Skip to main content

Advertisement

Log in

Examining Fatal Opioid Overdoses in Marion County, Indiana

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

An Erratum to this article was published on 21 February 2017

Abstract

Drug-related overdoses are now the leading injury-related death in the USA, and many of these deaths are associated with illicit opioids and prescription opiate pain medication. This study uses multiple sources of data to examine accidental opioid overdoses across 6 years, 2010 through 2015, in Marion County, IN, an urban jurisdiction in the USA. The primary sources of data are toxicology reports from the county coroner, which reveal that during this period, the most commonly detected opioid substance was heroin. During the study period, 918 deaths involved heroin, and there were significant increases in accidental overdose deaths involving both heroin and fentanyl. In order to disentangle the nature and source of opioid overdose deaths, we also examine data from Indiana’s prescription drug monitoring program and the law enforcement forensic services agency. Results suggest that there have been decreases in the number of opiate prescriptions dispensed and increases in law enforcement detection of both heroin and fentanyl. Consistent with recent literature, we suggest that increased regulation of prescription opiates reduced the likelihood of overdoses from these substances, but might have also had an iatrogenic effect of increasing deaths from heroin and fentanyl. We discuss several policy implications and recommendations for Indiana.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. In this paper, we use “opioid” to refer to the entire family of natural, synthetic, and semi-synthetic opiates, but use “opiate” to refer to synthetic prescription opiates.

  2. Missing data were largely due to what the MCCO referred to as a “green sheet”: cases where the decedent died in a hospital and the coroner’s office was not contacted, but instead the decedent went directly to the funeral home.

References

  1. CDC. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016; 64(50): 1378–1382.

    Google Scholar 

  2. ISDH. Indiana: special emphasis report: drug overdose deaths, 1999–2014. Indianapolis, Indiana: Indiana State Department of Health. Accessed August, 2016,

  3. Nunn S, Quinet K, Newby W, Burow S. Indiana Multi-Jurisdictional Drug Task Forces, 2002 and 2003. Cent Urban Policy Environ. 2005; 5: C12.

    Google Scholar 

  4. Rudd RA, Aleshire N, Zibbell JE, Matthew Gladden R. Increases in drug and opioid overdose deaths—United States, 2000–2014. Am J Transplant. 2016; 16(4): 1323–1327.

    Article  Google Scholar 

  5. Wysowski DK. Surveillance of prescription drug-related mortality using death certificate data. Drug Saf. 2007; 30(6): 533–540.

    Article  PubMed  Google Scholar 

  6. Linakis JG, Frederick KA. Poisoning deaths not reported to the regional poison control center. Ann Emerg Med. 1993; 22(12): 1822–1828.

    Article  CAS  PubMed  Google Scholar 

  7. Hoppe-Roberts JM, Lloyd LM, Chyka PA. Poisoning mortality in the United States: comparison of national mortality statistics and poison control center reports. Ann Emerg Med. 2000; 35(5): 440–448.

    Article  CAS  PubMed  Google Scholar 

  8. Hickman M, Madden P, Henry J, et al. Trends in drug overdose deaths in England and Wales 1993–98: methadone does not kill more people than heroin. Addiction. 2003; 98(4): 419–425.

    Article  PubMed  Google Scholar 

  9. Fernandez W, Hackman H, Mckeown L, Anderson T, Hume B. Trends in opioid-related fatal overdoses in Massachusetts, 1990–2003. J Subst Abus Treat. 2006; 31(2): 151–156.

    Article  Google Scholar 

  10. Bryant WK, Galea S, Tracy M, Piper TM, Tardiff KJ, Vlahov D. Overdose deaths attributed to methadone and heroin in New York City, 1990–1998. Addiction. 2004; 99(7): 846–854.

    Article  CAS  PubMed  Google Scholar 

  11. Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98. Addiction. 2003; 98(6): 739–747.

    Article  PubMed  Google Scholar 

  12. Galea S, Ahern J, Tardiff K, et al. Racial/ethnic disparities in overdose mortality trends in New York City, 1990–1998. J Urban Health. 2003; 80(2): 201–211.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mueller MR, Shah NG, Landen MG. Unintentional prescription drug overdose deaths in New Mexico, 1994–2003. Am J Prev Med. 2006; 30(5): 423–429.

    Article  PubMed  Google Scholar 

  14. Shah NG, Lathrop SL, Reichard RR, Landen MG. Unintentional drug overdose death trends in New Mexico, USA, 1990–2005: combinations of heroin, cocaine, prescription opioids and alcohol. Addiction. 2008; 103(1): 126–136.

    Article  PubMed  Google Scholar 

  15. Scott G, Thomas SD, Pollack HA, Ray B. Observed patterns of illicit opiate overdose deaths in Chicago, 1999–2003. J Urban Health. 2007; 84(2): 292–306.

    Article  PubMed  PubMed Central  Google Scholar 

  16. United States Census Bureau U.S. Department of Commerce. http://www.census.gov/quickfacts/table/PST045215/1836003. Accessed Aug 2016.

  17. Indiana Code 36-2-14. http://iga.in.gov/legislative/laws/2016/ic/titles/036/articles/002/chapters/014/. Accessed 23 November 2016.

  18. Quinet K, Nunn S, Ballew A. Who are the unclaimed dead? J Forensic Sci. 2016; 61(S1): 1–3.

    Google Scholar 

  19. Avella J, Katz M, Lehrer M. Assessing free and total morphine following heroin overdose when complicated by the presence of toxic amitriptyline levels. J Anal Toxicol. 2007; 31(8): 540–542.

    Article  CAS  PubMed  Google Scholar 

  20. Harruff R, Couper F, Banta-Green C. Tracking the opioid drug overdose epidemic in King County, Washington using an improved methodology for certifying heroin-related deaths. Acad Forensic Pathol. 2015; 5: 499–506.

    Article  Google Scholar 

  21. Wright ER, Kooreman HE, Greene MS, Chambers RA, Banerjee A, Wilson J. The iatrogenic epidemic of prescription drug abuse: county-level determinants of opioid availability and abuse. Drug Alcohol Depend. 2014; 138: 209–215.

    Article  PubMed  Google Scholar 

  22. Webster LR, Cochella S, Dasgupta N, et al. An analysis of the root causes for opioid‐related overdose deaths in the United States. Pain Med. 2011; 12(s2): S26–S35.

    Article  PubMed  Google Scholar 

  23. Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. 2006; 31(6): 506–511.

    Article  PubMed  Google Scholar 

  24. Darke S, Zador D. Fatal heroin ‘overdose’: a review. Addiction. 1996; 91(12): 1765–1772.

    Article  CAS  PubMed  Google Scholar 

  25. Darke S, Hall W. Heroin overdose: research and evidence-based intervention. J Urban Health. 2003; 80(2): 189–200.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Darke S. Polydrug use and overdose: overthrowing old myths. Addiction. 2003; 98(6): 711.

    Article  PubMed  Google Scholar 

  27. Park T. Benzodiazepine use increases risk of death from opioid overdose. Reactions. 2015; 1557: 7–27.

    Google Scholar 

  28. Jann M, Kennedy WK, Lopez G. Benzodiazepines a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014; 27(1): 5–16.

    Article  PubMed  Google Scholar 

  29. Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Aff. 2016; 35(7): 1324–1332.

    Article  Google Scholar 

  30. Delcher C, Wagenaar AC, Goldberger BA, Cook RL, Maldonado-Molina MM. Abrupt decline in oxycodone-caused mortality after implementation of Florida’s Prescription Drug Monitoring Program. Drug Alcohol Depend. 2015; 150: 63–68.

    Article  PubMed  Google Scholar 

  31. Patrick S. Opioid-related death rates reduced by monitoring programs. Reactions. 1608; 2016: 7–2.

    Google Scholar 

  32. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011; 305(13): 1315–1321.

    Article  CAS  PubMed  Google Scholar 

  33. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016; 374(2): 154–163.

    Article  CAS  PubMed  Google Scholar 

  34. Jones CM. The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence—An assessment of demographic and substance use trends, United States, 2003–2014. Addict Behav. 2017;65:229–5.

  35. Banerjee G, Edelman EJ, Barry DT, et al. Non‐medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study. Addiction. 2016;11(11):2021–2031.

  36. Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA. 2000; 283(13): 1710–1714.

    Article  CAS  PubMed  Google Scholar 

  37. Volkow ND. America’s addiction to opioids: heroin and prescription drug abuse. Washington, DC: Senate Caucus on International Narcotics Control; 2014.

    Google Scholar 

  38. Kuehn BM. CDC: major disparities in opioid prescribing among states: some states crack down on excess prescribing. JAMA. 2014; 312(7): 684–686.

    Article  PubMed  Google Scholar 

  39. Senate Enrolled Act 246. Indiana: http://www.in.gov/legislative/bills/2013/PDF/SE/SE0246.1.pdf. Accessed 23 November 2016.

  40. United States Drug Enforcement Agency. Owner and employees of Indiana Medical Center charged with multiple felony counts. 2016. https://www.dea.gov/divisions/chi/2013/chi041913.shtml. Accessed 23 November 2016.

  41. United States Drug Enforcement Agency. Cases against doctors. Last updated Nover 16, https://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf. Accessed 23 November 2016.

  42. Klobuchar A, Grassley C, Brown S. 3397: Secure and Responsible Drug Disposal Act of 2010: to amend the Controlled Substances Act to provide for take-back disposal of controlled substances in certain instances, and for other purposes. Paper presented at: 111th US Congress (2009–2010) www.opencongress.org/bill/111-s3397/show, 2010.

  43. Bohnert AS, Nandi A, Tracy M, et al. Policing and risk of overdose mortality in urban neighborhoods. Drug Alcohol Depend. 2011; 113(1): 62–68.

    Article  PubMed  Google Scholar 

  44. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison—a high risk of death for former inmates. N Engl J Med. 2007; 356(2): 157–165.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Merrall EL, Kariminia A, Binswanger IA, et al. Meta-analysis of drug-related deaths soon after release from prison. Addiction. 2010; 105(9): 1545–1554.

    Article  PubMed  PubMed Central  Google Scholar 

  46. SAMHSA. Opioid Treatment Program Directory. Augusta, Maine: Substance Abuse and Mental Health Services. http://dpt2.samhsa.gov/treatment/directory.aspx. Accessed August 2016.

  47. Williams M, Greene M, Wright E. Opioid Treatment Programs in Indiana: IUPUI (Campus). Center for Health Policy. 2013. Indianapolis, Indiana: Center for Health Policy. Available at: https://archives.iupui.edu/handle/2450/6872.

  48. ISDH. HIV outbreak in Southeastern Indiana. Indianapolis, Indiana: Indiana State Department of Health. http://www.in.gov/isdh/26649.htm. Accessed August 2016.

  49. Strathdee SA, Vlahov D. The effectiveness of needle exchange programs: a review of the science and policy. AIDScience. 2001; 1(16): 1–33.

    Google Scholar 

  50. Young AM, Glover N, Havens JR. Nonmedical use of prescription medications among adolescents in the United States: a systematic review. J Adolesc Health. 2012; 51(1): 6–17.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge Katharine Heinz, Brittany Hood, and Pamela Young for their assistance in collecting and coding death certificate and toxicology reports. We also want to thank Amanda Garrett for helping obtain prescription drug monitoring data and Mike Medler for forensic services data.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bradley Ray.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s11524-017-0144-3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ray, B., Quinet, K., Dickinson, T. et al. Examining Fatal Opioid Overdoses in Marion County, Indiana. J Urban Health 94, 301–310 (2017). https://doi.org/10.1007/s11524-016-0113-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-016-0113-2

Keywords

Navigation