Jackson County Medical Examiner data 2004 to 2011

Andrea Krause DVM Jim shames MD Tim Pike Wendy Moore Kiley Shannon

Overdose Deaths 2004-2011 Jackson County Oregon

50 45

40

35

30 # Deaths

Undetermined
25

Suicide Accidental

20

15

10

0 2004 2005 2006 2007 2008 2009 2010 2011

Accidental Overdose Deaths: Overdose Drug

Accidental Overdose Deaths 2004 - 2011: Overdose Drug by General Category
90 80 70 60

# Deaths

50 40 30 20 10 0

Prescription Rx Opiate + Rx Opiate + Rx Opiate + Opiate(s) Alcohol Other Rx illicit drug drug

Illicit drug

Non-opiate Rx drug

Other

Who is dying of opioid overdoses?

Middle aged White male Unmarried Limited education Substance abuse history Mental health history Taking methadone Also taking benzos Possibly a vet

Accidental Prescription Opiate Overdose Deaths

Age Distribution of Accidental Overdose Deaths: Methadone vs. Other Rx Opiates
0.5 0.45

0.4

0.35

Proportion of Deaths

0.3

0.25

Methadone

0.2

Other RX Opiates

0.15

0.1

0.05

36.2 % of all overdoses were in 45-54 age group

< 18 18-24 25-34 35-44 45-54 55-64 65-74 75

Age Category

Illicit Drug Overdose Deaths: Jackson County Oregon 2004-2011

Illicit Drug Overdoses: Specific Drugs
20

18

16

14

12

# Deaths

10

Part of Multiple Substance Overdose

Alone

Heroin may be underrepresented due to 7 morphine overdose deaths that may in fact have been heroin overdoses Heroin Methamphetamine Cocaine

Specific Opioid Involvement in All Overdose Deaths

100

90

80

70

60

# Deaths

Suicide
50

Undetermined
40

Accidental
30

20

10

Methadone = 39% of all OD Oxy=14% Morphine=17% Hydrocod=8.5%

Methadone Overdose Deaths in which the source of Methadone was the decedents own prescription
Prescription Methadone Source
25 22 20

# of Descedents

15

10

5 3

0 Private Prescriber Methadone Clinic

Analysis of Methadone data

988 individuals received almost 7 thousand prescriptions or 1.2 million doses of methadone over the 8 month study period. That averages 1,231 pills per person, or 207 pills per month. If you are 45 to 54 years old that average is 1,401 pills per person or 231 pills per month (more than 70mg/day)
100 90

# Deaths

Comparison with Allied (methadone clinic) data:

80 70 60 50

515 clients currently enrolled 40 30 Average dose 105 mg (liquid only) 20 3, possibly 4, documented overdose deaths 10 0 during the 2004-2011 study period

Accidental Prescription Opiate Overdose Deaths

Medical History in Accidental Opiate Overdose Deaths in Jackson County OR
0.8

0.7

69% 67% 60%

0.6

58%

Frequency of Occurrence

0.5

49% 46% 44%

0.4 31% 0.3 21% 0.2 15%

Methadone Other Rx Opiates

0.1

8%

0% 0

Chronic pain

Cardiovascular disease

Respiratory disease

Liver disease

Other concurrent Mental illness condition

Accidental Prescription Opiate Overdose Deaths

Substance Abuse History in Accidental Opiate Overdose Deaths
0.8 0.7

0.6

Frequency of Occurrence

0.5

0.4

Methadone
0.3

Other Rx Opiates

0.2

0.1

History of Any Substance Abuse

Alcohol abuse

Illicit drug Prescription Multiple abuse abuse substances

History of Previous Overdose

History of Addiction Treatment

Accidental Prescription Opiate Overdose Deaths

Accidental Opiate Overdoses: Toxicological Presence of Other Substances
0.6

0.5

0.4

Frequency

0.3

Methadone
0.2

Other Opiates

0.1

Jackson County Overdose Deaths in 2012

Data Analysis

Overdose Trends in Jackson County

Findings

Morphine
Found in toxicology reports of 38% of all overdose deaths Medical Examiner ruled Morphine as cause of death in 20% of all overdose deaths Of the 38%:
47% had opioid prescriptions 18% were for Morphine 29% were other prescription opioids

Heroin
Morphine was found in toxicology reports of 38% of all overdose deaths:
Medical Examiner ruled Heroin as cause of death in 16% of all overdose deaths Of the 16%
14% had known Methadone prescriptions 14% had other opioid prescriptions

69% of all Overdose Deaths Involved Prescription Opiates

Benzodiazepines were found in 71% Anticonvulsants were found in 39% Antidepressants were found in 32% Cannabinoids were found in 29% Ethanol was found in 29% The average number of contributory drugs found in toxicology was 5

Medical History
Chronic pain was found in 68% Mental illness was found in 61% Cardiovascular disease was found in 52% Pulmonary disease was found in 19% Other medical conditions was found in 55%

Substance Abuse History

Substance abuse was found in 52% History of overdose was found in 16% Alcohol use/abuse was found in 39% Smoking history was found in 45% History of addiction treatment 0%