2015 Ohio Drug Overdose Data Report FINAL
2015 Ohio Drug Overdose Data Report FINAL
2015 Ohio Drug Overdose Data Report FINAL
Overview
Unintentional drug overdose continued to be the leading cause of injury-related death in Ohio in 2015, ahead of
motor vehicle traffic crashes a trend which began in 2007.
Unintentional drug overdoses caused the deaths of 3,050 Ohio residents in 2015,1 the highest number on record,
compared to 2,531 in 2014. The number of overdose deaths increased 20.5 percent from 2014 to 2015, which is similar
to the increase from 2013 to 2014.
Fentanyl-related unintentional drug overdose deaths in Ohio more than doubled from 503 in 2014 to 1,155 in
2015 (figure 1).
Most often used to treat patients with severe pain, fentanyl is a Schedule II synthetic narcotic that in its
prescription form is estimated to be 30 to 50 times more potent than heroin and 50 to 100 times more potent than
morphine.2
Illicit fentanyl has been observed being mixed with other commonly abused drugs, such as heroin, resulting in
increased deaths between 2005 and 2007, and it seems to be reemerging in the U.S.3 People who use drugs may
not know when illicit fentanyl has been combined with other drugs.
Number of Deaths
1,200
1,000
800
600
503
400
200
0
75
Unintentional
Drug
Poisonings**
84
2012 2013 2014 2015
* Unintentional Drug Poisoning Death include deaths with manner on the death certificate listed as accidental.
There were
652 more
unintentional
fentanylrelated
overdose
deaths in 2015
than in 2014,
and 1,071
more than in
2013.
** Does not include intentional (homicide and suicide) and undetermined fentanyl related deaths; Additional 4 in 2012, 8 in 2013, 1 in 2014, and 22 in 2015.
Source: Ohio Department of Health, Bureau of Vital Statistics; Analysis Conducted by ODH Injury Prevention Program.
______________________________________________________________________________________________________________________________________
1
2015 drug overdose data is based on information listed on death certificates, including Ohioans who died in other states.
U.S. Drug Enforcement Administration. 21 CFR part 1310. Control of a Chemical Precursor Used in the Illicit Manufacture of Fentanyl as a List 1 Chemical. Federal
Register 2007; 72: 20039-47.
U.S. Drug Enforcement Administration, Office of Diversion Control. 2015. National Forensic Laboratory Information System Report: Opiates and Related Drugs
Reported in NFLIS, 2009-2014. Springfield, VA: U.S. Drug Enforcement Administration.
Department of Health
Although pharmaceutical fentanyl may be diverted for abuse in the U.S., the majority
of fentanyl drug reports and fentanyl reported with other drugs result from illegally
produced and trafficked fentanyl, not diverted pharmaceutical fentanyl.3
The number of fentanyl drug reports4 based on law enforcement drug seizures
increased in Ohio from 110 in 2013 to 3,882 in 2015. During the same period, fentanylrelated unintentional drug overdose deaths increased from 84 to 1,155 (figure 2).
2013
Dec
Oct
Nov
Aug
Sept
Jul
Jun
Apr
May
Feb
Mar
Dec
Jan
Nov
Oct
Sept
Jul
Aug
Jun
May
Apr
Mar
Feb
Dec
Jan
Nov
Oct
Sept
Jul
Aug
Jun
May
Apr
Mar
Jan
Feb
2014 2015
Source: National Forensic Laboratory Information System (provided by the State of Ohio Board of Pharmacy), and Ohio Department of Health, Bureau of Vital Statistics; Analysis Conducted by ODH Injury Prevention Program.
Counties with the most fentanyl-related unintentional overdose deaths were Hamilton (195), Summit (111),
Butler (104), Montgomery (102), Cuyahoga (83), Clermont (54), Clark (48), Lucas (41), Franklin (40), Stark (26),
Trumbull (25), Lorain (21), and Greene (20). These counties account for 75% of fentanyl-related unintentional
overdose deaths in Ohio.
____________________________________________________________________________________________
4
The National Forensic Laboratory Information System (NFLIS) is a U.S. Drug Enforcement Administration program that collects drug chemistry analysis results from cases analyzed by state,
local and federal forensic laboratories. These laboratories analyze substances secured in law enforcement operations across the country.
5
Fentanyl-related drug deaths in this report were identified based on the literal cause of death mentioned on the death certificate. A mention of fentanyl on the death certificate does not
mean that fentanyl was the sole cause of death. The presence of more than one drug can result in more than one mention from a single death.
6
Fentanyl-related overdose death was highest among persons 25 to 34 years of age (32 percent); and males
(70.5 percent) were about 2.4 times more likely to die from fentanyl-related overdose compared to women
(29.5 percent) (figure 3).
Figure 3: Fentanyl-Related Unintentional Overdose Deaths, by Age and Sex, Ohio, 2015
300
250
Number of Deaths
200
150
Male
100
Female
50
0
<1
1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age in Years
Source: Ohio Department of Health, Bureau of Vital Statistics, Analysis Conducted by ODH Injury Prevention Program.
Heroin-related deaths accounted for 1,424 unintentional drug overdose deaths in 2015, an increase from 1,196 in
2014. Heroin was involved in 46.7 percent of all overdose deaths.
Prescription opioid-related deaths accounted for 667 (21.9 percent) of unintentional drug overdose deaths in
2015, compared to 672 (26.6 percent) in 2014 (figure 4).
2010
45%
2011
40%
2012
35%
2013
30%
2014
25%
2015
20%
15%
10%
5%
0%
Prescription Opioids*
Fentanyl
Heroin
Benzodiazepines
Cocaine
The percentage
of prescription
opioid
overdose
deaths
decreased in
2015 for fourth
straight year.
Other/Unspecified**
drugs are likely under-estimates of their true contribution to the burden of fatal drug overdoses in Ohio.
Source: Ohio Department of Health, Bureau of Vital Statistics, Analysis Conducted by ODH Injury Prevention Program.
3
Opioids (heroin, fentanyl and prescription) remained the driving factor behind unintentional drug overdoses in
Ohio. In 2015, 2,590 (84.9 percent) of drug overdoses involved any opioid, compared to 2,020 (79.8 percent) in
2014 (figure 5 and table 1).
Prescription opioids*
1,000
Cocaine
800
Benzodiazepines
600
400
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
* Prescription opioids not including fentanyl; fentanyl was not captured in the data prior to 2007 as denoted by the dashed line.
Source: Ohio Department of Health, Bureau of Vital Statistics; Analysis Conducted by ODH Injury Prevention Program.
Multiple drugs are usually involved in overdose deaths. Individual deaths may be reported in more than one category.
Unintentional drug overdose death from multiple drug use (where the number of drugs involved was specified)
accounted for 1,747 (57.3 percent) in 2015, compared to 1,321 (52.2 percent) in 2014.
Ohios annual age-adjusted death rate from unintentional drug overdoses in 2015 was 27.7 per 100,000 persons,
compared to 22.8 in 2014 (figure 6).
Figure 6. Number of Deaths and Annual Age-Adjusted Death Rate* per 100,000 Population
from Unintentional Drug Overdose by Year, Ohio Residents, 2000-2015
Number of Deaths
25
Number of Deaths
3,000
20
2,000
15
10
1,000
0
30
5
l l l l l l l l l l l l l l l l l
4,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Source: Ohio Department of Health, Bureau of Vital Statistics; Analysis Conducted by ODH Injury Prevention Program.
*Beginning with the 2015 Ohio Drug Overdose Report, the death rate is presented as age-adjusted which allows a comparison of death rates between populations (e.g. counties and states).
The rates are adjusted to the U.S. 2000 standard population to allow a comparison of the overall risk of dying between different populations.
National Data
According to the most recent national data available:
In the U.S., 47,055 people died from a drug overdose in 2014. Since 2000, the age-adjusted drug overdose death
rate has more than doubled, from 6.2 per 100,000 in 2000 to 14.7 per 100,000 in 2014.7
The 2013 National Survey on Drug Use and Health showed that 4.5 million Americans used opiates and related
substances non-medically in 2013.8
____________________________________________________________________________________________
Rudd R, Aleshire N, Zibbelll J, Gladden R. Increases in Drug and Opioid Overdose Deaths-United states 2000-2014. 2016; 64(50):1378-82.
U.S. Drug Enforcement Administration, Office of Diversion Control. 2015. National Forensic Laboratory Information System Report: Opiates and Related Drugs Reported in NFLIS, 2009-2014.
Springfield, VA: U.S. Drug Enforcement Administration.
There were 81 million fewer opioid solid doses dispensed to Ohio patients in 2015 compared to 2011 (figure 7).
800 782
793
778
780
760
751
740
720
700
701
680
660
640
2011 2012 2013 2014 2015
There were
81 million
fewer doses
of opioids
dispensed to
Ohio patients
in 2015
compared to
2011.
There were 9.5 million more prescriber queries to OARRS in 2015 compared to 2011 (figure 8).
10
8
7.5
6
5.0
3.8
1.1
2011 2012 2013 2014 2015
The number of individuals doctor shopping for opioids and other controlled substances decreased from 2,205 in
2011 to 720 in 2015 (figure 9).
1,639
1,500
1,172
963
1,000
720
500
2011 2012 2013 2014 2015
*A doctor shopper is defined as an individual receiving a prescription from 5 or more prescribers in 1 calendar month.
Source: State of Ohio Board of Pharmacy, Ohio Automated Rx Reporting System.
7
Table 1. Unintentional Drug Overdose Deaths of Ohio Residents Involving Specific Drug(s),
as Mentioned on Death Certificate, by Year, 2003-20151-3
Drug Category
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
% of 2015
deaths
All opioids*
296
429
489
551
631
733
783
980
1,163
1,272
1,539
2,020
2,590
84.9%
Heroin
87
124
131
117
146
233
283
338
431
680
983
1,196
1,424
46.7%
75
84
503
1,155
37.9%
Fentanyl
Prescription opioids**
221
319
388
462
504
538
543
692
795
628
644
672
667
21.9 %
Benzodiazepines
38
69
90
121
133
154
211
300
376
311
328
420
504
16.5%
Cocaine
140
221
223
317
287
252
220
213
309
326
405
517
685
22.5%
Alcohol
40
38
58
89
135
181
173
195
226
282
304
383
380
12.5%
Methadone
55
116
144
161
176
168
169
155
156
123
112
103
108
3.5%
Hallucinogens
10
13
14
26
31
31
43
49
61
2.0%
Barbiturates
13
11
10
19
0.6%
154
256
289
378
453
475
396
343
376
389
319
274
194
6%
8884
9805
1,0166 1,0147
1,3218
1,7479
Other/unspecified
drugs only***
Multiple Drug
Involvement
Total unintentional
poisoning deaths
658
904
1,020
1,261
1,351
1,473
1,423
1,544
1,772
1,914
2,110
2,531
3,050
Age-adjusted annual
death rate per 100,000
5.8
7.9
8.9
11.0
11.7
12.8
12.5
13.7
15.6
17.1
18.8
22.8
27.7
Source: Ohio Department of Health, Bureau of Vital Statistics; Analysis by ODH Injury Prevention Program.
1. Total includes out of state deaths of Ohio residents for all years.
2. Individual drugs do not add up to totals as more than one drug may be listed on the death certificate for one death.
3. Data completeness varies from year to year for residents who died out of state; approximately 2 percent of the fatal overdoses on average each year.
4. 343 deaths in 2010 involved an unknown number of drugs.
5. 376 deaths in 2011 involved an unknown number of drugs; multiple drug involvement count is based on 1,396 deaths with known number of drugs included on death certificate.
6. 389 deaths in 2012 involved an unknown number of drugs; multiple drug involvement count is based on 1,525 deaths with known number of drugs included on death certificate.
7. 319 deaths in 2013 involved an unknown number of drugs; multiple drug involvement count is based on 1,791 deaths with known number of drugs included on death certificate.
8. 274 deaths in 2014 involved an unknown number of drugs; multiple drug involvement count is based on 2,257 deaths with known number of drugs included on death certificate.
9. 194 deaths in 2015 involved an unknown number of drugs; multiple drug involvement count is based on 2,856 deaths with known number of drugs included on death certificate.
*Includes prescription opioids, fentanyl and heroin;
** Prescription Opioids not including Fentanyl; Fentanyl was not captured in the data prior to 2007;
***Includes only those instances where no other drug than T50.9 (other/unspecified) is included as contributing to death.
Williams
6
Fulton
14.5
Henry
8.2
Defiance
14.4
Lake
21
Lucas
19.8
Ottawa
8.8
Sandusky
14.7
Wood
9.4
Paulding
Van Wert
12.4
Putnam
5.3
Shelby
15.7
Darke
18.7
Preble
21.9
Hardin
18.7
Auglaize
8.9
Mercer
8.4
Miami
16
Montgomery
35.3
Butler
33.2
Hamilton
25.7
Warren
15.4
Logan
12.8
Marion
27.3
Union
8.8
Champaign
19.1
Clark
29.5
Madison
15
Greene
19.6
Clinton
30.2
Fayette
28.1
Brown
40.2
Franklin
17
Pickaway
19.4
Ross
28.3
Highland
19.3
Clermont
35.2
Morrow
16.6
Delaware
7.3
Adams
32.7
Pike
26.2
Scioto
31
Medina
10.3
Ashland
5.4
Richland
18.4
Crawford
16.7
Wyandot
Wayne
10.4
Summit
18.1
Portage
13.8
Stark
13
Muskingum
8.5
Perry
13.4
Hocking
17.2
Vinton
18.3
Jackson
27.3
Mahoning
22.2
Columbiana
19.9
Tuscarawas
Coshocton
9.6
9.2
Licking
13.5
Trumbull
27.7
Carroll
11.7
Holmes
Knox
15.1
Fairfield
11.1
Geauga
14
Cuyahoga
18
Lorain
18.7
Huron
18.7
Seneca
13.3
Hancock
11.6
Allen
12.7
Erie
23.3
Ashtabula
22.5
Harrison
18.1
Guernsey
19.9
Noble
Jefferson
28.8
Belmont
15.7
Monroe
Morgan
12
Washington
13.4
Athens
18.4
Meigs
15.4
Gallia
20.6
Lawrence
22
Sources: Ohio Department of Health, Bureau of Vital Statistics; Analysis by ODH Injury Prevention Program; U.S. Census Bureau (population estimates).
Includes Ohio residents who died due to unintentional drug poisoning (primary underlying cause of death ICD-10 codes X40-X44).
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
20102015
Total
Crude
Rate
Age
Adjusted
Rate
Ratio
County to
State
BROWN
10
12
13
17
11
14
17
17
23
99
37.2
40.2
2.1
MONTGOMERY
55
127
116
125
130
145
121
113
119
150
199
251
239
1,071
33.4
35.3
1.8
CLERMONT
14
25
22
31
36
38
32
49
49
56
65
80
105
404
33.7
35.2
1.8
BUTLER
23
21
31
47
45
55
68
59
80
92
120
151
195
697
31.2
33.2
1.7
ADAMS
10
10
10
12
50
29.5
32.7
1.7
SCIOTO
10
14
17
15
19
20
24
22
25
17
18
23
30
135
28.8
31.0
1.6
CLINTON
12
10
11
13
16
13
20
71
28.3
30.2
1.6
CLARK
11
25
15
18
20
19
19
19
34
36
28
38
71
226
27.5
29.5
1.5
JEFFERSON
10
12
12
15
23
13
25
14
17
21
16
106
25.9
28.8
1.5
ROSS
14
11
19
20
24
17
18
12
15
29
38
129
27.7
28.3
1.5
FAYETTE
12
16
45
26.0
28.1
1.5
TRUMBULL
23
38
29
30
58
41
43
43
57
34
37
54
89
314
25.3
27.7
1.4
MARION
13
19
18
27
22
107
27.0
27.3
1.4
JACKSON
14
12
53
26.9
27.3
1.4
PIKE
13
11
42
24.6
26.2
1.4
HAMILTON
62
72
86
98
96
113
101
110
150
159
212
248
335
1,214
25.2
25.7
1.3
ERIE
18
12
12
16
17
23
98
21.4
23.3
1.2
ASHTABULA
10
11
18
18
26
15
27
21
125
20.8
22.5
1.2
MAHONING
17
16
29
25
25
42
38
48
47
48
41
48
60
292
20.7
22.2
1.2
LAWRENCE
13
11
17
10
23
76
20.5
22.0
1.1
PREBLE
11
11
15
52
20.7
21.9
1.1
LAKE
13
18
29
26
15
20
39
42
48
43
53
50
275
20.0
21.0
1.1
GALLIA
34
18.5
20.6
1.1
COLUMBIANA
18
17
27
19
30
119
18.7
19.9
1.0
GUERNSEY
12
43
18.1
19.9
1.0
LUCAS
21
21
49
44
75
73
49
54
57
88
72
115
118
504
19.2
19.8
1.0
GREENE
15
16
19
21
16
31
21
27
23
23
21
40
43
177
18.0
19.6
1.0
PICKAWAY
14
12
10
10
63
18.6
19.4
1.0
1.0
HIGHLAND
12
45
17.4
19.3
OHIO TOTAL
658
904
1,020
1,261
1,351
1,473
1,423
1,544
1,772
1,914
2,110
2,531
3,050
12,921
18.6
19.2
CHAMPAIGN
11
40
16.9
19.1
1.0
LORAIN
13
12
13
18
16
18
25
21
25
70
69
71
63
319
17.6
18.7
1.0
HURON
14
17
10
61
17.2
18.7
1.0
DARKE
11
13
52
16.5
18.7
1.0
HARDIN
10
10
32
16.8
18.7
1.0
RICHLAND
13
16
10
12
18
14
15
11
22
31
36
129
17.5
18.4
1.0
ATHENS
13
10
12
10
52
13.3
18.4
1.0
10
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
20102015
Total
Crude
Rate
Age
Adjusted
Rate
Ratio
County to
State
VINTON
13
16.3
18.3
1.0
SUMMIT
49
60
50
53
66
46
54
66
56
91
76
118
173
580
17.9
18.1
0.9
HARRISON
14
14.9
18.1
0.9
CUYAHOGA
87
114
115
168
134
144
144
159
212
230
255
255
275
1,386
18.3
18.0
0.9
HOCKING
30
17.2
17.2
0.9
FRANKLIN
63
72
102
154
187
179
139
192
209
191
196
196
279
1,263
17.4
17.0
0.9
CRAWFORD
10
12
10
10
38
14.8
16.7
0.9
MORROW
33
15.7
16.6
0.9
MIAMI
11
10
20
15
14
12
16
12
19
17
90
14.5
16.0
0.8
BELMONT
10
14
18
60
14.3
15.7
0.8
SHELBY
12
42
14.3
15.7
0.8
WARREN
14
11
21
17
17
33
34
25
26
32
27
40
42
192
14.6
15.4
0.8
MEIGS
21
14.9
15.4
0.8
KNOX
10
12
50
13.6
15.1
0.8
MADISON
10
41
15.7
15.0
0.8
SANDUSKY
11
13
12
49
13.5
14.7
0.8
FULTON
34
13.3
14.5
0.8
DEFIANCE
30
12.9
14.4
0.8
GEAUGA
11
11
11
15
63
11.2
14.0
0.7
PORTAGE
12
16
14
16
22
30
36
124
12.8
13.8
0.7
LICKING
12
13
10
13
15
27
20
24
22
13
23
23
29
134
13.3
13.5
0.7
WASHINGTON
12
44
11.9
13.4
0.7
PERRY
26
12.0
13.4
0.7
SENECA
11
41
12.2
13.3
0.7
STARK
10
15
16
25
25
30
21
39
40
35
42
59
59
274
12.2
13.0
0.7
LOGAN
32
11.7
12.8
0.7
ALLEN
14
15
12
18
73
11.5
12.7
0.7
VAN WERT
19
11.1
12.4
0.6
MORGAN
10
11.2
12.0
0.6
CARROLL
17
10.0
11.7
0.6
HANCOCK
10
11
13
50
11.1
11.6
0.6
FAIRFIELD
12
13
17
15
12
19
17
15
16
94
10.5
11.1
0.6
WAYNE
11
13
13
24
67
9.7
10.4
0.5
MEDINA
13
13
17
14
17
27
95
9.1
10.3
0.5
TUSCARAWAS
13
11
53
9.5
9.6
0.5
WOOD
10
14
10
16
22
68
8.8
9.4
0.5
COSHOCTON
18
8.2
9.2
0.5
11
2010
2011
2012
2013
2014
2015
20102015
Total
Crude
Rate
Age
Adjusted
Rate
Ratio
County to
State
25
9.1
8.9
0.5
10
30
9.4
8.8
0.5
21
8.5
8.8
0.5
10
13
42
8.1
8.5
0.4
20
8.2
8.4
0.4
12
7.1
8.2
0.4
13
11
12
12
10
16
15
12
12
77
7.0
7.3
0.4
13
5.8
6.0
0.3
16
5.0
5.4
0.3
11
5.4
5.3
0.3
2003
2004
2005
2006
2007
2008
2009
AUGLAIZE
UNION
OTTAWA
MUSKINGUM
MERCER
HENRY
DELAWARE
WILLIAMS
ASHLAND
PUTNAM
WYANDOT*
NOBLE*
PAULDING*
MONROE*
HOLMES*
Table includes Ohio residents who died due to unintentional drug poisoning (primary underlying cause of death X40-X44).
Sources: Ohio Department of Health, Bureau of Vital Statistics; analysis by Injury Prevention Program; U.S. Census Bureau (population estimates).
County is based on county of residence; beginning in 2015 the residence county value was derived from the geocoded county value based on the decedents residence street address when the
geocode was considered of high quality.
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