march 4, 2021 ioapi opioid surveillance: indicators and

IOAPI OPIOID

SURVEILLANCE:

INDICATORS AND

USEFULNESS

March 4, 2021

Outlines

• Overview of the Reporting

• Drug & Opioid Deaths

• Naloxone/Narcan® Incidents

• Drug Overdose Incidents

• Opioid-overdose-related ED Visits

• Drug-related Child Removals

• Opioid Prescribing Trends

• Q&A

OVERVIEW

IOAPI Opioid Surveillance

How Did We Get Here?

• The Ingham County Opioid Surveillance System

was launched in 2014

• A collaborative effort between governmental and

non-governmental agencies in the Tri-County area

• Note: this presentation focuses more on nature of

data than on numbers.

Purpose

• Monitor opioid-related overdose incidents and

deaths in our community through active surveillance

• Inform county PH policymaking by tracking the

adverse impact of the opioid epidemic in our

community

Usefulness

• Track countywide impact of the opioid epidemic

overtime

• Map persons, places, and time where incidents and

deaths occur

• Disseminate the collected real-time, multiagency

information to guide actions to combat the epidemic

Usefulness (cont’d)

• Help prioritize PH intervention implementation

towards communities hit the most

• Prevent deaths

• Offer more access to available medical and social

services

Data Sources & Related Indicators

1. IC Office of Medical Examiner (OME):

Deaths/Mortality

2. City of Lansing Fire Department/EMS: Naloxone

Incidents

3. Law Enforcement Agencies (LE): Drug

overdose/Heroin Incidents in the Tri-county Area

Data Sources & Related Indicators

4. State of Michigana. MSSS: OD-related ED Visits

b. IC DHHS: Child Removals

c. LARA: (Annual) Drug Utilization Report

5. CDC: Opioid Prescribing Trends

DRUG & OPIOID DEATHS (OME)


Drug & Opioid Deaths

• Indicator: Opioid-related Mortality

• Measures:• Number of drug-related deaths

• Number of drug-related deaths involving opioids

• Opioid death rate

• Usefulness: • Analysis of trends, demographics

• Identification of new risks (i.e. new opioid/combination of drugs)

involved in overdose death

Drug & Opioid Deaths (cont’d)

• Limitations: • Drug types not mutually exclusive

• Reported numbers subject to revision as cases are being reviewed

• Rates calculated only when there were sufficient numbers of cases

present (20+)

• Possible discrepancies in Ingham-related numbers depending on the

reporting agency’s methodology (ICHD, IC OME, MDHHS Vital

Records)

• Especially due to residency/jurisdiction classification

103

88

15

104

81

23

101

84

17

111

89

22

97

84

13

0

20

40

60

80

100

120

Total Drug Deaths Opioids Non-Opioids

Total Drug-related Deaths in Ingham County, 2016-2020*

2016 2017 2018 2019 2020*

Source: Ingham County Medical Examiner Records 2020

*Data is current as of 10/7/2020

Note: Drug related Deaths independent of the place of residence in Ingham County.

87

77

10

91

73

18

91

76

15

97

78

19

86

76

10

0

20

40

60

80

100

120

Total Drug Deaths Opioids Non-Opioids

Drug-related Deaths among Residents in Ingham County 2016 - 2020*

2 2017 2018 2019 2020*



Note: Drug-related deaths including residents who died out of Ingham County limits.

11 8 8 11 8

7773 76

7876

0

10

20

30

40

50

60

70

80

90

100

2016 2017 2018 2019 2020*

Total Opioid-related Deaths by County of Residence, 2016 - 2020*

Non-County Residents Ingham County Residents



Q1 Q2 Q3 Q4

2016 18 22 12 25

2017 16 18 19 20

2018 23 17 20 20

2019 15 21 15 27

2020* 23 34 19

0

5

10

15

20

25

30

35

40

Quarterly Opioid-related Deaths among Residents in Ingham County, 2016 – 2020*



2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 *2014 *2015 *2016 *2017 *2018 *2019*†202

0

# of Deaths 16 15 8 15 17 16 17 29 29 40 55 68 77 73 76 78 76

0

10

20

30

40

50

60

70

80

90

Number of Opioid-related Deaths Ingham County, 2004-2020†

Source: Michigan Resident Death Files (2004-2013)

*Source: Ingham County Medical Examiner Records 2014 – 2020

† Data is current as of 10/7/2020.

77

21

29

62

178

0 20 40 60 80 100 120 140 160 180 200

Prescription Opioids**

Non-prescription Opioids and Benzodiazepines

Prescription Opioids** and Benzodiazepines

Heroin

Fentanyl and/or Analogues

Opioid-related Deaths by Selected Type of Opioid among Ingham County Residents, Ingham County 2018 - 2020*



**Morphine, Codeine, Methadone, Oxycodone, Hydrocodone, Hydromorphone, Oxymorphone, Tramadol, and Meperidine

27

21 22

28

12

27

34

51

64

63

22

14

13

11

5

39

23

17

32

28

2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 9 2 0 2 0 *

Opioid-related Deaths by Selected Type of Opioid among Ingham County Residents, 2016-2020*

Heroin Fentanyl & Fentanyl analogue Prescription Opioids** and Benzodiazepines Prescription Opioids**



**Morphine, Codeine, Methadone,Oxycodone, Hydrocodone, Hydromorphone, Oxymorphone, Tramadol, and Meperidine

31

37

56

66

73

35

47

67

82 83

2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 9 2 0 2 0 *

Fentanyl/Analog(s)-related Deaths among Ingham County Residents, 2016-2020*

% of all drug deaths % of opioid deaths



26

65

77

89

106

24

1

0 20 40 60 80 100 120

≥65

55-64

45-54

35-44

25-34

15-24

<15

Opioid-related Deaths by Age Groups in Ingham County, 2016-2020*; N= 380



7

54

319

Other

Black/African American

White

0 50 100 150 200 250 300 350

Opioid-related Deaths by Race in Ingham County, 2016-2020*; N=380



77

72

40 1

73

66

51 1

76

63

11

02

78

61

16

0 1

76

57

18

0 10

10

20

30

40

50

60

70

80

90

All Races White Black/African American Asian Other

Opioid-related Deaths by Race in Ingham County 2016-2020*

2016 2017 2018 2019 2020*



251

129

Opioid-related Deaths by Sex in Ingham County, 2016-2020*;N= 380

Male

Female



77

54

23

73

46

27

76

48

28

78

49

29

76

54

22

0

10

20

30

40

50

60

70

80

90

Both Sexes Male Female

Opioid-related Deaths by Sex Ingham County 2016-2020*

2016 2017 2018 2019 2020*



NALOXONE INCIDENTS

(LFD/EMS)


Naloxone/Narcan® Incidents

• Indicator: Use of Naloxone (Narcan®)

• Measures:• Number of Narcan® incidents

• A patient record from EMS where Narcan® was administered to

a person at a specific place and time in Ingham County,

regardless of the person’s place of residence

• Usefulness: • Proxy for drug overdoses

• Potential of identifying the drug potency

• Analysis of trends, demographics

• Mapping of “hotspots” in the Lansing area

Naloxone Incidents (cont’d)

• Limitations:• Repeated doses administered to a person at the same place not

included in calculations

• Findings represent only a portion of the County.

• Most of the demographic information (race) based on the

individual’s assessment of the EMT

• Impressions of the patient identified by the EMT should not be

interpreted as a diagnosis.

255

373341 330

206

0

50

100

150

200

250

300

350

400

2016 2017 2018 2019 2020*

Naloxone Incidents, City of Lansing - Ingham County, 2016–2020*

Source: City of Lansing Fire Department/EMS


255

373

341

330

206

185

231

211

194

183

59

106

105

108

89

10

26

23

26

25

1

10

2

2

9

0 100 200 300 400 500 600 700 800

2016

2017

2018

2019

2020*

Naloxone Incidents by Number of Doses Administered per Person, 2016 – 2020*

Total Naloxone Incidents (NI) NI = 1 dose/ person NI = 2 doses/person NI = 3 doses/person NI = 4+ doses/person



Q1 Q2 Q3 Q4

2016 44 50 64 97

2017 86 68 126 93

2018 79 82 101 79

2019 59 111 68 92

2020* 96 108 102

0

20

40

60

80

100

120

140

Quarterly Naloxone Incidence, City of Lansing - Ingham County, 2016 – 2020*



38

114

224

246

322

506

151

4

0 100 200 300 400 500 600

**NI

≥65

55-64

45-54

35-44

25-34

15-24

<15

Naloxone Incidents by Age Groups 2016-2020*, N= 1605

Source: City of Lansing Fire Department/EMS,


**NI= not identified

744

34

201

626

**NI

Other

Black/African American

White

0 100 200 300 400 500 600 700 800

Naloxone Incidents by Race 2016-2020*, N= 1605



**NI= not identified

25

147

83

59

214

100

0

228

113

0

212

118

0

204

102

0

50

100

150

200

250

Not Identified Male Female

Naloxone Incidence by Sex 2016-2020*, N= 1605

2016 2017 2018 2019 2020*



DRUG OVERDOSE/HEROIN

INCIDENTS (LE)


Drug Overdose (OD) Incidents

• Indicator: Drug OD/Heroin incidents

• Measures:• Number of drug overdose-related cases

• Number of drug overdose-related deaths

• Usefulness: • Analysis of trends, demographics

• Offers a larger picture at the Try-county scale

• Limitations:• Measures stratified by LE jurisdictions, with potential for

discrepancies in data updates

Jurisdiction 2016 2017 2018 2019 2020* Total

Bath Twp 1 2 1 0 0 4

Charlotte PD 4 0 1 1 0 6

CCSO/CCSD 2 5 3 5 15

Delhi Twp 0 1 0 0 0 1

DeWitt Twp PD 0 3 2 1 1 7

ECSO/ECSD 4 1 0 0 0 5

E. Lansing PD 8 11 6 5 4 34

Ingham County Sheriff Office

(ICSO)/ICSD14 19 11 18 13 75

Williamston PD 0 0 5 1 6

ICSO/ Leslie 2 0 0 0 0 2

Lansing PD 118 240 249 197 168 972

Lansing Charter Twp PD 0 0 0 0 0 0

Mason/ICSO Assist 1 0 0 0 0 0

Meridian Charter Twp PD 4 0 2 1 0 7

MSU PD 1 2 1 0 4

Total 157 281 278 231 192 1,139

Number Of Drug Overdose-related Cases (Including Overdose-related Deaths) By Law

Enforcement Jurisdiction and Month of Incident, Tri-county Area 2016-2020*

Source: Ingham County law enforcement jurisdictions *Data is current as of 10/14/2020 Note: ICSO - Ingham County sheriff’s office, ECSO - Eaton County sheriff’s office, MTPD - Meridian Township Police Dept., MSU PD - Michigan State University Police Dept.

Number of drug overdose-related deaths by law enforcement jurisdiction and month of incident, Tri-County

Area 2016-2020*

Jurisdiction 2016 2017 2018 2019 2020* Total

Bath Twp1 1 1 0 0

3

DeWitt Twp PD1 1 1 0

3

Charlotte PD1 1 0

2

ECSD4 1 0

5

ELPD3 2 2 1 0

8

ICSO/ICSD1 2 1 4 5

13

CCSD/CCSO3 3 3

9

Lansing PD17 19 23 21 12 92

MTPD

1 1 02

Total 27 26 32 32 20 137

Source: Ingham County law enforcement jurisdictions *Data is current as of 10/14/2020 Note: ICSO - Ingham County sheriff’s office, ECSO - Eaton County sheriff’s office, MTPD - Meridian Township Police Dept., MSU PD - Michigan State University Police Dept.

OPIOID-OD-RELATED ED VISITS

(MSSS)


Opioid-OD-Related ED Visits

• Indicator: Opioid-OD-related ED visits

• Measures:• Number of opioid-OD-related ED visits (formerly drug OD in

general)

• Usefulness: • Trends and demographics from medical side

• View on opioid-related emergency care seeking

• Limitations:• Data query more sensitive than specific

• Records complaint-based, not diagnosis-based

• Diagnoses overestimated or underestimated.

Q1 Q2 Q3 Q4

2017 148 113 150 133

2018 109 88 76 103

2019 92 108 105 107

2020* 186 169 111

0

20

40

60

80

100

120

140

160

180

200

Quarterly emergency room visits* related to drug overdose Ingham County, 2017 –2020**

Source: Michigan Syndromic Surveillance System

*Numbers are based on emergency department visit (chief complaints) and before any confirmed diagnosis are made.

**Data is current as of 10/16/ 2020 and include opioids only

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 **2020

# of ER visits 120 75 46 32 41 155 344 320 383 446 544 376 412 466

0

100

200

300

400

500

600

Number of Overdose-related* Emergency Room Visits Ingham County, 2007-2020**

Source: Michigan Syndromic Surveillance System

*Numbers are based on emergency department visit (chief complaints) and before any confirmed diagnosis are made.

**Data is current as of 10/16/ 2020 and include opioids only.

DRUG-RELATED CHILD

REMOVALS (IC DHHS)


Drug-Related Child Removals

• Indicator: Drug-related child removals

• Measures:• Number of opioid-related child removals

• Number of substance-use-related child removals

• Usefulness: • Analysis of trends and proportions from a social service side

• Limitations:• Aggregate numbers, without demographics

Number of Child Removals by Month, Ingham County 2020*

Source: Ingham County Department of Health and Human Services (DHHS)


Child Removals Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Year to Date

Total Removals 10 10 10 3 3 5 4 11 13 69

Substance Abuse 4 8 7 0 2 0 3 5 12 41

Opioids 1 3 1 0 0 0 1 1 3 10

Non-Opioids 3 5 6 0 2 0 2 4 9 31

No Substance Abuse 6 2 3 3 1 5 1 6 1 28

Number of Removals by Substance Abuse, Ingham County

2020*

Source: Ingham County Department of Health and Human Services (DHHS)


Removals w/ No Substance Abuse

28

w/ Opioids

10

No Opioids31

Removals w/ Substance

Abuse41

Total DHHS Removals = 69

OPIOID PRESCRIBING TRENDS

(LARA, CDC)


Opioid Prescribing Trends

• Indicator: Prescribing Trends

• Measures:• Percentage of persons who had at least one prescription filled for an

opioid

• Opioid Prescribing Rate (PR) per 100 Persons by Prescriber County

• Opioid Prescribing Rate (PR) per 100 Persons by Patient County

• Average MME* Prescribed per dispensation

• Usefulness: • See trends and demographics by opioid type breakdowns from

prescribers’ practice side

*MME= Morphine Milligram Equivalent contained in a narcotic pill.

Sources: Michigan Department of Licensing and Regulatory Affairs (LARA) from MI Automated Prescription System (MAPS) ; CDC County

Opioid Prescribing Rate Maps; IC OME;

Opioid Prescribing Trends

• Limitations:• Gap in data availability across sources

• Data from LARA reported before 2018 are less detailed.

Michigan Department of Licensing and Regulatory Affairs (LARA) from MI Automated Prescription System (MAPS) ; CDC; IC OME

Note: % will not add up to 100%. Calculate separately the age range % based on count and the correspondent Ingham County population estimate for the

report year.

Michigan Department of Licensing and Regulatory Affairs (LARA) from MI Automated Prescription System (MAPS)

1.43.0

5.3

17.0

26.1

33.3

42.3

51.2

22.1

0.2 0.6 0.6 0.1 0.6 0.2 0.6 0.4 0.4

0

10

20

30

40

50

60

≤4 5-17 18 - 24 25-34 35-44 45-54 55-64 ≥65 All Ages

Perc

en

t

Age Range

% for Full Agonist Opioids % for Partial Agonist Opioids

Percentage of persons who had at least one prescription filled for an opioid, by age

group — Ingham County, 2018

(All Opioids, N=211,454)

Note: % will not add up to 100%. Calculate separately the age range % based on count and the correspondent Ingham County population estimate for the

report year.


0.2

0.6

0.6

0.1

0.6

0.2

0.6

0.4

0.4

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

≤4 5-17 18 - 24 25-34 35-44 45-54 55-64 ≥65 All Ages

Perc

en

t

Age group (years)

% for Partial Agonist Opioids

Percentage of persons who had at least one prescription filled for an opioid, by age

group —

Ingham County, 2018 (Partial Agonist Opioids only, n=10,908)

Michigan Department of Licensing and Regulatory Affairs (LARA) from MI Automated Prescription System (MAPS) ; CDC; IC OME

2013 2014 2015 2016 2017 2018

Prescribing rate per 100 persons

by Prescriber County107.8 109.9 114.5 108.8 102.8 95.4

Prescribing rate per 100 persons

by Patient County87.2 90.1 94.4 91 84.6 72.2

50

60

70

80

90

100

110

120

Ra

te p

er

10

0 p

ers

on

s

Year

Ingham County Opioid Prescribing Rate (PR) per 100 Persons by Prescriber

County and by Patient County, 2013-2018 (All Opioids, N=211,454)

Michigan Department of Licensing and Regulatory Affairs (LARA) from MI Automated Prescription System (MAPS) ; CDC; *Michigan Substance

Use Disorder Data Repository, from Michigan Resident Death Files, 2006-2017 (Ingham County Medical Examiner Records have slightly higher

numbers for 2014-2019)

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Michigan PR 80.2 85.6 89.9 91.6 96 98.8 100.7 98.9 98 90.5 84.9 74.2 74.2 58

Ingham County PR 69.47 79.5 85.3 89.2 94.5 96.9 93.5 91.6 86 76.7 71.7 63.7 63.7 73.3

# Opioid Deaths* 8 15 17 16 17 29 29 40 46 52 66 63 74

0

20

40

60

80

100

120

Ingham County Opioid Prescribing Rate (PR) per 100 Persons and Concurrent

Number of Opioid-Related Deaths, 2006-2019

*MME= Morphine Milligram Equivalent contained in a narcotic pill.


85.9

8.0

2.1 1.7 2.3

0

10

20

30

40

50

60

70

80

90

100

200 or less 201-400 401-600 601-800 >800

Pe

rce

nt

of

Pre

scri

be

rs

Average MME Prescribed per Dispensation

6.1% of prescribers prescribed more than 375 MME (average

among Ingham County Prescribers)

Distribution of Average MME* Prescribed – Ingham County, 2018

Questions?

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