overdose fatality review...rev iew of 2017 ty ra sche rer, ms, inj ur y prevention coordin ator ......

OVERDOSE FATALITY REVIEW Review of 2017 

Tyra Scherer, MS, Injury Prevention Coordinator

Tara Jimison, BSN, RN, Epidemiologist 

The data in this presentation is collectedin partial fulfillment of the grantrequirements of the Injury Preventiongrant awarded to Clermont County PublicHealth by the Ohio Department of Health.

This presentation is an overview ofunintentional and undetermined overdosefatalities that occurred in ClermontCounty in 2017.  

OVERVIEW

THE GOAL OF THISPRESENTATION ISTO PROVIDE ASNAPSHOT  OFTRENDS RELATEDTO OVERDOSEDEATHS INCLERMONTCOUNTY. 

DATA COLLECTIONLIMITATIONS

DATA SOURCES

LIMITED INFORMATIONPROVIDED WHEN CASES ARETRANSPORTED OUT OF COUNTY

AUTOPSY REPORTS

LIMITED DATA ON SUBSTANCESOURCES (LEGAL AND ILLEGAL)

TOXICOLOGY SCREENS

SOME DATA POINTS NOTSPECIFICALLY NOTED INREPORTING AND THEREFORE 

NOT CAPTURED

POLICE REPORTS

INFORMATION PROTECTED BYLAW  (HEALTH HISTORY)

CLERK OF COURTSRECORDS

ADDITIONAL PUBLICINFORMATIONAVAILABLE ONLINE

OVERDOSE FATALITIES BY YEAR

2014

2015

2016

2017

68 Unintentional deaths

93 Unintentional deaths

83 Unintentional deaths; 1 Undetermined

76 Unintentional deaths

Source: Clermont County Coroner's Office

NUMBER OF UNINTENTIONAL AND UNDETERMINED DRUG OVERDOSE DEATHSTHAT OCCURRED IN CLERMONT COUNTY

OVERDOSE DEATHS BY MONTH, 2017

3 3

6 6

7

9

8

7

6

5

3

13

0

5

10

15

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

Nu

mb

er o

f Dea

ths

OF 2017 DRUGOVERDOSE DEATHS

OCCURRED INDECEMBER (n=13)

14%

PERCENTAGE OF DEATHS BY MONTH, 2014-2017

2017

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0

10

20

2016

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0

10

20

2015

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0

10

20

2014

J.. F.. M.. A.. M.. J.. J.. A.. S.. O.. N.. D..0

10

20

2017

2016

2014

2015

Per

cen

tage

Per

cen

tage

Per

cen

tage

Per

cen

tage

DEMOGRAPHICS

GENDER BY YEAR

Male Female

75%

67%71%

59%

25%

33%29%

41%

2014 2015 2016 20170

10

20

30

40

50

60

70

80

OVERDOSE DEATHS  THAT OCCURRED IN 2017 

WERE WOMEN

2/5

HISTORICALLY, THIS IS THECLOSEST GAP BETWEENTHE PERCENTAGES OFMALES AND FEMALES

(n=69)

(n=94)

(n=82)

(n=76)

Per

cen

tage

AGE RANGE BY YEAR

<15 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75+ years

0

5

10

15

20

25

30

35

2014 2015 2016 2017

Per

cen

tage

(n=69)

(n=94)

(n=82)

(n=76)

15-24 years (5.26%) 25-34 years (26.32%) 35-44 years (31.58%)

45-54 years (18.42%) 55-64 years (18.42%)

AGE SNAPSHOT, 2017

YOU

NG

EST

O

LDE

ST

AVE

RA

GE

(n=76)

FEMALES

Males (n=45) Females (n=31)

0

5

10

15

20

25

15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs

BREAKDOWN: AGE AND GENDER

AVERAGE AGE

MALES

43

39

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es

MARITAL STATUS SNAPSHOT

Single

Married

Divorced

Widowed

Unknown

47%

29%

18%

4%

1%

80%

OF 2017 CASESWERE SINGLE,DIVORCED, OR

WIDOWED 

(n=76)

EDUCATION SNAPSHOT

Unknown 1% (n=1)

College Graduate 3% (n=2)

High School Graduateor GED 74% (n=56)

Less than High School 22% (n=17)

CRIMINAL HISTORY

Yes Unknown

2014 2015 2016 20170

10

20

30

40

50

60

70

THE MOST COMMONCHARGES ARE :

** Percent of cases with acriminal history (n=50)

THEFT ORROBBERY-RELATED 

(74%**)

DRUG-RELATED(70%**)

(n=69)

(n=94)

(n=82)

(n=76)

Per

cen

tage

HEALTH FACTORS

1 IN 3 CASES HAD A CHRONICILLNESS OF THE LIVER INCLUDINGHEPATITIS C AND CIRRHOSIS OF

THE LIVER (n=24) 

75%

PHYSICAL ILLNESS

CASES IDENTIFIED ORREPORTED HAVING APHYSICAL ILLNESS 

THE MOST COMMON PHYSICALILLNESSES IDENTIFIED:

DISEASES OF THE HEART

47% CASES (n=36)

RESPIRATORY ILLNESSES 17% CASES (n=13)

DISEASES OF THE LIVER

32% CASES (n=24)

13% OF CASES REPORTED ACUTEILLNESS PRIOR TO DEATH (n=10)

THIS IS A 116% INCREASEFROM 2016 (n=12)

16%

MENTAL ILLNESS

CASES IDENTIFIED ORREPORTED A MENTAL ILLNESS(n=12) (NOT INCLUDING SUD)

Depression (4)

Anxiety (4)

Bipolar (5)

PTSD (2)

Other (5)

11% OF CASES HAD  A HISTORY OF

SUICIDAL THOUGHTSOR ATTEMPTS (n=8)

** Some cases reported multiple mental illnesses. 

MENTAL ILLNESS IS LIKELYUNDER REPORTED DUE TO

LACK OF ACCESS TOMEDICAL HISTORY 

AND LACK OF  PHYSICAL  EVIDENCE  IN AUTOPSY

84%

SUBSTANCE ABUSE HISTORY

CASES IDENTIFIED ORREPORTED A HISTORY OFSUBSTANCE ABUSE  (n=64)

16% CASES NOTED A HISTORY

OF SUBSTANCE ABUSETREATMENT  (n=12)

AMONG 2017 CASES WITH A NOTEDHISTORY OF SUBSTANCE ABUSE, 

HEROIN WAS THE SUBSTANCE MOSTREPORTED (77%, n=49)

ACCORDING TO SAMHSA,SUBSTANCE USE DISORDERSOCCUR WHEN THE RECURRENTUSE OF ALCOHOL AND/ORDRUGS CAUSES CLINICALLY ANDFUNCTIONALLY SIGNIFICANTIMPAIRMENT, SUCH AS HEALTHPROBLEMS, DISABILITY, ANDFAILURE TO MEET  MAJORRESPONSIBILITIES AT WORK,SCHOOL, OR HOME. 

14% CASES REPORTED A HISTORY OFPRESCRIPTION DRUG ABUSE  (n=11)

DEATH INVESTIGATION

Decendent's Home Friend's Home

Hospital / Nsg Home Car Other

44

9

17

24

0

10

20

30

40

50

2017 (n=76)

OTHER LOCATIONS INCLUDE TWOHOTELS, A HOMELESS SHELTER,

AND A BUSINESS

OF DEATHSOCCURRED AT THECASE'S RESIDENCE

58%

LOCATION OF DEATH

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es

Sleeping (9%) Driving (1%) Other (65%) Unknown (25%)

ACTIVITY AT  TIME OF DEATH

Yes (45%) No (38%) Unknown (17%)

ILLICIT DRUGS FOUND AT SCENE

Yes (45%) No (31%) Unknown (24%)

RX DRUGS FOUND AT SCENE

39%

CASES WHERE DRUGPARAPHERNALIA WASFOUND AT THE SCENE 

**Activity at time of death is placed in relation to where the case was found

No (n=12) Yes (n=46) Unknown (n=18)

61%

24%

16%

LIFE SAVING INTERVENTIONS/ATTEMPTS

ALONE AT TIME OF DEATH MORE THAN 1/3 CASES

RECEIVED CPR PRIOR TOEMS ARRIVAL (36%)

CASES NOTEDNALOXONE WASADMINISTEREDEITHER BY EMS 

OR A BYSTANDER**

18%

**Naloxone administration data is gleaned from police reports notEMS reports, and is not always noted 

TOXICOLOGY TYPE

Polysubstance Single Drug No Tox Screen

2014 2015 2016 20170

10

20

30

40

50

60

70

80

90

100

n=69

n=94

n=82

n=76

OF CASES'TOXICOLOGY SCREENRESULTS WEREPOLYSUBSTANCE IN2017** (n=64; 63autopsy, 1 hospital)

100%

**100% of cases where a toxicologyscreen was performed (n=64, 84%of total cases)

Per

cen

tage

SUBSTANCES PRESENT BY YEAR

Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants

Sedatives Other Rx OTC

0

10

20

30

40

50

60

70

80

90

100

2014 2015 2016 2017(n=45)

(n=69)

(n=77)

(n=64)

NOTE: DATA LABELS INDICATE THE NUMBER OF CASES WHERE SUBSTANCE WAS PRESENT,THEREFORE NUMBERS MAY ADD UP TO MORE THAN THE TOTAL NUMBER OF CASES

Per

cen

tage

SUBSTANCES PRESENT, 2017 

Alcohol Marijuana Cocaine Methamphetamine Heroin Other Opioids (incl. Fentanyl) Anti-Depressants

Sedatives Other Rx OTC

17%

31% 30% 34%

50%

95%

6%

33%

20%13%

0102030405060708090

100

2017 (n=64)

BETWEEN 2016 AND 2017 THERE WAS A 580%INCREASE IN THE PRESENCE OF

METHAMPHETAMINE

OTHER PRESCRIPTIONMEDICATIONS PRESENT INTOXICOLOGY SCREENS WEREGABAPENTIN AND AMPHETAMINE

Per

cen

tage

(2017 n=22, 34%;  2016 n=4, 5%)

OPIOIDS PRESENT 

84%Fentanyl and Related Drugs

50%Heroin

30%Morphine/Codeine

14%Oxycodone

5%Methadone

5%Hydrocodone

2%Buprenorphine

11%Other

95% OF CASES' TOXICOLOGY SCREENS

WERE POSITIVE FOR AT LEASTONE OPIOID (n=60)

n=64

OTHER OPIOIDS PRESENT INCASES' TOXICOLOGY SCREENSINCLUDE OXYMORPHONE,DIHYDROCODEINE, ANDNALTREXONE

TRENDS 

Fentanyl Heroin

2010 2011 2012 2013 2014 2015 2016 20170

10

20

30

40

50

60

70

80

Source: Ohio Public Health Data Warehouse, 5/17/18

INCLUDES CLERMONT COUNTY RESIDENTS WHO DIED DUE TO UNINTENTIONALDRUG POISONING WHERE THE HEROIN INDICATOR OR FENTANYL AND ITSANALOGUES ARE SPECIFICALLY NOTED ON THE DEATH CERTIFICATE  

PERCENTAGE OF FENTANYL AND HEROINRELATED DRUG OVERDOSE DEATHS BY YEAR,

CLERMONT COUNTY RESIDENTS

Per

cen

tage

82

232

195

138

Q1 Q2 Q3 Q40

50

100

150

200

250

78

153

8270

Q1 Q2 Q3 Q40

88

175

MERCY HEALTH CLERMONT HOSPITALEMERGENCY DEPARTMENT ENCOUNTERS DUE

TO OPIATE OVERDOSE, BY QUARTER, 2017

NALOXONE ADMINISTRATION  BY OHIO EMS PROVIDERS,

CLERMONT COUNTY, 2017**

**72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone

Administration by County

Source: Mercy Health Clermont HospitalEmergency Department

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Ad

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atio

ns

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iate

Ove

rdo

se E

nco

un

ters

**72.6% of Transporting Ohio EMS Agencies Reporting Source: Ohio Emergency Medical Services, Naloxone Administration by Zip Code

NALOXONE ADMINISTRATION BY OHIO EMS PROVIDERSBY ZIP CODE, CLERMONT COUNTY, 2017**

EPICENTER SYNDROMIC SURVEILLANCE 

EMERGENCY DEPARTMENT VISITSAMONG CLERMONT COUNTY

RESIDENTS, ALL FACILITIES, 2017

953

INDIVIDUALS PRESENTING TOMERCY CLERMONT HOSPITAL

EMERGENCY DEPARTMENT , 2017

563

EPICENTER COLLECTS EMERGENCY DEPARTMENT CHIEF COMPLAINT DATA FROM 180HOSPITALS AND URGENT CARE FACILITIES ACROSS OHIO IN REAL TIME AND CLASSIFIES

THEM INTO SYMPTOM AND SYNDROME CATEGORIES. CHIEF COMPLAINTS FROM THETRAUMATIC INJURY - DRUGS CLASSIFIER ARE ANALYZED FOR OVERDOSE SURVEILLANCE. 

**Data was analyzed and excludes overdose encounters with mention of Tylenol, insulin, ibuprofen, etc.Suicides or intentional injuries are also excluded.  

EMERGENCY DEPARTMENT VISITS DUE TO DRUG OVERDOSE , 2017**

OF CASES HADCONTACT WITH AMERCY EMERGENCYDEPARTMENT FORPAIN OR ANOVERDOSEWITHIN ONE YEAROF THEIR DEATH 

(n=38)

1 CASE VISITED MERCY ED'S 63 TIMES IN THE YEAR PRIOR TODEATH (60 FOR PAIN, 3 OD)

**Data was provided by Mercy Health Clermont Hospital Emergency Department 

AMONG THE 2017 CASES, THERE WERE 110 VISITS FOR PAINAND 31 VISITS FOR OVERDOSE AT MERCY EMERGENCYDEPARTMENTS WITHIN ONE YEAR OF DEATH

32 OF THE 76 CASES HAD NO CONTACT WITH MERCYED'S WITHIN ONE YEAR OF THEIR DEATH FOR PAIN OR OD 

MERCY ED'S HAD NO RECORD FOR 6 OF THE CASES

MERCY EMERGENCYDEPARTMENT INTERACTIONSWITHIN ONE YEAR OF DEATH

50%

OPIOID PRESCRIPTIONSDISPENSED BY YEAR,CLERMONT COUNTY

268.3261.6

258.2263.2

253.8

2013 2014 2015 2016 2017250

263

275

DOSES PER PATIENT

75.671.0 66.9 62.7 58.4

2013 2014 2015 2016 201740

60

80

DOSES PER CAPITA

**Solid Oral Doses *Population Data from 2010 Ohio Department of Development

BETWEEN  2013-2017 THERE

HAS BEEN A22.79% DECREASEIN TOTAL DOSESDISPENSED INCLERMONT COUNTY. 

Do

ses

per

Pat

ien

t**

Do

ses

per

Cap

ita*

*

Source: Ohio Automated RxReporting System

ACCOMPLISHMENTS TO DATE

OUTREACH TO HEALTHCARE PROVIDERS AND NONTRADITIONAL PARTNERS TO HELP EDUCATE THECOMMUNITY ON SUBSTANCE MISUSE PREVENTION

INDIVIDUALSWERE REFERREDTO TREATMENTDURING QRT

RUNS IN 2017

133

QUICK RESPONSE TEAMS FORMED IN UNION TOWNSHIPAND THE CLERMONT COUNTY SHERIFF'S OFFICE IN 2017

MERCY HEALTH CLERMONT HOSPITALREFERRED 239 INDIVIDUALS TOTREATMENT FOR DRUG USE DURINGSBIRT SCREENINGS IN 2017

VOCATIONAL OPPORTUNITIES FORPEOPLE IN RECOVERY INCLUDINGCASC AND GCB VOCATIONAL PROGRAM

ACCOMPLISHMENTS TO DATE

IMPLEMENTATION OF A SYRINGESERVICES PROGRAM INCLERMONT COUNTY

1,381 LBS COLLECTED IN PERMANENT DRUG DROP BOXES IN 2017

FITZGERALD'S PHARMACY(WILLIAMSBURG) ADOPTED APHYSICIAN APPROVED PROTOCOLTO DISPENSE NALOXONE WITHOUTA PRESCRIPTION

PROJECT D.A.W.N.KITS DISTRIBUTED

IN CLERMONTCOUNTY IN 2017

353

PROJECT D.A.W.N.

LIVE STORIES OVERDOSE DATA TOOLPROVIDES NUMBER OF 911 CALLS ANDED VISITS DAILY

INTERVENTIONS TO CONSIDER

WORKING WITH THE FAITH BASED COMMUNITY TO ASSIST WITH PREVENTIONEFFORTS AND CONNECTING INDIVIDUALS TO AVAILABLE RESOURCES

IMPORTANCE OF CALLING 911 IF SOMEONE ISOVERDOSING EVEN IF NARCAN IS BEING ADMINISTERED

INCREASING AWARENESS AND OUTREACH EFFORTS DURINGEND OF THE YEAR AND HOLIDAY SEASON 

OTHER SUGGESTIONS FOR INTERVENTIONS OR EFFORTS ALREADY IN PLACE?

ADDRESSING CHILDHOOD TRAUMA DUE TO SUBSTANCE USE DISORDER;28 CHILDREN LOST A MOTHER OR FATHER WHO IS INCLUDED IN THISREPORT (SOURCES: OBITUARIES, POLICE REPORTS)

QUESTIONS

TARA JIMISON, BSN, RN, EPIDEMIOLOGIST 

TYRA SCHERER, MS, INJURY PREVENTION COORDINATOR

TJIMISON@CLERMONTCOUNTYOHIO.GOV

TSCHERER@CLERMONTCOUNTYOHIO.GOV

This work was supported by the Cooperative Agreement number, 6 NB01OT009137-01-02, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do notnecessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.