Examining Fatal Opioid Overdoses in Marion County, Indiana

Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena

doi:10.1007/s11524-016-0113-2

Cited by 20 publications

(11 citation statements)

References 37 publications

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“…In recent years, Indiana has experienced an increase in overdose‐related deaths . As the largest city, Indianapolis has been home to a large majority of these deaths with recent increases in heroin‐ and fentanyl‐related overdose deaths .…”

Section: Methodsmentioning

confidence: 99%

EMS naloxone administration as non‐fatal opioid overdose surveillance: 6‐year outcomes in Marion County, Indiana

et al. 2018

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Background and Aims Despite rising rates of opioid overdose in the United States, few studies have examined the frequency of non-fatal overdose events or mortality outcomes following resuscitation. Given the widespread use of naloxone to respond to overdose-related deaths, naloxone administration may provide a useful marker of overdose events to identify high-risk users at heightened risk of mortality. We used naloxone administration by emergency medical services as a proxy measure of non-fatal overdose to examine repeat events and mortality outcomes during a 6-year period. Methods We conducted a retrospective investigation of all cases in Marion County, Indiana between January 2011 and December 2016 where emergency medical services used naloxone to resuscitate a patient. Cases were linked to vital records to assess mortality and cause of death during the same time-period. We used Cox regression survival analysis to assess whether repeat non-fatal overdose events during the study period were associated with the hazard of mortality, both overall and by cause of death. Results Of 4726 patients administered naloxone, 9.4% (n = 444) died an average of 354 days [standard deviation (SD) = 412.09, range = 1-1980] following resuscitation. Decedents who died of drug-related causes (34.7%, n = 154) were younger and more likely to have had repeat non-fatal overdose events. Patients with repeat non-fatal overdose events (13.4%, n = 632) had a ×2.07 [95% confidence interval (CI) = 1.59, 2.71] higher hazard of all-cause mortality and a ×3.06 (95% CI = 2.13, 4.40) higher hazard of drug-related mortality. Conclusions Among US emergency medical service patients administered naloxone for opioid overdose, those with repeat non-fatal opioid overdose events are at a much higher risk of mortality, particularly drug-related mortality, than those without repeat events.

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Section: Methodsmentioning

confidence: 99%

EMS naloxone administration as non‐fatal opioid overdose surveillance: 6‐year outcomes in Marion County, Indiana

et al. 2018

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“…The procedures for manual abstraction and coding of toxicology reports are detailed elsewhere. 12,15,16 Two researchers (P.H. and E.M.) coded data from death certificates and toxicology reports.…”

Section: Methodsmentioning

confidence: 99%

Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016

Gupta

Cohen²,

Lowder

et al. 2019

Public Health Rep

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Objectives: Understanding the scope of the current opioid epidemic requires accurate counts of the number of opioid-involved drug overdose deaths. Given known errors and limitations in the reporting of these deaths, several studies have used statistical methods to develop estimates of the true number of opioid-involved overdose deaths. This study validates these procedures using a detailed county-level database of linked toxicology and vital records data. Methods: We extracted and linked toxicology and vital records data from Marion County, Indiana (Indianapolis), during a 6-year period (2011-2016). Using toxicology data as a criterion measure, we tested the validity of multiple imputation procedures, including the Ruhm regression-based imputation approach for correcting the number of opioid-involved overdose deaths. Results: Estimates deviated from true opioid-involved overdose deaths by 3% and increased in accuracy during the study period (2011-2016). For example, in 2016, 231 opioid-involved overdose deaths were noted in the toxicology data, whereas the corresponding imputed estimate was 233 opioid-involved overdose deaths. A simple imputation approach, based on the share of opioid-involved overdose deaths among all drug overdose deaths for which the death certificate specified ≥1 drug, deviated from true opioid-involved overdose deaths by ±5%. Conclusions: Commonly used imputation procedures produced estimates of the number of opioid-involved overdose deaths that are similar to the true number of opioid-involved overdose deaths obtained from toxicology data. Although future studies should examine whether these results extend beyond the geographic area covered in our data set, our findings support the continued use of these imputation procedures to quantify the extent of the opioid epidemic.

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“…A study was conducted in Marion County, IN to assess the fatal opioid overdoses in the county from 2010 through 2015. 11 Of the 1,199 cases identified, 918 involved an opioid drug such as heroin, fentanyl, morphine, or codeine, and 185 (20%) involved the use of fentanyl. From 2010 to 2015, fentanyl-related overdoses in Marion County, IN increased from 15 cases to 63 cases, a 64% rate of annual change.…”

Section: Introductionmentioning

confidence: 99%

Surge in Fentanyl Toxicity Deaths in Jefferson Parish, LA, 2013-2018

Noto

Troxclair²,

Williams

et al. 2019

TOJ

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Background: The opioid epidemic in the United States has resulted in a significant increase in fentanyl-related overdoses nationwide since 2013. Because of an increased rate of fentanyl-related overdoses seen in Jefferson Parish, LA, the Jefferson Parish Coroner's Office (JPCO) hypothesized that the opioid epidemic, specifically related to fentanyl, had reached this region. To test this hypothesis, JPCO analyzed fentanyl overdose deaths to determine if the deaths had increased during a 6-year period and if the change met the definition of an epidemic.Methods: In the toxicology laboratory at JPCO, enzyme-linked immunosorbent assay screening and gas chromatography/mass spectrometry are used in-house to determine the presence of drugs. Drug-positive samples are sent to National Medical Services (NMS) Labs to quantify the analyte concentration in each sample. Data for each decedent were extracted from the Medicolegal Death Investigation Log (MDILog) database for the years 2013 through 2018.Results: A slow increase in fentanyl-related deaths during the first 3 years of the study period was followed by a near doubling of cases in 2016, a tripling of cases in 2017, and a 6-fold increase in incidence in 2018. During the 6-year study period, fentanyl-related deaths increased from 6 in 2013, to 8 in 2014, to 14 in 2015. Twenty-five deaths in 2016 spiked to 66 in 2017 and increased to 78 fentanyl-related overdose deaths in 2018. The percentage of fentanyl-related overdose deaths increased from 4% of all drug deaths in 2013 to 45% in 2018.Conclusion: The data validate the hypothesis that the fentanyl epidemic has affected Jefferson Parish in southeast Louisiana.

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Examining Fatal Opioid Overdoses in Marion County, Indiana

Cited by 20 publications

References 37 publications

EMS naloxone administration as non‐fatal opioid overdose surveillance: 6‐year outcomes in Marion County, Indiana

EMS naloxone administration as non‐fatal opioid overdose surveillance: 6‐year outcomes in Marion County, Indiana

Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016

Surge in Fentanyl Toxicity Deaths in Jefferson Parish, LA, 2013-2018

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