Page 1 Drug Overdoses and Deaths, 2019

Population Health Vital Statistics Brief:

Drug Overdoses, April 1 - April 30, 2019
The Population Health Vital Statistics Data Brief series was created to provide regular updates to the 2016
Community Health Assessment and to provide the community with additional important information about
population health. For more information on the Community Health Assessment and to access other reports in
the Vital Statistics Data Brief series, please visit scph.org/assessments-reports

Summit County Public Health Ÿ Population Health Division

1867 W. Market St., Akron, Ohio 44313 Ÿ (330) 923-4891
www.scphoh.org

Drug Overdose Visits to Hospital Emergency Rooms

From January 1, 2019 to April 30, 2019, emergency rooms serving Summit County residents have treated an
estimated 449 drug overdoses (OD); an average of 3.7 overdoses per day.* Overdoses have been fairly volitle
over the past month; spiking briefly in early April, then bottoming out by the middle of the month and then
returning to the yearly average of about 4 per day.

Multiple OD visits (more than one visit to an ER in the same hospital system) -- So far in 2019, 24 of the 449
people visiting an ER for an overdose have made more than one visit (5.3% of the total). Four of these cases
have three visits each since January 1st, while one person had five.

*
Drug overdose data is retrieved from
the state’s EpiCenter surveillance
tool. “Overdose” cases include all
emergency visits by a Summit County
resident to any medical provider in
which drugs were identified as the
cause of traumatic injury. Overdose
cases were further refined by selecting
only those cases where the case notes
included the terms “OD” or “overdose.”
Traumatic injuries due to drugs caused
by suicide attempts, allergic reactions
to normal medications, or accidental
overdoses of everyday drugs (such
as Tylenol or Ibuprofin) were removed
where identified. Zip codes refer to the
zip code of residence of the patient
visiting the ER. Data cited in this report
represents the full-day totals from the
day before the report’s release.

It is important to note that these are

estimated figures rather than a full
and final count because initial diag-
noses and/or details of a particular
case may change from a patient’s
initial examination to his or her final
outcomes, and because the limited
case notes field in EpiCenter may not
include all details necessary to firmly
classify a case as an overdose.

It is also important to note that case

notes available through EpiCenter
rarely identify the specific drug or
drugs involved in an overdose. There-
fore the figures here can be associated
Figure 1a and 1b: Visits to the ER Due To Drug Overdoses By Day (top figure) and By Seven-Day Moving Aver- with any drug, not just heroin and/
age (bottom figure) -- Note: Because day-to-day total ER visits tend to fluctuate, a seven-day simple moving average or fentanyl.
chart is included to more clearly examine trends in the data. Source: EpiCenter
Figure 2: ER Visits by Time of Day and Day of Week -- The chart above presents total Summit County ER visits for each hour of each day. The chart is read left to right, and presents the
percentage of each day’s ER visits due to drug overdoses that occur in each hour of the day for all days from January 1, 2019 to December 31, 2019. The cells are also color coded to show
a “heat map” effect of busier and slower times throughout each of the seven days of the week. Source: EpiCenter and SCPH calculations.
Drug Overdoses and Deaths, 2019

Figure 3: Summary Chart of

ER Visits by Hour of the Day,
Jan 1, 2019 to Dec. 31, 2019
Source: EpiCenter / SCPH

Figure 4: Summary Chart of

ER Visits by Day of the Week,
Jan. 1, 2019 to Dec. 31, 2019,
Source: EpiCenter / SCPH
Page 2
 Page 3 Drug Overdoses and Deaths, 2019

Demographic and Geographic Profile of Overdoses, YTD 2018

Age - People in the 25-34 and 35-49 age categories (37% and 32%, respectively) have the highest
percentage of overdoses. Another 12% were in the 18-24 category, while people age 50-64 accounted
for 14%. People in the under 18 and over 65 categories accounted for a combined 6%.

Gender - Males made up 63% of overdoses so far in 2018; females 37%.

Geography* - Overdoses have happened throughout the county, with zip codes 44203 and 44310 having
the highest number of overdoses at 48 and 42, respectively (21% of all cases combined). Zip Codes
44305 and 44320 had 39 and 30, respectively. Combined, Akron currently makes up 61% of all overdoses
in 2018, while suburban communities make up the remaining 39%.

Number and Percent of Overdoses

by Zip Code, January 1 - December 31, 2019 Emergency Room Visits Due to Drug Overdose,
Summit County by Home Zip Code of Patient,
All Summit County Provider Types, As Of 4/30/2019

®
v
v ®
® v 44202

44087
44067 44056

44141

44236
44264
44286

44223 44224

44333

44221 44262
v
® ®
v
44313

44303 44310
44278
44321 v
®
44302 44304
44308 ®
v
® v
44320 v
® 44305
44307
44311
44260
44301 44306
44314
v
® Hospitals in Summit County 44312

Summit County 44203 44250

®
v v
®
City of Akron
Zip Code of Patient 44319

31 - 48
19 - 30 44685

10 - 18
44216
1-9
44720
None reported

Source: EpiCenter

Figure 5a: Number and Percent of ER Visits Due to Drug Overdoses, YTD 2018
Source: EpiCenter and SCPH. Note: Figures for zip codes with fewer than 10 overdoses are not shown to preserve confidentiality.

* - Overdoses for the 44250 zip code area (Lakemore) are sometimes reported by EpiCenter as being in 44312.
Drug Overdoses and Deaths, 2019 Page 4

Race - Over 90% of overdoses in 2019 have been

white, while nearly 8% have been black. The
remaining 2% includes people of Asian, other,
or unknown races. Whites make up 90% of
overdoses but only 79% of the population (making
them over-represented), while blacks make up 8%
of overdoses but 15% of the population (making
them under-represented).

Figure 5b: Overdoses by Race and Population by Race, Whites and Blacks
only, Source: EpiCenter, American Community Survey, 2016

Overdoses Per 1,000 by Zip Code - Figure 6a shows the number of overdoses per 1,000 population by
zip code. So far in 2019, the heaviest concentration of overdoses per 1,000 population are in zip codes in
the central portions of the county.

Change In Overdoses by Zip Code - Figure 6b shows the change in overdoses by patient zip code on a
year-over-year basis, comparing totals for Year-To-Date 2018 with totals for Year-To-Date 2019. Thirteen
zip codes have shown year-over-year increases as of April 2019, while most have shown decreases.

Emergency Room Visits Due to Drug Overdose Change In Emergency Room Visits Due to Drug
Per 1,000 Population, Jan 1 - Apr 30, 2019 Overdose, Summit County by Home Zip Code of
44202 Patient, All Provider Types, Year-Over-Year
Change, Jan-Dec 2018 to Jan-Dec 2019
44056 44087
44202
44067

44087
44067 44056

44141

44236
44286 44141
44264

44236
44264
44286

44223 44224

44333
44223 44224

44221 44262
44333
44313

44221 44262
44303
44310 44313
44278
44321
44302 44304 44303
44310
44308 44278
44320 44305 44321
44307 44302
44311 44308
44320 44304 44305
44260 44307
44312 44311
44301
44306 44312 44260
44314
44301 44306
Narcan available w/o an Rx 44250
Summit County 44314
44203
Summit County City of Akron
44203 44250

City of Akron Zip Code of Patient

44319
1.6 - 2.5 Jan-Dec 18 to Jan-Dec 19 Change
44319
0.8 - 1.5 1 - 15 increase
44685
0.5 - 0.7 No change
44685
0.1 - 0.4 1 - 14 decrease
44216

None reported 44720 Source: EpiCenter 44216

44720
Source: EpiCenter

Figure 6a: Drug Overdoses Per 1,000 Population, YTD 2019

Source: EpiCenter, U.S. Census Bureau, Ohio Pharmacy Board Figure 6b: Change in Number of Overdoses, Jan-Apr 2018 to
(Narcan) Jan-Apr 2019 Source: EpiCenter
 Page 5 Drug Overdoses and Deaths, 2019

Overdose Death Hot Spots

Figures 7 and 8 at right show how drug overdose
fatalities have spread over time in Summit County.
So-called “hot spots” on these maps show areas
of the county where the number of drug overdose
fatalities are more heavily clustered than other
parts of the county. In the same way, cold spots are
those areas where fatalities are less clustered than
other parts of the county. Each area of the maps are
shaded to show how much confidence there is that
each area is either a hot spot (shades of red), a cold
spot (shades of blue), or neither (yellow).

Figure 7, above right, shows the calculated hot spots

for drug overdose fatalities between 2007 and 2012.
Hot spots with 90% and 95% confidence levels can
be found in Barberton in the west and running from
the Akron Central and Southeast clusters through
parts of the Springfield / Lakemore cluster. Cold
spots were also found in both the Akron Northwest Figure 7: Drug Death Hotspot Map, 2007-2012
and Cuyahoga Falls clusters.

Figure 8, below right, shows the calculated hot

spots for drug overdose fatalities between 2013 and
2017. As the map shows, the hot spots now run from
northern Barberton and eastern Norton in the west
up through the Akron Southwest, South, Southeast,
Central, and North clusters and on into western
portions of the Munroe / Tallmadge cluster. These
hot spots are also more intense and more tightly
clustered than in the previous five year period. Unlike
2007-2012, most hot spots in the current period are
at the 99% confidence level, with only a handful of
locations showing lower levels of confidence. Cold
spots can also be found in several locations including
significant portions of the Twinsburg, Hudson, and
Akron Northwest clusters.

Figure 8: Drug Death Hotspot Map, 2013-2018

Drug Overdoses and Deaths, 2019 Page 6

Trends In Substance Abuse, Akron-Canton Region

The table below presents data from “Surveillance of Drug Abuse Trends in the State of Ohio, June 2017 -
January 2018” published by the Ohio Substance Abuse Monitoring Network (OSAM). The data in this report
highlights emerging trends in the previous six month period and provides some insight on how those
trends impact today’s overdose picture. The report relies primarily on input by focus groups made up of
drug users, community professionals, service providers, and law enforcement.

One of the findings of the report was that the availability of heroin was growing while quality was declining.
According to the report, “heroin” in this region has morphed into pure fentanyl often cut with other substances
(including heroin itself) to reduce its potency. By early 2017, users reported that dealers were deliberately
reducing potency, both to increase profit and to reduce the odds of their users dying of an overdose (which
helps the dealers avoid murder / manslaughter charges).

A second finding is that users were beginning to switch to meth to reduce the risk of dying from a heroin
overdose and, for users taking Vivatrol, to replace the high lost when Vivatrol shuts off the brain’s opiate
receptors. All parties reported rapidly growing availability of meth throughout the region. Additional details
by specific type of drug can be found in the table and notes below.
 Page 7 Drug Overdoses and Deaths, 2019

Trends In Overdose Deaths

Total overdose deaths rose sharply from 2013 to 2016,
then began a rapid decline, and are now back to
2014 levels (see Figure 11a). Opiates such as heroin,
fentanyl, and carfentanil drove the sharp increases
over the past 3 years. However, the mix of drugs
driving overdoses today appears to be changing.
Figure 11a: Drug Overdoses 2000-2018, Source: ODH Death Re-
cords, SCPH
Figures 11b and 11c show selected drugs that have
been included on the death certificates of drug
poisoning victims over the past several years. From
2014-2018, 785 people who died of drug poisoning
had an opiate mentioned on their death certificate.
More than 650 had either fentanyl or a fentanyl
analog mentioned, while 239 mentioned carfentanil
from 2016 to 2018.

Figure 11c shows trends in the drugs contributing Figure 11b: Overdoses Involving Selected Drugs, 2014-2018
Source: ODH Death Records, SCPH
to the overdose epidemic. As a percentage of total
overdoses, all but one drug peaked or leveled off
in 2017 or before; prescription opiates and fentanyl
peaked in 2016; carfentanil and cocaine peaked in
2017. Heroin peaked in 2013 (included on 48% of
death certificates) then dropped to only 5% by 2018.

The one drug that has shown a sustained

increase as a percentage of the total since 2014 is
methamphetamine. In 2014, methamphetamine
Figure 11c: Specific Drugs Mentioned On Death Certificates As A
only appeared on one death certificate. By Percent of All Poisoning Deaths, 2012-2018 Source: ODH Death
Records, SCPH (Note: Since many overdose fatalities involve mul-
2017, methamphetamine appeared on 54 death tiple drugs, totals will not add up to 100%).
certificates. As a percentage of all drug poisoning
deaths, methamphetamine was mentioned on 25%
of all death certificates in 2018; a higher rate than
either heroin or carfentanil.

Drug-Related Deaths by Race

Drug-related death rates by race have evolved
over time. Both black and white rates experienced
a significant rise between the 2012-2014 and 2015-
Figure 12: Age-Adjusted Drug Poisoning Deaths Per 1,000 Popu-
2017 periods. In 2018, the rate for whites declined lation, Total And By Race, 2012-2018 (primary underlying cause
significantly, but only declined slightly for blacks. of death X40 - X44), Source: ODH Death Records, SCPH.
Drug Overdoses and Deaths, 2019 Page 8

From 2012-2014, the black drug-related death rate

was just 58% as high as the white rate. By 2015-2017, • In 2016 and 2017, the biggest age group was 25-
the black rate was nearly 75% of the white rate. By 34, which accounted for 26% and 29% of deaths,
2018, the black rate was nearly 168% of the white rate. respectively. In 2018, the 35-44 age group was
the highest at 30%.
What these figures make clear is that the overdose • Male deaths were higher than female deaths in
epidemic remains a community-wide crisis. The all three years, and by a wide margin.
epidemic is striking all parts of the community; city
• The vast majority of drug poisoning deaths were
and suburban, white and black, male and female,
to those with an educational attainment level of
young and old.
high school graduate or GED in all three years.

Figures 13 to 16 present some basic demographic • Though the vast majority of deaths were white in
information about drug poisoning deaths in 2016 all years, African-American deaths as a percent
vs. 2017 for which detailed death certificate data of the total rose sharply between 2017 and 2018
is currently available (2016, 298 deaths; 2017, 235 (13% to 23%).
deaths; 2018; 105 deaths).

Figure 13: Age At Death of Persons Dying of Accidental Drug Poisoning, Figure 14: Race of Persons Dying of Accidental Drug Poisoning, 2016-2018,
2016-2018, Source: Ohio Department of Health Death Records, SCPH Source: Ohio Department of Health Death Records, SCPH

Figure 15: Sex of Persons Dying of Accidental Drug Poisoning, 2016-2018, Figure 16: Educational Attainment of Persons Dying of Accidental Drug Poi-
Source: Ohio Department of Health Death Records, SCPH soning, 2016-2018, Source: Ohio Department of Health Death Records, SCPH