With so many of our health and public health resources being used to combat the coronavirus pandemic, there’s a growing concern that many of the health crises identified before the pandemic are not being addressed and won’t be for some time. Obviously, it’s imperative to stop the spread of COVID-19 in our communities but continuing to address other public health crises is also critical. One of those is the Opioid Epidemic — an alarming public health issue that killed 450,000 Americans from 1999 - 2018.1
September is National Alcohol and Drug Addiction Recovery Month, and a great incentive to reflect on the Opioid Epidemic.
According to CDC data, the largest percentage (about 32%) of all opioid-related deaths in 2018 involved prescription opioids.1 Because of this, public health overdose-prevention efforts have targeted opioid prescribing rates. These have decreased overall since 2012, but there is still work to be done. The map below shows states (in red) that have higher opioid prescription rates despite these efforts.1
Figure 1. U.S. map showing states with higher Opioid Prescription Rate compared to national value
Digging Deeper to Reveal Disparities
Looking at the national landscape of prescription opioid rates doesn’t give a complete picture of the issue. For example in Figure 1 above, Virginia had one of the lower opioid prescription rates in the U.S. at the state level — 6.6% less than the average U.S. rate of 51.4 prescriptions per 100 persons.1 But look more closely at the regional and county level, and disparities in communities that are hardest hit are revealed. This is an important revelation with potential differences in public health resources needed to address opioid issues in these communities.
The map below shows the death rates due to prescription opioid overdose in Virginia by county in 2018. Counties in red indicate higher associated death rates compared to 75% of all Virginia counties. The trend over time chart shows that Fluvanna county death rates due to prescription overdose approximately doubled after four years.2
Figure 2. Death Rate due to Prescription Opioid Overdose by county in Virginia, 2018
Figure 3. Trend chart of Death Rate due to Prescription Opioid Overdose in Fluvanna County, VA
These statistics suggest that efforts to build state and local prevention as well as response capacity, access to care, and more public health and public safety collaborations are needed to battle against opioid epidemic disparities among regions.
Digging deeper into data shows that disparities not only exist among counties in each state, but also for different racial/ethnic, gender and age groups.
Shifting focus to the West Coast, with 5.8 opioid-involved overdose deaths per 100,000 persons in 2018, California had a lower death rate due to drug overdose compared to most other states.3
In 2019, emergency department visits related to opioid overdoses (excluding heroin) totaled 5,041. But when the age-adjusted ED visit rate due to opioid overdose (excluding heroin) is shown by race and gender, populations at higher risk due to opioid overdose become clear.
As Figure 3 and 4 below show, that rate among men was almost double the rate among women in 2019. And the age-adjusted ED visit rate of non-Hispanic blacks was four ED visits per 100,000 residents higher than non-Hispanic whites, and three times higher compared to Latinos.4
Figure 3. Age-adjusted ED Visit Rate due to Opioid Overdose (excluding Heroin) in California, by gender
Source: California Opioid Overdose Surveillance Dashboard
Figure 4. Age-adjusted ED Visit Rate due to Opioid Overdose (excluding Heroin) in California, by race/ethnicity
Trends Show a Growing Danger
The opioid crisis has changed in character. Trends indicate the total number of prescriptions dispensed has decreased by more than 22% in recent years, yet prescription opioids remain the leading cause of opioid overdose deaths.3 In California alone, the age-adjusted ED visit rate due to opioid overdose increased 69.8% between 2015 and 2019.3 Potential inconsistencies between indication-specific prescribing patterns and emergency visits due to opioid overdoses highlight that reductions in opioid prescriptions has not been enough to resolve the opioid epidemic.
Figure 5. Age-adjusted ED Visit Rate due to Opioid Overdose (excluding Heroin) in California
Source: California Opioid Overdose Surveillance Dashboard.
Local Insights are Key
State and local health and behavioral health departments, hospitals, and community-based organizations have a very important role to play in preventing opioid overdoses and related harms. Local data helps programs more effectively target areas that are most impacted by the epidemic.
Some of the programs that have proven success in reducing opioid misuse include:
- Prescription drug monitoring programs
- Regulating controlled substances
- Licensed addiction care providers in rural areas
- Quick responses to drug overdose outbreaks
- Adequate public health insurance coverage and workers compensation programs
- Syringe exchange programs, and Naloxone Distribution networks.
For these strategies to be effective in addressing the opioid epidemic, a more complete understanding of most-affected communities is crucial. This ensures that already limited public health funding, especially during the coronavirus pandemic, can have maximum benefit for communities most impacted by the opioid crisis.
As health professionals work to cultivate paths to better health outcomes amidst numerous public health crises and challenges, finding populations in need is increasingly vital to effectively focus resources and implement evidence-based programs that will improve community health across populations and geographies. Local data is an essential ingredient in the process.
About Healthy Communities Institute
Conduent Healthy Communities Institute enables health-focused organizations to efficiently and measurably impact the populations they serve. The HCI platform includes more than 150 health, social, and economic indicators. Through HCI’s platform and services, users can swiftly gain insights from data, identify disparities, plan and implement initiatives, and collaborate and communicate to make a difference. The HCI Strategy Tracking Solution combines the expertise and support of public health consultants with the power of the leading strategy-tracking software.
To make localized population health data available to organizations on the front lines of the fight against coronavirus, HCI launched: HCI COVID-19 At-Risk Populations.
Contact Conduent Healthy Communities Institute at firstname.lastname@example.org.
1Centers for Disease Control and Prevention. (2020). Opioid Overdose.
2Virginia Department of Health. (2019). Opioid Data.
3National Institute of Health. (2019). Opioid Summaries by State. National Institute on Drug Abuse.
4California Opioid Overdose Surveillance Dashboard. (2020, August 14). California Quick Stats.