERVICES PROGRAM CONTINUED TO SERVE CLERMONT COUNTY RESIDENTS.

2020 ACCOMPLISHMENTS

DESPITE THE COVID-19 PANDEMIC, SERVICESACROSS THE SPECTRUM OF TREATMENTCONTINUED TO SERVE CLIENTS ACROSS THECOUNTY.

PROJECT D.A.W.NKITS DISTRIBUTED

IN CLERMONTCOUNTY IN 2020

15,653 SYRINGES EXCHANGED351 VISITS BY CLERMONT COUNTY RESIDENTS254 DOSES OF NALOXONE DISTRIBUTED

407

PROJECTD.A.W.N.

CLERMONT COUNTY RECOVERY CENTER AND CHILD PROTECTIVE SERVICES BEGAN COORDINATING CARE FOR HIGH-RISK FAMILIES.

INTERVENTIONS TO CONSIDER

QUESTIONS

TYRA SCHERER, MS, EPIDEMIOLOGISTTSCHERER@CLERMONTCOUNTYOHIO.GOV

MEGAN DAVISH, MPH, INJURY PREVENTION COORDINATORMDAVISH@CLERMONTCOUNTYOHIO.GOV

This work is funded either in whole or in part by a grand awared by the Ohio Department of Health, Office of Health Improvement and Wellness, Violence and Injury Prevention Section and as a subaward of a grant issued by Preventative Health and Health Services BLock Grant under the Injury Prevention Program Grant. Grant award number r 6NBO1OT009137-01-03, and CFDA number 93.758