Update on Opioid Epidemic in Baltimore City
This update provides insights into the opioid epidemic in Baltimore City as of February 25, 2020. It covers overdose deaths, trends, non-fatal alerts, impact of trauma, and the rise of prescription drugs and fentanyl contributing to record-level fatalities.
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Update on the Opioid Epidemic in Baltimore City February 25, 2020 Jonathan Gross, MPH, CPH Epidemiologist Baltimore City Health Department Epidemiological Services jonathan.gross@baltimorecity.gov @Bmore_Healthy BaltimoreHealth Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City health.baltimorecity.gov
Overview Overdose deaths, substances, trends Age, sex, race, and residency Non-fatal overdose alerts via Bad Batch How trauma affects health and substance use Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 2
Bottom Line The rise of prescription drugs, fentanyl and multi-level trauma in Baltimore have led to record-levels of overdose deaths. Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 3
~1,200 Lives Lost in 2018 From two preventable causes 888 drug- and-alcohol overdose deaths in 2018 ~ 3x times 309 homicide victims in 2018 Bernard C. Jack Young Mayor, Baltimore City Note: Each dot represents 100 people. By incident location. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 4
Number of Fatal Drug and Alcohol Overdoses Occurring in Baltimore City, by Year 1000 888 900 761 800 694 700 600 Deaths 500 393 400 305 287 300 246 239 225 184 172 167 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Year As of Q3, in 2019, +3% YTD Bernard C. Jack Young Mayor, Baltimore City Maryland Department of Health. Unintentional Drug and Alcohol Intoxication Deaths. https://health.maryland.gov/vsa/Pages/overdose.aspx. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 5
Percent of Fatal Overdoses that are Fentanyl-related, by Year Occurring in Baltimore City, by Year 85.4 90.0 75.3 80.0 70.0 60.4 60.0 Percent 50.0 40.0 30.5 30.0 23.6 20.0 4.9 10.0 1.8 1.0 2.3 1.2 1.7 1.1 0.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Year In 2019, as of Q3, 89% of fatal drug and alcohol overdose deaths were fentanyl-related. Bernard C. Jack Young Mayor, Baltimore City Maryland Department of Health. Unintentional Drug and Alcohol Intoxication Deaths. https://health.maryland.gov/vsa/Pages/overdose.aspx. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 6
Baltimore City: Overdose Deaths By Substance(s) 900 In 2018 Opioid-related (814) Fentanyl-related (758) 800 Number of Deaths in Baltimore City 700 600 500 Cocaine-related (423) 400 300 Heroin-related (286) 200 Prescription opioid- related (128) 100 0 2014 2015 2016 Year 2017 2018 Bernard C. Jack Young Mayor, Baltimore City Source: MDH Deaths within Baltimore City by incident location. Decedents can belong to multiple categories. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 7
Prescription Drugs More Likely for First Use ALIVE study (AIDS-linked to the Intravenous Experience) of people who inject drugs in Baltimore City (PWID) A lower proportion of PWID began their drug use with injection drugs. Higher proportion nearly 50% report prescription drugs were first used. Modified from Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pon e.0213357&type=printable Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 8
Prescription Drugs More Likely for First Use Self-reported first drug used - ALIVE Study Injection drugs Prescription drugs opioid and non-opioid, non-injection, illicit Non- injection, illicit Prescription, non-opioids Prescription opioids Study Recruitment Birth Cohort Median age at enrollment = 44 Bernard C. Jack Young Mayor, Baltimore City Modified from Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pon e.0213357&type=printable Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 9
Residence vs. Incident Location Unintentional Drug and Alcohol Overdose Deaths: MDH (2018): 888 overdose deaths in city -CDC (2018): 664 city residents 224 888 city residents =25% or were non- Notes: Public health agencies report by residence of decedent. OCME and public safety agencies report out numbers by incident location/jurisdiction. Bernard C. Jack Young Mayor, Baltimore City CDC Wonder, Underlying Cause of Death: https://wonder.cdc.gov/controller/saved/D76/D76F456 Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 10
Drug Overdose Deaths among Baltimore City Residents The next slides look at specifically at drug overdose deaths (all intents), age, sex, race, and ethnicity. Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 11
Demographics Overview Among Baltimore City residents that died from drug overdose all intents (2018), n=665. Age 435 deaths (65%) were between 45-64 years old 15 deaths (2%) in 25-34 year olds. Under 25 age group very small/suppressed. Sex 491 deaths (74%) were male Race and Ethnicity 70% Black/African-American 30% White Hispanic/Latino: 2% Bernard C. Jack Young Mayor, Baltimore City Source: CDC Wonder - Underlying Cause of Death: https://wonder.cdc.gov/controller/saved/D76/D76F893 Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 12
Age-Specific Fatal Drug Overdose Rates, 2018 Largest increase in rate +38% compared to 2017 Deaths 223 (2018) 164 (2017) 350 302.7 291.4 300 per 100,000 Population 250 200 Rate 150 119 103.5 100 60.6 50 0 25-34 35-44 45-54 Age Group 55-64 65-74 The 45-54 age group has the highest fatal drug overdose rate. Age 55-64 had biggest increase between 2017-2018. Note: Under 25 age group rate is suppressed due to small numbers. 75 and older also had a small number of deaths and were suppressed. Bernard C. Jack Young Mayor, Baltimore City Source: CDC Wonder - Underlying Cause of Death: These are age-specific/stratified rates. https://wonder.cdc.gov/controller/saved/D76/D76F899 Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 13
Baltimore City: Fatal Drug Overdose Rate, by Race (Non-Hispanic) and Year, 2010-2018 120 Black/African-American rate ~equal to white rate Age-Adjusted Rate per 100,000 100 80 Population 60 White rate higher 40 20 0 2010 2011 2012 2013 2014 Year 2015 2016 2017 2018 Black or African American White Drug overdose is also a leading cause for people of Hispanic/Latino ethnicity. - 13 overdose-related deaths in 2018. https://wonder.cdc.gov/controller/saved/D76/D76F509 Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 14
Baltimore City: Fatal Drug Overdose Rate by Race and Gender, 2018 200 186.1 Access to treatment and buprenorphine are not equal. Age-Adjusted Rate per 100,000 180 160 149 140 Population 120 100 80 59.5 49.9 60 40 20 0 Black/African American Male White Male White Female Black/African American Female Race (non-Hispanic) and Sex Combination Buprenorphine Treatment Divide by Race/Ethnicity and Payment https://wonder.cdc.gov/controller/saved/D76/D76F511 Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 15
Baltimore City: Fatal Drug Overdoses, Place of Death, 2018 Place Deaths (%) Decedent s Home 348 (52%) Other (dead on arrival at hospital, emergency room or outpatient facility, other, and unknown) Medical Facility Outpatient or ER Medical Facility Inpatient 139 (21%) 120 (18%) 52 (8%) Having naloxone kits at home/on-hand remain vital since more than half of fatal overdoses occur in the home. Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City https://wonder.cdc.gov/controller/saved/D76/D76F508 16
Neonatal Abstinence Syndrome (NAS) 776 NAS births 2014-2018 in Baltimore City Since 2009-2013, no change in NAS birth rate per 1,000 newborns in Baltimore City. Baltimore City has the highest NAS rate in Maryland among large population counties. 2ndis Baltimore County Statewide highest rate is in white, non- Hispanic persons. Bernard C. Jack Young Mayor, Baltimore City Silcox KS (2019) Neonatal Abstinence Syndrome among Maryland Newborns. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 17
Non-fatal Overdose Alerts Health Department partnership with EMS and Bad Batch Text JOIN to 443-201-7598 www.badbatchalert.com Sophisticated analytics vs. ODMAP Bernard C. Jack Young Mayor, Baltimore City Non-fatal overdose surveillance/Project SOON funded by Council of State and Territorial Epidemiologists https://github.com/bchd/Nonfatal-Overdose-Surveillance Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 18
911 Police Calls for Service Description of call contains: Overdose , OD , Naloxone , or Narcan OpenBaltimore dataset: https://data.baltimorecity.gov/ Contains citizen and police calls Can t get a denominator for calls 2018: 5,032 calls (~14 per day) 2019: 4,843 calls Source: 911 Police Calls for Service, https://data.baltimorecity.gov/Public-Safety/911-Police- Calls-for-Service/xviu-ezkt/data Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 19
Big Data / Machine Learning Hopkins Collaboration with CRISP and State Health Department: Linked records and modeled risk Top 5% highest risk for opioid overdose accounted for 40% of fatal overdoses. PDMP alone is very accurate Hospital-records were most useful Those with treatment were much less likely to have a fatal overdose Unlocking the Potential of Big Data to Reduce Opioid Overdose: Lessons from Unlocking the Potential of Big Data to Reduce Opioid Overdose: Lessons from Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 20
Data Sharing Challenges The data needed to help prevent overdoses exists but there are challenges. But, data is spread across different agencies and often unable to be linked. Why? Agency-specific regulations, Maryland Confidentiality of Medical Records Act , HIPAA, and federal laws regarding behavioral health data. Working to get more permissions to publically share data. Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 21
Trauma in Baltimore Poverty, segregation, basic needs unmet ~1/3 children (<18) live in poverty 1-out-of-4 households -food stamps in last 12m Public schools receive poor ratings Has the majority of the state s 1-star schools 50%+ of city schools only received 1-2 stars US Census Bureau. 2014-2018 American Community Survey. Bernard C. Jack Young Mayor, Baltimore City Bowie and Richman (2018). Maryland releases first star ratings for every public school; 60 percent earn four or five stars out of five. Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City
Trauma in Baltimore Think about how many survivors! ~1/3 children have had 2 or more Adverse Childhood Experience (ACEs) 11.1% of children have lived with someone mentally ill/suicidal vs. 7.2% statewide Very high incarceration rates ~1-out-20 people in Sandtown in 2010 Children of incarcerated parents Bernard C. Jack Young Mayor, Baltimore City Childhealthdata.org. Adverse Childhood Experiences among Baltimore & Maryland's Children Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 23
ACEs Impact Health Adults with four or more ACEs: 6x: problematic alcohol use 7-8x: victim or perpetrate violence 10x: problematic drug use 30x: more likely to report a suicide attempt Bernard C. Jack Young Mayor, Baltimore City The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 24
Themes from Overdose Discussions Importance of trauma Addiction is a disease Reducing stigma is important (recovery culture) Treatment Medical, support services Families and children Incarcerated persons, and Returning citizens Relapse is part of recovery DOJ: https://changingmindsnow.org/ Bernard C. Jack Young Mayor, Baltimore City Dr. Letitia Dzirasa, M.D. Commissioner of Health, Baltimore City 25
Questions? Thank you! jonathan.gross@baltimorecity.gov @Bmore_Healthy BaltimoreHealth Bernard C. "Jack" Young Mayor, Baltimore City Letitia Dzirasa, MD Commissioner of Health, Baltimore City health.baltimorecity.gov 26
