scholarly journals Using Local Toxicology Data for Drug Overdose Mortality Surveillance

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Haylea A. Hannah ◽  
Karina Arambula ◽  
Rochelle Ereman ◽  
Darrell Harris ◽  
Alexandra Torres ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Overdose ◽  
Specific Detail ◽  
Local Public Health ◽  
Marin County ◽  
The Difference ◽  
Multiple Drugs ◽  
Overdose Mortality ◽  
Public Health Practitioners ◽  
Overdose Deaths

ObjectiveTo describe the potential impact of using toxicology data to supportdrug overdose mortality surveillance.IntroductionAlthough Marin County ranks as the healthiest county in California,it ranks poorly in substance abuse indicators, including drug overdosemortality.1Death certificates do not always include specific detail onthe substances involved in a drug overdose.2This lack of specificitymakes it difficult to identify public health issues related to specificprescription drugs in our community. We analyzed 2013 drugoverdose death toxicology reports to determine if they could improvethe description of drug overdose deaths in our community and todescribe associated data characteristics.MethodsToxicology reports were requested from the Office of the Sheriff-Coroner for 37 drug overdose deaths among Marin County residents,comprising 95% of the 39 total drug overdose deaths in 2013.The remaining two deaths were excluded as they were associated withinhalation of therapeutic gases. Select information from toxicologyreports was entered into a database for aggregate analyses. Drugoverdose deaths were considered “fully detailed” if they included thespecific types of drugs involved in the death and did not use any broadlanguage to describe the death (i.e. narcotic, multiple drugs). Student’sT-tests (α=0.05) were used to identify significant differences betweengroups of interest.ResultsOf the 37 drug poisoning deaths analyzed, 34 (92%) had availabletoxicology information. The remaining three (8%) deaths occurredoutside of Marin County and were thus investigated by anotherjurisdiction. A basic toxicology panel was ordered on 17 (50%) ofthe 34 drug overdose deaths, while an expanded toxicology panelwas ordered on the remaining 17 (50%). Alcohol was identified inthe toxicology screen of 15 (44%); Amphetamines were identifiedin 8 (24%); and opiates were identified in 25 (74%) drug overdosedeaths. Among the 25 deaths with at least one opiate identified on thetoxicology screen, the majority (52%, n=13) also had alcohol present.The majority of drug overdose deaths, 18 (53%), did not have fullinformation about the type of drug involved. The average numberof drugs identified on the toxicology screen of all 34 drug overdosedeaths was 6 (SD: 3). The average number of drugs identified in thetoxicology screen significantly differed (p=0.0001) between causes ofdeath that were fully detailed (Mean: 4; 95% CI: 3-5) and those thatwere not fully detailed (Mean: 8; 95% CI: 7-10).ConclusionsData from the Sheriff-Coroner’s office provided detail on thetypes of drugs involved in overdose deaths; however, it is difficultfor local public health practitioners to make decisions about causalityor contributions of these drugs to the death. These data may beuseful in understanding the difference between fully detailed andnon-detailed drug overdose deaths, and a broader context of drugcombinations associated with these deaths. Less drugs were identifiedin the toxicology screen of deaths that were fully detailed, suggestingthat overdose deaths that are not fully detailed may be exceedinglycomplex, making it difficult for medical examiners and coroners toassess causality. Approximately three-quarters of 2013 drug overdosedeaths contained opiates on the toxicology screen, indicating thatopiates may be a significant contributor to overdose deaths in ourcommunity. Our results are descriptive in nature; therefore, eventhough alcohol or opiates were identified on the toxicology screen,they may not be responsible for the overdose death. Given that overhalf of our 2013 overdose deaths were not fully detailed with drugtype, local jurisdictions should work closely with their corner and/ormedical examiner to fully detail death certificates with drugs involvedin overdose deaths.

scholarly journals At udskyde det uundgåelige: Om brugen af kausal viden i forebyggende tiltag

2012 ◽  
Vol 9 (17) ◽  
Author(s):  
Morten Hulvej Rod ◽  
Tine Curtis
Keyword(s):  
Public Health ◽  
Social Interaction ◽  
Health Agency ◽  
Public Health Research ◽  
Causal Knowledge ◽  
Local Public Health ◽  
The Future ◽  
Prevention And Health Promotion ◽  
Local Public Health Agency ◽  
Public Health Practitioners

This paper discusses the heavy reliance upon a particular kind of causal knowledge in prevention and health promotion. Based on ethnographic fieldwork with prevention professionals working with interventions targeting teenage drinking in Denmark, the paper argues that, while attempting to provide predictions for the future, prevention creates certain problems for itself in the moments of social interaction where it is practiced. The paper suggests that prevention can be seen as an attempt at postponing the future and through empirical examples it is illustrated how this project causes a number of practical problems to prevention professionals. The paper begins by sketching the causal epistemology that dominates current public health research. Next, ethnographic descriptions of (i) an educational intervention in Danish schools and (ii) a meeting for parents arranged by a local public health agency provide the material for discussing the practical use of causal knowledge. It is shown that this knowledge becomes contradicted and undermined in the social interaction between public health practitioners and their target groups, and that – paradoxically – this knowledge tends to actualize the very phenomenon it seeks to prevent. The paper employs Bourdieu’s distinction between two modes of anticipatory intelligence, the project and the protention, and argues that, in the interaction between prevention professionals and target group, the widespread use of causal knowledge might inhibit and counteract the situational competencies of prevention professionals.

scholarly journals Drug Overdose Trends among Black Indiana Residents: 2013-2017

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Raven Helmick
Keyword(s):  
Mortality Rate ◽  
Drug Overdose ◽  
Rate Increase ◽  
Mortality Rates ◽  
Time Frame ◽  
Minority Population ◽  
Racial Inequalities ◽  
Specific Mortality ◽  
Overdose Mortality ◽  
Overdose Deaths

ObjectiveTo understand trends in race-specific mortality rates between blacks and whites to discover any racial inequalities that might exist for drug overdose deaths. To delve into the types of drugs that are prominently involved in black drug overdose deaths from 2013-2017 in the state of Indiana.IntroductionBlack Hoosiers, the largest minority population in Indiana, make up almost 10% of the state’s population, and accounted for 8% of the total resident drug overdose deaths from 2013-2017 compared to whites at 91%. However, a closer look at race-specific mortality rates might reveal racial inequalities. Therefore, the purpose of this project was to analyze drug overdose morality rates among white and black Hoosiers to discover possible racial inequalities and to discover trends in drug involvement in overdose deaths among blacks.MethodsDrug overdose deaths that occurred in Indiana between 2013 and 2017 were identified using the underlying and contributing cause of death ICD-10 codes and abstracted from the Indiana State Department of Health’s annual finalized mortality dataset. Race-specific drug overdose death rates were calculated and compared among racial groups. Drug overdose deaths in blacks were examined for trends over time and by the types of drugs involved.ResultsBetween 2013 and 2017, drug overdose mortality rates for whites increased from 17.05 to 27.28 per 100,000. Blacks saw a higher rate increase during this same time frame: from 10.74 to 30.62 per 100,000, surpassing the mortality rate of whites by the end of 2017. Drug overdose deaths in blacks increased 197% from 2013-2017 and drug specific mortality rate increases were seen across all drug category’s. Opioids, which were involved in 61% of the 2017 drug overdose deaths among blacks, had a rate increase from 3.05 to 18.62 per 100,000 between 2013 and 2017. Drug specific overdose mortality rate increases were also seen for overdoses involving cocaine (1.76 to 10.62 per 100,000), benzodiazepines (0.32 to 3.08 per 100,000), and psychostimulants other than cocaine (0.16 to 1.69 per 100,000) such as amphetamines.ConclusionsWhile white Hoosiers had higher drug overdose mortality rates between 2013 and 2016, black Hoosiers had a greater mortality rate increase and surpassed the mortality rate in whites in 2017. Opioids, the most frequently involved substance in overdose deaths among blacks from 2013-2017, showed increasing rates during this time period. However, increases in drug specific overdose mortality rates for cocaine, benzodiazepines, and psychostimulants other than cocaine also call for public health attention. These results promote the inclusion of minority health experts in drug overdose prevention efforts and issue a call for future prevention efforts to be targeted toward the state’s largest minority population. 

A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA

2016 ◽  
Vol 47 (2) ◽  
pp. 164-184 ◽  
Author(s):  
Amos Irwin ◽  
Ehsan Jozaghi ◽  
Ricky N. Bluthenthal ◽  
Alex H. Kral
Keyword(s):  
Public Health ◽  
United States ◽  
San Francisco ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Effective ◽  
The United States ◽  
Local Public Health ◽  
Supervised Injection ◽  
Overdose Deaths

Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.

scholarly journals Assessing Knowledge and Application of Emergency Risk Communication Principles Among Public Health Workers in China

2014 ◽  
Vol 8 (3) ◽  
pp. 199-205 ◽  
Author(s):  
James R. Cope ◽  
Melinda Frost ◽  
Li Richun ◽  
Ruiqian Xie
Keyword(s):  
Public Health ◽  
Risk Communication ◽  
Health Workers ◽  
International Health ◽  
Current Status ◽  
Local Public Health ◽  
Public Health Agencies ◽  
Health Agencies ◽  
Health Practitioners ◽  
Public Health Practitioners

AbstractObjectiveSince 2003, the Chinese National Health and Family Planning Commission (formerly the Ministry of Health) has implemented changes to more effectively communicate risk during public health emergencies. In spite of ongoing improvements, provincial and sub-provincial leaders face barriers, such as established modes of operation, lack of training, shortage of trained risk communicators, and limited understanding and willingness of recipients to mitigate risks.MethodsWe assessed the current status of and barriers to risk communication knowledge and practice among public health practitioners in China. We designed the survey questionnaire to capture information related to the risk communication core capacities required by international health regulations and common risk communication principles.ResultsOur findings showed that risk communication training has successfully developed an awareness of risk communication principles and the ability to implement those principles in practice in China.ConclusionsFuture efforts should focus on areas such as a dedicated risk communication workforce, requirements that public health agencies develop a risk communication plan, and additional training for public health practitioners and their partners. It is critical that the infectious diseases prevention and control law be amended to grant provincial and local public health agencies more autonomy to release information. (Disaster Med Public Health Preparedness. 2014;0:1-7)

scholarly journals Exploring Drug Overdose Mortality Data in Harris County, Texas

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric V. Bakota ◽  
Deborah Bujnowski ◽  
Larissa Singletary ◽  
Sherry Onyiego ◽  
NAdia Hakim ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Abuse ◽  
Drug Overdose ◽  
The United States ◽  
Mortality Data ◽  
Harris County ◽  
Death Rates ◽  
Overdose Death ◽  
The Past ◽  
Overdose Mortality

ObjectiveIn this session, we will explore the results of a descriptive analysis of all drug overdose mortality data collected by the Harris County Medical Examiner's Office and how that data can be used to inform public health action.IntroductionDrug overdose mortality is a growing problem in the United States. In 2017 alone over 72,000 deaths were attributed to drug overdose, most of which were caused by fentanyl and fentanyl analogs (synthetic opioids)1. While nearly every community has seen an increase in drug overdose, there is considerable variation in the degree of increase in specific communities. The Harris County community, which includes the City of Houston, has not seen the massive spikes observed in some communities, such as West Virginia, Kentucky, and Ohio. However, the situation in Harris County is complicated in mortality and drug use. From 2010 - 2016 Harris County has seen a fairly stable overdose-related mortality count, ranging from 450 - 618 deaths per year. Of concern, the last two years, 2015-2016, suggest a sharp increase has occurred. Another complexity is that Harris County drug related deaths seem to be largely from polysubstance abuse. Deaths attributed to cocaine, methamphetamine, and benzodiazipine all have risen in the past few years. Deaths associated with methamphetamine have risen from approximately 20 per year in 2010 - 2012 to 119 in 2016. This 6-fold increase is alarming and suggests a large-scale public health response is needed.MethodsData were collected by the Harris County Institute of Forensic Sciences (IFS), which is part of the Harris County Medical Examiner's Office. IFS is the agency responsible for collecting and analyzing human tissue of the deceased for toxicological information about the manner and cause of death. IFS is able to test for the presence of multiple substances, including opioids, benzodiazepines, methamphetamines, cocaine, ethanol, and many others.These data were cleaned and labeled for the presence of opioids, cocaine, benzodiazepine, Z-drug (novel drug), amphetamines, ethanol, and carisoprodol. Explorative descriptive analyses were then completed in R (version 3.4) to identify trends. An RShiny app was created to further explore the data by allowing for rapid filtering and/or subsetting based on various demographic characteristics (e.g., age, sex, race).ResultsWe found that Harris County is experiencing a modest upward trend of drug related overdoses, with 529 observed in 2010 and 618 in 2016. We also found that the increase was not uniform across all classified drugs: amphetamines, cocaine, and ethanol all saw increases. Deaths involving amphetamine increased substantially from 21 in 2010 to 119 in 2016 (Figure 1). Deaths involving cocaine saw the next sharpest increase with 144 in 2010 and 237 in 2016. Deaths associated with opioids remained fairly constant, with 291 deaths in 2010 and 271 deaths in 2016.Differences in mortality across race and sex groups were also observed. The proportion of amphetamine deaths among whites jumped sharply, while the proportion of opioid and benzodiazepine deaths among whites decreased in recent years. The proportion of amphetamine and cocaine deaths among men rose more sharply than with women in the past three years, whereas for opioids, the proportion of women dying has dropped.ConclusionsIt is undeniable that the opioid epidemic is a true public health emergency for the nation. New surveillance tools are needed to better understand the impact and nature of this threat. Additionally, as we have found in Harris County, the threat may be polysubstance in nature.Our report offers two important insights: 1) that mortality data is a useful and actionable surveillance resource in understanding the problem of substance abuse; and 2) public health needs to look at substance abuse from a holistic and comprehensive perspective. Keeping the purview limited to opioids alone may create significant blind spots to the public health threat facing us.References1. National Institute of Health. (2018) Overdose Death Rates. Retreived from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

scholarly journals Importance of Scientific Resources Among Local Public Health Practitioners

2015 ◽  
Vol 105 (S2) ◽  
pp. S288-S294 ◽  
Author(s):  
Robert P. Fields ◽  
Katherine A. Stamatakis ◽  
Kathleen Duggan ◽  
Ross C. Brownson
Keyword(s):  
Public Health ◽  
Local Public Health ◽  
Health Practitioners ◽  
Public Health Practitioners

scholarly journals Job Satisfaction and Expected Turnover Among Federal, State, and Local Public Health Practitioners

2016 ◽  
Vol 106 (10) ◽  
pp. 1782-1788 ◽  
Author(s):  
Jonathon P. Leider ◽  
Elizabeth Harper ◽  
Ji Won Shon ◽  
Katie Sellers ◽  
Brian C. Castrucci
Keyword(s):  
Public Health ◽  
Job Satisfaction ◽  
Federal State ◽  
Local Public Health ◽  
Health Practitioners ◽  
State And Local ◽  
Public Health Practitioners

Legal Innovations to Advance a Culture of Health

2015 ◽  
Vol 43 (4) ◽  
pp. 904-912
Author(s):  
James G. Hodge ◽  
Kim Weidenaar ◽  
Andy Baker-White ◽  
Leila Barraza ◽  
Brittney Crock Bauerly ◽  
...  
Keyword(s):  
Public Health ◽  
Technical Assistance ◽  
Federal State ◽  
Robert Wood Johnson Foundation ◽  
Local Public Health ◽  
Health Practitioners ◽  
New Ideas ◽  
Laws And Policies ◽  
Public Health Practitioners ◽  
Health Laws

Since its inception in 2010, the Network for Public Health Law (Network) has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation (RWJF) has invited the Network and other partners to consider new ideas and strategies toward building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations.

scholarly journals At-a-glance - Impact of drug overdose-related deaths on life expectancy at birth in British Columbia

2018 ◽  
Vol 38 (6) ◽  
pp. 248-251 ◽  
Author(s):  
Xibiao Ye ◽  
Jenny Sutherland ◽  
Bonnie Henry ◽  
Mark Tyndall ◽  
Perry Robert William Kendall
Keyword(s):  
British Columbia ◽  
Socioeconomic Status ◽  
Life Expectancy ◽  
Drug Overdose ◽  
Causes Of Death ◽  
Lower Socioeconomic Status ◽  
Life Expectancy At Birth ◽  
Lower Socioeconomic ◽  
Overdose Mortality ◽  
Overdose Deaths

We quantified the contributions of leading causes of death and drug overdose to changes in life expectancy at birth over time and inequalities by sex and socioeconomic status in British Columbia. From 2014 to 2016, life expectancy at birth declined by 0.38 years and drug overdose deaths (mainly opioid-involved) contributed a loss of 0.12 years of the decrease. The analysis also demonstrated that the higher drug overdose mortality among males and among those in lower socioeconomic status communities contributed to a differential decrease in life expectancy at birth for males and for those in the latter category.

scholarly journals P105: BC’s public health emergency and naloxone administration by the BC Ambulance Service

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S114 ◽  
Author(s):  
R. Purssell ◽  
L. Mathany ◽  
M. Kuo ◽  
M. Otterstatter ◽  
J. Buxton ◽  
...  
Keyword(s):  
Public Health ◽  
Drug Overdose ◽  
Illicit Drug ◽  
Descriptive Analysis ◽  
Public Health Emergency ◽  
Ambulance Service ◽  
Opioid Antagonist ◽  
Critical Element ◽  
Naloxone Administration ◽  
Overdose Deaths

Introduction: In 2015, there were 476 apparent illicit drug overdose deaths, prompting BC’s Provincial Health Officer to declare a public health emergency on 14 Apr 2016. Paramedics of BC’s Ambulance Service (BCAS) are on the front lines in this crisis. Here we examine recent trends in the number of suspected overdose events attended by the BCAS and the use of naloxone, an opioid antagonist, by BCAS paramedics. Methods: The BC Centre for Disease Control receives a weekly data feed from BC Emergency Health Services that includes all records from the BCAS Patient Care Record where: naloxone was administered by paramedics; the primary impression code indicates poisoning or overdose; or, the originating call is associated with ingestion poisoning (‘card 23’). Here, we report a descriptive analysis of these data for suspected drug overdose events during the period January 1, 2010 to September 30, 2016. Results: Between January 2010 and September 2016 BCAS paramedics attended 164,227 suspected overdose events; 12% of these events (n=16,944) included naloxone administration by BCAS paramedics. Paralleling the rise in illicit drug overdose deaths in BC, naloxone administration by paramedics has been increasing rapidly, doubling from approximately 180/month in 2014, to 370/month in 2016. When naloxone was administered by paramedics, 90% of these patients were transported, whereas 77% were transported when naloxone was not administered. Administrations occurred most frequently on Friday and Saturday evenings. Almost half (46%) of all naloxone administrations by paramedics were recorded as being in a home or residence; 18% were recorded as occurring on a street or highway. The proportion of naloxone administrations among males has increased yearly. In 2010, 58% of naloxone administrations were in males compared to 69% in 2016. Conclusion: The number of overdose deaths in BC has risen drastically in recent years and the proportion of ambulance calls requiring administration of naloxone by BCAS has climbed correspondingly. The vast majority of overdose cases-especially those requiring naloxone-are transported to the emergency department. With the overdose crisis showing little sign of abating, the administration of naloxone by BC paramedics will continue to be a critical element of the provincial response.

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