Asamota's Corner: Drug Overdoses increase in Ohio; the innocent pay for the sins of the guilty; Tyree King, Jonathan Crawford murdered by the police; more whites kill themselves od'ing on heroin

God has put it on my heart to continually tell you that the innocent will pay for the sins of the guilty!!! You have murdered people, your police, just because they were black; now your white children are killing themselves with heroin!!! The innocent will pay for the sins of the guilty!!!!

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Increasing Heroin Overdoses in Ohio:

Understanding the Issue

Governor’s Cabinet

Opiate Action Team

Epidemiological Report, No. 3

April 2014

Increasing Heroin Overdose in Ohio:

Understanding the Issue

Prepared by:

Ohio Department of Mental Health and Addiction Services

Governor’s Cabinet Opiate Action Team

Orman Hall, M.A.

Office of Quality, Planning & Research

Rick Massatti, Ph.D., M.S.W., L.S.W. and Laura Potts, M.A.

Ohio Department of Health

Division of Prevention and Health Promotion, Violence and Injury Prevention Program

Christy Beeghly, M.P.H. and Mbabazi Kariisa, Ph.D.

Please direct inquiries about

Increasing Heroin Overdose in Ohio: Understanding the Issue

to:

General: Media:

Rick Massatti, Ph.D., M.S.W., L.S.W.

Eric Wandersleben, Director of Media Relations

Ohio Department of Mental Health

and Addiction Services

Office of Quality, Planning & Research

Office of Public Affairs

30 E. Broad St., 8th Floor

30 E. Broad St., 36th Floor

Columbus, OH 43215

P: 614.752.8718 P: 614.728.5090

F: 614.488.4789 C: 614.359.6754

Rick.Massatti@mha.ohio.gov

Eric.Wandersleben@mha.ohio.gov

Suggested citation:

Massatti, R., Beeghly C., Hall, O., Kariisa, M. & Potts, L. (2014, April).

Increasing Heroin Overdoses in

Ohio: Understanding the Issue

. Columbus, OH: Ohio Department of Mental Health and Addiction

Services.

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Increasing Heroin Overdoses in Ohio: Understanding the Issue

Unintentional drug overdose deaths have increased exponentially in the last decade, both nationally

and statewide. In Ohio, there has been a 366% increase in drug overdose deaths from 2000 to 2012.

Unintentional drug overdoses caused 1,914 deaths in 2012. Over this period of time, prescription drugs

have been involved in most of the unintentional drug overdoses and have largely driven the rise in

deaths. Data from 2012 reveal a significant shift in this trend, with an apparent leveling off of prescription

opioid-related overdose deaths contrasted with a large increase in heroin-related deaths.

Figure 1. Number of Deaths and Death Rate Per 100,000 from Unintentional Drug Overdose

by Year, Ohio Residents, 2000-2012 (Source: ODH Vital Statistics)

Figure 2. Number of Unintentional Drug Overdoses Involving Selected Drugs by Year, Ohio,

2000-2012 (Source: ODH Vital Statistics)

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Increasing Heroin Overdoses in Ohio: Understanding the Issue

Contributing Factors to Increasing Heroin Overdose Rates

This shift is due to a number of factors, primarily the increasing availability of heroin throughout Ohio,

coupled with the shutdown of southern Ohio pill mills and dissemination of prescribing guidelines

on appropriate use of prescription opioids. With increasing availability, heroin has become a cheap

er alternative for prescription opioid users. Although prescription opioids do remain highly available

throughout Ohio, increasing heroin availability and purity, as well as changes in the formulation of some

prescription opioids to make them tamper-resistant have caused users to switch to heroin. Figure 3 high

lights additional contributing factors.

The shift towards increased heroin use has resulted in a higher death rate among younger Ohioans.

Ohioans aged 45-54 are at the highest risk for prescription opioid overdose; whereas young males aged

25-34 are at the highest risk for fatal heroin overdose. White Ohioans continue to be at the greatest

risk for fatal drug overdose regardless of substance; however, black males are at greater risk for hero

in overdose than white females while the reverse is true for prescription opioids. From 2011 to 2012,

the reduction in prescription opioid related

drug overdose deaths was more pronounced

among males than females, leaving females

with an ever-increasing proportion of the

total prescription opioid deaths (43% in 2012

vs. 36% in 2007). Heroin overdoses have also

impacted urban communities and northeast

ern Ohio with more intensity than prescrip

tion opioid overdoses. Table 1. Highlights

additional high risk groups by substance.

Figure 3. Key Contributing Factors to the Heroin Shift in Ohio

Changing Characteristics of Treatment Admissions

The admissions rate for opioid (i.e., heroin and prescription opioid) abuse and dependence has increased

dramatically from SFYs 2001 to 2012. While there has been virtually no change in the demographics of

client admissions, the drug of choice for those clients has changed significantly. The number of clients

with a primary diagnosis of opioid abuse and dependence rose from 5,790 in SFY 2001 to 24,833 in SFY

2012. The largest percentage of clients diagnosed with opioid abuse and dependence in any county for

SFY 2001 was 14.3 percent, but the latest figures show this number climbed sharply to 69.7 percent by

SFY 2012.

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Increasing Heroin Overdoses in Ohio: Understanding the Issue

Increasingly, clients in publicly funded AOD treatment are entering with a heroin or other opioid as their

drug of choice. Data from the treatment admissions system show that almost every demographic increas

ingly reported heroin as a primary drug of choice over time. The percentage of people reporting heroin

as a primary drug of choice was higher for women than men. The average percentage of Whites report

ing heroin as a primary drug of choice was two-and-a-half times than of African Americans. Most age

groups show increases in the percentage reporting heroin of as a primary drug of choice, with 18 to 24

years and 25 to 34 year olds reporting the largest increases.

Prescription Opioids and Prescribing Patterns

Data from the State Board of Pharmacy’s prescription monitoring program (Ohio Automated Rx Report

ing System; OARRS) reveal interesting trends when examining prescribing practices, which are especially

important given the transition some addicts make from prescription opioids to heroin. The per capita

opioid dosage rate rose from 2010 to 2012, slightly increasing from 66.3 pills to 66.9 pills for every man

women and child in Ohio. However, preliminary data for 2013 suggest that the physicians have begun

changing their practices; the number of pills prescribed per capita dropped to 65.3. While this decrease

in pills per capita is headed in the right direction, it only amounts to one less pill per capita from 2010

numbers. The OARRS program also shows some notable regional trends. All Ohio counties experienced

a decrease in average morphine equivalence per patient between 2010 and 2012 when weighting doses of

prescription opioids by a standard unit to make prescriptions comparable. Nevertheless, the rates are still

very high in some areas; southern Ohio appears to have the highest average morphine equivalence per

patient, followed by eastern and central Ohio. In Southern Ohio, Trumbull and Meigs counties stand out

as the top two counties experiencing the highest average morphine equivalence per patient (271 mg and

270 mg respectively) in 2012.

Heroin Use and Overdose

According to the EMS Reporting Incident System, the number of emergency medical services (EMS)

runs for suspected opioid-related overdose has also increased. Approximately 74,000 naloxone adminis

trations occurred from 2003 to 2012. The number of naloxone administrations per year grew every year

from 4,010 in 2003 to 10,589 in 2012 (164%).

This means that, on average, there were 11

administrations per day (or 334 per month) in

2003 and 29 administrations per day (or 882

per month) in 2012.

Many of these overdoses

are attributed to users who find themselves in

one of the high risk categories (Table 2). Per

sons who have abstained from using (typically

due to incarceration or treatment), but return

to opioid abuse may find their tolerance levels

had diminished. Additionally, those using mul

tiple drugs, especially multiple central nervous

system depressants or multiple opioids, are at a

heightened risk for overdose.

Asamota's Corner

Wednesday, September 28, 2016

Drug Overdoses increase in Ohio; the innocent pay for the sins of the guilty; Tyree King, Jonathan Crawford murdered by the police; more whites kill themselves od'ing on heroin

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