Highlight on Wisconsin: As opioid overdose and deaths rise, state seeks $15.7 million in SAMHSA support

The rate of opioid overdose deaths in Wisconsin has risen approximately 81 percent from 2006 through 2015, according to a new Wisconsin Department of Health Services (DHS) report, titled “Select Opioid-Related Morbidity and Mortality Data for Wisconsin.” In response, the Wisconsin DHS has submitted an application for up to $15.7 million in federal funding to boost the state’s response to the growing misuse and abuse of opioids from the Substance Abuse and Mental Health Services Administration (SAMHSA). The amount of the grant is based on the unmet need for opioid-related treatment and the number of opioid-related deaths in the state. Wisconsin is eligible to receive up to $7,636,938 each year for the next two years under the 21st Century Cures Act.

The DHS report provides statewide and county-level data on opioid-related deaths and hospital visits, neonatal abstinence syndrome (NAS) (in which an infant is born with withdrawal symptoms from substances taken by the mother), and data on ambulance runs in which naloxone (a medication used to reverse opioid overdose) was administered. The report includes these data highlights:

  • The rate of opioid overdose deaths increased from 5.9 deaths/100,000 residents in 2006 to 10.7 deaths/100,000 in 2015.
  • Rates of drug overdose deaths involving opioids were higher among counties in the southeastern region of the state (Milwaukee area), and higher among men compared with women.
  • Drug overdose deaths involving opioids were highest among young men aged 25-34, and among women aged 35-54.
  • Hospital visits involving opioid acute poisoning (including overdose) increased from 25.3 to 52.0 per 100,000 between 2006 and 2014.
  • The rate of ambulance runs in which naloxone was administered rose from 51.2 to 67 per 100,000 from 2011 to 2015.
  • The rate of NAS increased from 2.0 to 8.7 per 1,000 live births from 2006 to 2014, a rate increase of 335 percent.

In 2016, DHS issued a Public Health Advisory due to the opioid epidemic. In 2017, Governor Scott Walker called for a special session of the legislature to consider recommendations presented by the Governor’s Task Force on Opioid Abuse. New legislative proposals will build on efforts already underway under the HOPE (Heroin, Opioid Prevention and Education) agenda, which includes 17 bills aimed at prevention and treatment of opioid addiction and overdose.

Pending approval from SAMHSA, the funds will be used to:

  • Support community coalitions focused on reducing the nonmedical use of opioids among people age 12 to 25.
  • Establish a hotline to provide information on treatment services and recovery supports.
  • Expand access to treatment for uninsured and underinsured individuals.
  • Establish new opioid-specific treatment programs to reduce the distance people have to travel for these services.
  • Establish a network of individuals in long-term recovery from the misuse and abuse of opioids trained to coach people through the treatment and recovery process.
  • Develop training for professionals on proven intervention and treatment strategies for opioid misuse and abuse.

 

Highlight on Ohio: CDC reports on risk factors for unintentional fentanyl overdose deaths

The Ohio Department of Health (ODH) announced that the Centers for Disease Control and Prevention (CDC) issued a report examining the increase in unintentional fentanyl-related drug overdose deaths in Ohio. ODH requested CDC’s assistance in September 2015 after 2014 drug overdose data showed that Ohio’s fentanyl-related overdose deaths increased from 84 in 2013 to 502 in 2014, a 500 percent increase. Preliminary data also indicated that the number of fentanyl-related deaths in Ohio was continuing to increase in 2015.

Fentanyl-related deaths in Ohio also accounted for 20 percent of all drug poisoning deaths in 2014, a substantial increase over the 4 percent in 2013. According to a CDC Health Alert Network advisory, Ohio also ranked number one in the nation in total fentanyl seizures in 2014, with 1245 compared to the second ranked state, Massachusetts, which had a total of 630 seizures.

Ohio’s Public Health Response

The ODH has launched a comprehensive response to the increase in fentanyl-related deaths. A broad overview of these activities can be found on the Ohio Mental Health and Addiction services website.  They include: (1) investment of $1 million over the fiscal years 2016-2017 to expand access to naloxone (a medication used to block the effects of opioids, especially in overdose) through local health departments; (2) growth of the governor’s Start Talking! initiative to continue efforts to prevent drug use before it starts; (3) increased functionality of prescription drug monitoring through improvements in the usability of Ohio’s Automated Rx Reporting System (OARRS); and (4) continued work with communities to enhance local efforts through the Health Resources Toolkit for Addressing Opioid Abuse.

CDC Assistance Sought

As part of its public health response, the ODH also requested CDC’s assistance in an epidemiologic investigation (EpiAid) to examine the ongoing increase in unintentional fentanyl-related overdose deaths in their state. To that end, on October 26, 2015, CDC’s Epidemic Intelligence Service (EIS) Officers deployed to Columbus, Ohio, and in conjunction with ODH officials, conducted a three-week investigation which included visits to four regional hotspots of the epidemic (Hamilton, Cuyahoga, Scioto, and Montgomery Counties).

CDC Findings

The CDC discovered that the sharp increase in fentanyl-related deaths in Ohio appeared to closely coincide with a similar sharp increase in the confiscation of illicitly-produced fentanyl by law enforcement in Ohio, based on data obtained from the U.S. Drug Enforcement Administration (DEA). On March 18, 2015, the DEA issued a nationwide alert on fentanyl as threat to health and public safety.

The CDC found that the majority of the Ohio population experiencing fentanyl-related unintentional overdose deaths were male (69 percent), white (89 percent), never married (55 percent), and had some college or less education (94 percent). The average age of fentanyl decedents was 37.9 years old, with ages ranging from 17 to 71 years old. Although large metropolitan counties (population more than 1 million) had a higher number and percentage of all fentanyl-related deaths (47 percent), moderate metropolitan counties (population 250k to 1 million) had the highest rate of fentanyl-related deaths (6.63 per 100,000).

The report showed that the risk factors for fentanyl-related overdose deaths in Ohio included: male gender, white race, some college or less education, history of substance abuse problem, and current mental health problem (e.g., depression, anxiety, or bipolar disorder). Additional risk factors included a recent release from an institution within the last month (e.g. jail, hospital, and treatment facility), and a history of using high-dose opioid prescriptions.

The report also showed a correlation between heroin and fentanyl deaths in Ohio. For example, approximately 62 percent of all fentanyl and heroin decedents had a record of at least one opioid prescription from a healthcare provider during the seven years preceding their death. In addition, one in 10 heroin decedents, and one in 5 fentanyl decedents, had an opioid medication prescribed to them at the time of their death.

Further analysis of OARRS data revealed that substantial percentages of fentanyl and heroin decedents (40 percent and 33 percent, respectively) had been prescribed an opioid at high doses (at least 90 morphine milligram equivalents) at some point in the seven years preceding death. The CDC suggested further analysis to determine the duration and timing of these high dose opioid prescriptions.

CDC Recommendations

CDC’s recommendations to OPH focused on enhancing public health surveillance for fentanyl morbidity and mortality, targeting of public health response to high-burden counties and high-risk groups, enhancing and facilitating response to fentanyl-related overdoses by emergency personnel and laypersons, and improving access to naloxone and addiction services.

Highlight on Pennsylvania: State hit hard by opioid addiction, struggles to find solutions

Although Pennsylvania is due to receive $1.8 million in federal funding to combat opioid abuse, none of that money is going to Pittsburgh. Although the rising number of heroin deaths in the city may seem to indicate that the area is in drastic need of the funding, heroin use is a widespread problem throughout the state.

Federal funding

On March 11, 2016, HHS announced a $94 million award to health centers across the country to be directed toward combating the heroin epidemic. This funding was made available by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and went to 45 states, Washington D.C., and Puerto Rico. Estimates of opioid-related deaths have risen sharply: unintentional overdoses from pain medications has almost quadrupled since 1999, and the agency believes that deaths related to heroin increased 39 percent in one year, from 2012 to 2013.

Pennsylvania’s overdose journey

The University of Pittsburgh Graduate School of Public Health studied accidental overdose deaths in the state over time and found that the number has increased 14 times in the last three-and-a-half decades. The deaths were concentrated in southwestern Pennsylvania, around Philadelphia, and near Scranton. The Lehigh County Coroner was forced to request more money to cover drug overdose autopsies in 2015, Northampton County had 50 percent more opiate related deaths in the first three months of 2015 than the entirety of 2014. Although adults ages 34-44 had the greatest increase in overdose death rates since 1979, the younger 25-34 year old age bracket had the highest death rate in 2014. Death rates were higher in men than women, but the death rate in young white women was the fastest-climbing demographic. The report also noted that non-fatal overdoses requiring hospitalizations surged dramatically.

Small towns not exempt

An NPR reported traveled to a rural Pennsylvania county to see how a small town is impacted by addiction. A paramedic revealed that heroin is cheap and easily available from surrounding towns, and that there is no pattern to the addiction. He spoke of seeing young and old, well-off and poor using the drug. The paramedics are familiar with using naloxone, a rescue drug that reverses an overdose and can wake an unresponsive patient. As of the second week of March, they had already used the drug on ten patients. He admitted that they never have to worry about their stockpile expiring because they go through it so quickly.

Schools shaken by tragedy

High schools in the area reported losing six students to heroin overdoses in a two-year span. Some believe that small-town boredom lends itself to drug use, and Kutztown Area High School has formed a group to provide diversion for students, such as basketball tournaments. The state mandates a student assistance team, which includes teachers, counselors, and a contracted specialist, who keep an eye out for at-risk kids. Although it is difficult to know whether these groups help at all, the staff believes their efforts are crucial.

Pittsburgh left out of funding, despite high overdose rates

Pennsylvania received a $1.8 million chunk of the $94 million in federal funding, but the Pittsburgh region is left out in the cold. Philadelphia is the number one area in the state for heroin overdoses, but Allegheny County, where Pittsburgh is located, runs second. A local Pittsburgh paper reported that the county lost 157 people to heroin overdoses in 2014, which rose to 217 in 2015. An HHS spokesman stated that the funding awards were competitive, but did not say whether any southwestern Pennsylvania health centers applied. He did note that several Pittsburgh treatment centers are already federal funding recipients.