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By Eric Hulsey, DrPH, MA & Karen Hacker, MD, MPH

Since 2008, Allegheny County has experienced a dramatic increase in fatal drug overdoses, mostly driven by the use of heroin and other opioids. Our local experience mirrors the epidemic nationally.

Research confirms that the recent epidemic of heroin use throughout the U.S. has been influenced by several factors, including the increase in opioid prescriptions for pain, marketing and formulation changes for long-acting opioid analgesics, and the cheap price of heroin which, in Allegheny County, increasingly contains synthetic opioids (such as fentanyl) that have entered our regional heroin supply through their use as cutting agents.

To better understand opiate-related overdose and identify opportunities for intervention, the Allegheny County Department of Human Services and Allegheny County Health Department recently collaborated on a report entitled Opiate-Related Overdose Deaths in Allegheny County: Risks and Opportunities for Intervention.”  Using the DHS Data Warehouse and other data sources, this report analyzed opiate overdoses in Allegheny County from 2008 through 2014 with the following goals:

– Use data to better understand risk factors for opiate overdose in Allegheny County
– Identify opportunities for intervention
– Assess the impact of current strategies in place to save the lives of those at risk of fatal overdose
– Provide recommendations for policymakers and other multi-sector overdose initiatives in the region based on available data
– Empower stakeholders by providing them with information relevant to their role in the crisis

What is the DHS Data Warehouse?

The DHS Data Warehouse is a central repository of social and human services data related to DHS clients and the services they receive through DHS as well as through a number of other public entities. Over 29 data sources are integrated within the Data Warehouse including behavioral health and pharmacy, County jail, child welfare, and homeless services. It also includes data from other county agencies and services, as well as the Pittsburgh Public Schools.

Using data from the Medical Examiner’s office on individuals who died from opioid overdoses during the seven year period, we were able to match 68% of the sample with records in the DHS Data Warehouse. In other words, 68% of those who died from opioid overdoses had some encounter with a service or system that is represented in the DHS Data Warehouse.

What Does the Report Tell Us About Overdose in Our County?

Between 2008 and 2014, there were 1,962 drug-related overdose deaths in Allegheny County; 1,399 of these deaths were related to opiate use. Some of the key findings in the report are listed below.

Age: Opiate-related overdose deaths increased most rapidly among County residents ages 25 through 34.

Geography: There were some high-incidence areas that we identified by census tract (see Figure 12 below). The full report shares these maps and the department’s analytics website provides additional maps of these deaths (by city/county council districts and municipalities).

figure 1

Drugs Contributing to Death: Heroin, not prescription opioids, was indicated in more recent overdose deaths. There were an increasing number of overdose fatalities that involved prescription opiate medications until 2011, when heroin became increasingly indicated in fatal overdoses.

Use of Prescription Medications: Suboxone and Vivitrol, medications used to treat opioid use disorders, did not directly contribute significantly to overdose deaths. Suboxone was indicated in only two deaths and Vivitrol was not present in any deaths. Discontinuing treatment using these medications, however, may have resulted in an increased risk of overdose death. Another observation was that many of the Medicaid members who died had previously received a prescription for opioids and other psychotherapeutic medications.

Figure 5

Emergency Calls: We observed no statistical difference in calls to 911 related to overdose despite state-wide legislation that improved opportunities for naloxone prescribing and providing some immunity for good Samaritans who act in the event of an overdose.

Many Who Died Had Recently Received Services

Many overdose deaths occurred following release from jail, discharge from short-term rehabilitation, involvement in methadone maintenance treatment, or involvement with a mental healthcare service. Among people who died following release from the County jail, more than half (109 of 211 or 52%) occurred during the first 90 days. The largest number of these overdose deaths (54 of 211 or 26%) occurred during the first 30 days after release from the jail.

Figure 2

Among people who had received a publicly funded mental health treatment service in the year prior to their death, 45% (231 of 510) died within 30 days of a recent mental health service.

Figure 3

Among people who had received a publicly funded substance use disorder treatment service in the year prior to their death, 38% (134 of 350) died within 30 days of a recent SUD treatment service; non-hospital (inpatient) “rehab” and methadone maintenance were the two most common services received.

Figure 4

Recommendations and Future Monitoring

Based upon the key findings in the report, we offered specific recommendations to reduce overdose deaths targeting specific audiences including physicians and healthcare professionals as well as public health, human services, and criminal justice stakeholders.

Through collaboration between County agencies and community stakeholders the Allegheny County Department of Human Services and Department of Health aim to continue monitoring fatal overdoses and help to coordinate targeted and effective interventions in the County.

To view the full report and access additional maps and datasets please visit http://www.alleghenycountyanalytics.us. For more information, feel free to contact Eric Hulsey at eric.hulsey@alleghenycounty.us or (412) 350-6351.

Dr. Eric Hulsey serves as the Manager of Behavioral Health Analytics within the Allegheny County Department of Human Services, Office of Data Analysis, Research and Evaluation. Dr. Karen Hacker is Director of the Allegheny County Health Department.