governor raimondo’s task force on overdose prevention and ......2020/10/13 · 48% 7% 12% 33% 0%...

Governor Raimondo’s Task Force on Overdose

Prevention and InterventionOctober 14, 2020

DIRECTOR NICOLE ALEXANDER-SCOTT, M.D., M.P.H.; RHODE ISLAND DEPARTMENT OF HEALTH

DIRECTOR KATHRYN POWER, M.Ed.; RHODE ISLAND DEPARTMENT OF BEHAVIORAL HEALTHCARE,

DEVELOPMENTAL DISABILITIES, AND HOSPITALS

WELCOME &

ANNOUNCEMENTS

CODE Meeting Action Steps: Response to Increases in Overdoses

In July, RIDOH and BHDDH hosted an emergency

Community Overdose Engagement (CODE) meeting with

state and local partners. In response, we are:

• Increasing funding for street outreach with certified

peer recovery support specialists.

• Deploying additional staff in overdose hot spots

across the state.

• Purchasing and distributing harm reduction supplies.

• Providing wrap-around services and basic needs.

• Identifying a point person to coordinate outreach

efforts at both the state and local level.

CODE Meeting Action Steps:Response to Increases in Overdoses

• Increasing housing supports for vulnerable

populations in Woonsocket and Providence.

• Increasing linkages to treatment by embedding

certified peer recovery support specialists at Rhode

Island Hospital and Landmark Hospital.

• Continuing to explore additional overdose prevention

and intervention activities.

Recovery Friendly WorkplaceOctober Designees

The Recovery Friendly Workplace (RFW) Initiative gives business owners and managers the

resources and support they need to foster a supportive environment that encourages the success of

their employees in recovery. Learn more at RecoveryFriendlyRI.com

Machiste Rankin, RICARES

Data Update: Accidental Drug Overdose DeathsJanuary 2020-June 2020

October 14, 2020

Governor Gina M. Raimondo’s Overdose

Prevention and Intervention Task Force

How Does RIDOH Report on Fatal Drug Overdoses?

• RIDOH reports on drug overdose deaths using data

from the Office of State Medical Examiners (OSME).

• It can take up to 90 days for the OSME to confirm a

decedent’s cause and manner of death.

• RIDOH reports on drug overdose deaths whereby the

manner of death is “Accident,” and does not include

other manners such as suicides, homicides, or

undetermined deaths.

General Data Trends

All Drug Fatal Overdoses January 2016-June 2020

179 158 156 156193

0

50

100

150

200

250

300

350

400

2016 2017 2018 2019 2020

Nu

mb

er o

f D

eath

s

January-June July-December

336 324 314 308

11% 1% 0% 24%

Fatal overdoses, for which any drug contributed to cause of

death, increased by 24%, compared to the same time period in

2019.

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.

147 135 135 127169

0

50

100

150

200

250

300

350

2016 2017 2018 2019 2020

Nu

mb

er o

f D

eath

s

January-June July-December

290 286272

256

Opioid-Involved Fatal Overdoses January 2016-June 2020

8% 6%0% 33%

Fatal overdoses, for which any opioid, including fentanyl,

contributed to the cause of death, increased by 33%,

compared to the same time period in 2019.


Demographics

Proportion of Fatal Overdoses by Age Category, January 2020-June 2020

People 25 years of age and older make up the highest proportion

of fatal overdoses. These data are similar to the same time period

in previous years.

4%

23%25% 26%

22%

0%

5%

10%

15%

20%

25%

30%

Under 25 25-34 35-44 45-54 55 & Older

Jan-Jun 2020


Rate of Fatal Overdoses per 100,00 Residents by Age Category, January 2020-June 2020

People between the ages of 25 and 54 experience the greatest

burden of fatal overdose.

3.2

56.7

73.9 70.7

23.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Under 25 25-34 35-44 45-54 55 & Older

Rat

e p

er 1

00

,00

0 R

esid

en

ts

Jan-Jun 2020

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.Note: Population denominator based on ACS one-year estimates for each year divided by half; 2019 estimate applied for 2020 rates. Data limited to accidental drug overdose deaths occurring in Rhode Island among Rhode Island residents.

Proportion of Fatal Overdoses by RaceSimilar to previous time periods, about nine out of 10 fatal

overdoses from January 2020 to June 2020 occurred among

the White population.

4%11% 8%

13% 10%

94%87%

91%86% 89%

0%

20%

40%

60%

80%

100%

Jan-Jun 2016 Jan-Jun 2017 Jan-Jun 2018 Jan-Jun 2019 Jan-Jun 2020

Black White

Note: Due to small numbers, proportion of fatal overdoses among decedents of Asian or unknown race are not shown.


Rate of Fatal Overdoses per 100,000 Residents by RaceFrom 2016 to 2019, the rate of fatal overdose among the White population

decreased. However, from January 2020 to June 2020, the rate of fatal

overdose among the White population increased.

33.0

28.0 28.826.9

36.6

0.0

15.0

30.0

45.0


Rat

e p

er 1

00

,00

0 R

esid

ents

White

Note: Due to small numbers, rates of fatal overdoses among decedents of Asian or unknown race are not shown. Population denominator based on ACS one-year estimates for each year divided by half; 2019 estimate applied for 2020 rates. Data are limited to accidental drug overdose deaths occurring in Rhode Island among Rhode Island residents.


Rate of Fatal Overdoses per 100,000 Residents by Race2019 saw higher rates of fatal overdose among the Black population

compared to the White population.

From January 2020 to June 2020, the rate of fatal overdose among the

Black population was similar to that of the White population.

13.9(n=6)

38.3(n=16)

20.8(n=9)

35.4(n=18)

35.4(n=18)33.0

(n=144) 28.0(n=125)

28.8(n=127)

26.9(n=117)

36.6(n=159)

0.0

15.0

30.0

45.0


Rat

e p

er 1

00

,00

0 R

esid

ents

Black White

Note: Due to small numbers, rates of fatal overdoses among decedents of Asian or unknown race are not shown. Population denominator based on ACS one-year estimates for each year divided by half; 2019 estimate applied for 2020 rates. Data are limited to accidental drug overdose deaths occurring in Rhode Island among Rhode Island residents.


Proportion of Fatal Overdoses by Ethnicity

Similar to previous time periods, the majority (84%) of fatal

overdoses occurred among non-Hispanics.

7% 7%11% 12% 10%

91%87%

78% 75%

84%

3% 6%12% 13%

6%

0%

20%

40%

60%

80%

100%


Hispanic non-Hispanic Unknown


Rate of Fatal Overdoses per 100,000 Residents by EthnicityFrom 2016 to 2019, the rate of fatal overdose among non-Hispanics

decreased. However, the rate of fatal overdose among non-Hispanics

increased from January to June 2020.

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.Note: Population denominator based on ACS one-year estimates for each year divided by half; 2019 estimate applied for 2020 rates. Data are limited to accidental drug overdose deaths occurring in Rhode Island among Rhode Island residents.

31.1(n=140) 28.1

(n=126) 24.3(n=108)

23.5(n=104)

34.1(n=151)

0.0

10.0

20.0

30.0

40.0


Rat

e p

er 1

00

,00

0 R

esid

ents

non-Hispanic

Rate of Fatal Overdoses per 100,000 Residents by Ethnicity

Over time, the rate of fatal overdose among Hispanics has increased;

however, it remains lower than the rate among non-Hispanics.

11.4(n=9)

13.5(n=11)

17.8(n=15)

18.5(n=16)

22.0(n=19)

31.1(n=140) 28.1

(n=126) 24.3(n=108)

23.5(n=104)

34.1(n=151)

0.0

10.0

20.0

30.0

40.0


Rat

e p

er 1

00

,00

0 R

esid

ents

Hispanic non-Hispanic

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.Note: Population denominator based on ACS one-year estimates for each year divided by half; 2019 estimate applied for 2020 rates. Data limited to accidental drug overdose deaths occurring in Rhode Island among Rhode Island residents.

Type of Setting Where the Overdose Occurred

Proportion of Fatal Overdoses by Type of Settings

The majority of fatal overdoses continue to occur in private settings.

From January 2020 to June of 2020, 93% of fatal overdoses occurred

in a private setting compared to 88% in the same time period in 2019.

5%

7%

88%

4%

3%

93%

0% 20% 40% 60% 80% 100%

Public

Semi-Private

Private Jan-Jun 2020

Jan-Jun 2019

Jan-Jun 2018

Jan-Jun 2017

Jan-Jun 2016

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.Note: Private settings include places such as apartments and homes, semi-private settings include places such as treatment facilities, hospitals, and prisons, and public settings include places such as abandoned property, businesses, and sidewalks, and parks.

Substances Contributing to Cause of Death

Substances Contributing to Cause of Death January 2016-June 2020

Source: OSME, RIDOH. Data updated as of 9/28/2020.Notes: Substance categories are not mutually exclusive. More than one substance may have contributed to cause of death.

81%

67%

49%

5%13%

31%

85%

72%

53%

9%13%

38%

88%

75%

48%

7%12%

33%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Jan-Jun 2019

Jul-Dec 2019

Jan-Jun 2020

Any Opioid Fentanyl Cocaine Amphetamines Benzodiazepines Alcohol

Three out of four fatal overdoses involved fentanyl. About one

in two fatal overdoses involved cocaine.

Substances Contributing to Cause of DeathBy Drug Type, January-June 2016-2020

The majority (72%) of fatal overdoses involved illicit drugs. This

proportion is higher in 2020 compared to the same time period in previous

years.

The proportion of fatal overdoses involving only prescription medication

has decreased over time, when comparing the same time period in

previous years.

63%51%

67% 64% 72%

16%28%

21% 27% 20%21% 21% 12% 9% 8%

0%

20%

40%

60%

80%

100%


Illicit Combination Prescription


Substances Contributing to Cause of Death Opioids and Fentanyl

The majority (88%) of fatal overdoses continue to involve any opioid.

From January 2020 to June 2020, the majority of opioid-involved fatal

overdoses are due to illicit opioids, such as fentanyl. Eighty-five percent

of opioid-involved fatal overdoses involved fentanyl, compared to 63%

during the same time period in 2016.

Source: Office of State Medical Examiners (OSME), Rhode Island Department of Health (RIDOH). Data updated as of September 28, 2020.Note: Substance categories are not mutually exclusive. More than one substance may have contributed to cause of death.

63% 67%84% 82% 85%

37% 33%16% 18% 15%

0%

20%

40%

60%

80%

100%


Fentanyl

No Fentanyl

Proportion of Opioid-Involved Fatal Overdoses by Fentanyl

Geographic Patterns

Count of Overdose Fatalities by Municipality of Incidence, January 2020 to June 2020

Count of Overdose Fatalities by City/Town

of Incidence

Legend

Source: Office of the State Medical Examiners (OSME)

0

Less than 5

5-8

9-13

14-21

22-50

0 3 6 miles

Municipalities Where

Fatal Overdoses

Occurred

Percent Change of Overdose Fatalities: Comparing January 2019-June 2019 to January 2020-June 2020 By Municipality of Incidence

Percent Change from 01/01/2019-06/30/2019 to

01/01/2020-06/30/2020

Legend


Over 25% Decrease

Less than 25% Increase

25% to 50% Increase

Over 50% Increase

Less than 5 Overdose Fatalities in either

time period

0 3 6 miles

Count of Overdose Fatalities by Municipality of Residence from January 2020-June 2020

Count of Overdose Fatalities by City/Town

of Residence

Legend


0

Less than 5

5-8

9-13

14-21

22-48

0 3 6 miles

Municipalities Where the Victim Lived

Percent Change of Overdose Fatalities: Comparing January 2019-June 2019 to January 2020-June 2020 By Municipality of Residence

Percent Change from 01/01/2019-06/30/2019 to

01/01/2020-06/30/2020

Legend


Less than 25% Decrease

Over 25% Decrease

Less than 25% Increase

25% to 50% Increase

Over 50% Increase

Less than 5 Overdose Fatalities in either

time period

0 3 6 miles

Compared to 2019, Providence

and Warwick have doubled their

count of fatal overdoses among

their residents.

Conclusions

Demographics

• People between the ages of 25 and 54 suffer the greatest burden

of fatal overdose.

• In 2019, the rate of fatal overdoses were higher among the Black

population compared to the White population.

• From January 2020 to June 2020, the burden of fatal overdoses

among the Black population has not changed; however, the burden

among the White population has increased. Both populations are

experiencing an equal burden in 2020.

• Over time, the rate of fatal overdose among Hispanics increased;

however, it remains lower than the rate among non-Hispanics.

Conclusions

Setting

• The majority of fatal overdoses in 2020 continue to occur in private

settings.

Substances Contributing to Cause of Death

• The majority of fatal overdoses involve illicit drugs only. The

proportion of fatal overdoses involving prescription-only drugs has

decreased over time.

• The majority (88%) of fatal overdoses continue to involve any

opioid. The majority of opioid-involved fatal overdoses are due to

illicit opioids, such as fentanyl, and not prescription opioids.

• About half of the fatal overdoses from January 2020 to June 2020

involved cocaine. These findings are similar to the same time

period 2019.

Conclusions

Geographic Patterns

• During the first six months of 2020, almost every municipality in

Rhode Island has been impacted by an increase in fatal overdoses.

• The number of Warwick and Providence residents suffering a fatal

overdose has doubled in the first six months of 2020, compared to

the same time period in 2019.

• In North Kingstown and Scituate, the total number of fatal

overdoses that occurred among residents in the first six months of

2020 has exceeded the total number of fatal overdoses for all of

2019.

Rachel P. Scagos, MPH

Acting Drug Overdose Surveillance Program

Manager

Division of Policy, Information, and

Communication

Rhode Island Department of Health

[email protected]

Rhode Island’s Review of Overdose Accidental Deaths (ROAD): August 2020 Findings

October 14, 2020

Governor’s Task Force on Overdose Prevention

and Intervention

Background Information

Goals of ROAD Meetings:

• Examine emerging trends in the overdose epidemic.

• Identify demographic, geographic, and structural

points for prevention.

RIDOH’s Role:

• Organize and facilitate the meetings.

• Convene a diverse, multidisciplinary group of

stakeholders to inform the recommendations of the

meetings.

• Publish recommendations emerging from meetings.

ROAD Background

• First ROAD meeting took place in 2016, with limited

membership.

• Legislation passed in July 2018 (2018-S 2577),

providing protections and allowing the broadening

of ROAD membership.

• Legislation sunsets on December 31, 2020. We

will continue to work to remove the sunset date

in early 2021.

• Conduct three to four ROAD meetings per year with

a specific meeting theme determined.

Data Sources Utilized

RIDOH Fatal Overdose Data

• Office of State Medical Examiners (OSME),

and/or

• State Unintentional Drug Overdose Reporting

System (SUDORS)

BHDDH

Prescription Drug Monitoring Program (PDMP)

Emergency Medical Services (EMS)

Law Enforcement

• Heroin Opioid Prevention Effort (HOPE) Initiative

• Police reports within OSME data

• Court Connect

August 2020 Meeting

Precipitated by:• Concerns about the increase in overdose deaths in

2020.

• Concerns if the individuals experiencing a fatal

overdose in 2020 may have had a history of

substance use treatment.

• Questions about the interaction between the COVID-

19 pandemic and the drug overdose epidemic.

Reviewed 12 cases of deaths: • Occurring in March or April 2020.

• Cases include deaths of individuals with a history of

substance use and/or mental health treatment.

Community Recommendations

• Consider temporal financial factors when

developing plans for strategic naloxone

distribution.

• Increase awareness about the health risks

associated with cocaine and polysubstance use;

promote local resources for treatment and

recovery support for polysubstance use.


• Continue to partner with faith-based

organizations to disseminate treatment and

recovery resource materials. Encourage faith

communities to offer recovery support services

to members.

• Continue to connect parents and caregivers who

have a history of opioid use disorder to

treatment and recovery support services,

particularly during child custody transitions.


• Increase outreach to individuals or family

members who have lost a loved one to

overdose. Provide outreach to individuals or

family members who may be living with a

substance use disorder and experienced the

loss of a loved one due to overdose.

• Increase awareness about the availability of

comprehensive, whole-person treatment

services across the state.

Structural Recommendations

• Expand buprenorphine access to people who

are uninsured and have opioid use disorder.

• Expand low-threshold buprenorphine treatment

options for people with opioid use disorder.

• Amend Rhode Island regulations to include the

tracking of all prescription medications in the

Rhode Island PDMP database.


• Consider including data from the Rhode Island

Department of Labor and Training (DLT) to

inform ROAD case reviews.

• Utilize the Rhode Island DLT Unemployment

Insurance Division to distribute treatment and

recovery resources to people receiving

unemployment benefits.

• Consider amending the Rhode Island Good

Samaritan Law to protect people who have

active arrest warrants.


• Address or develop policies to decriminalize the

possession of Medication Assisted Treatment

(MAT), specifically buprenorphine.

• Conduct a comprehensive evaluation of patient

outcomes associated with the expansion of

methadone take-home treatment, particularly

during the activation of Rhode Island’s COVID-

19 Stay-At-Home Order.

Post Meeting Action Steps

• Surveyed ROAD participants to receive general

feedback and feedback on the virtual version of

the meeting.

• Presented ROAD findings at various meetings,

including:

• Weekly STOP call

• RIDOH Peer Recovery Support Specialist Outreach

Call

• Harm Reduction Work Group

• View the August 2020 ROAD Report here.

• Next ROAD meeting: October 29, 2020.

https://health.ri.gov/publications/bytopic.php?parm=Addiction%20and%20Overdose

Rachel Scagos, MPH

Acting Drug Overdose Surveillance Program Manager

Division of Policy, Information, and Communication


[email protected]

Heather Seger, LICSW

Family Outreach Coordinator, Drug Overdose Prevention

Program

Division of Community Health and Equity


[email protected]

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