Examining Opioid-Related Overdoses One at a Time

Examining Opioid-Related Overdoses One at a Time

Other states may want to take notice of an ambitious research program underway in Utah that is studying opioid-related overdose deaths one at a time.

The Utah Department of Health's Opioid Fatality Review Committee (OFRC), established in 2018, has already come up with a lot of useful data for more effective policies to prevent fatal overdoses.

By studying one case at a time, the OFRC is able to reveal far more data about the situations leading up to and surrounding each death than can be gleaned from terse coroners' reports. Instead of the usual few facts - age, gender, location, substance(s) etc., - the researchers drilled down to learn what each victim was doing before the event and what led to it. This shines a bright light on what might have been done to prevent it, and suggested how to prevent occurrences in the future.

Of course, researchers looked at toxicology reports. But adding more information from other available sources and collating it all under specific categories has proved invaluable.

For example, where did it happen? What pills or other substances were found near the victim when they died? Had they recently been incarcerated, in a hospital, in a treatment situation - anywhere they might have experienced a "dry period" shortly before their death? It's well known that opioid tolerance can rapidly diminish after even a short period of abstinence, and victims don't realize it until too late.

More than 50 recommendations

The work has been so revealing that the OFRC already has made more than 50 recommendations for prevention, based on in-depth reviews of just 58 individual overdose deaths from 2017.

Researchers have been able to identify and collate "hot spots" for opioid overdose deaths around the state, discover where certain substances are more prevalent, including prescription vs. street drugs like heroin, how many victims were also abusing gabapentin, and much more.

"The greatest threat of gabapentin occurs when used with an opioid, because both drugs have been identified and shown to suppress breathing, which can be fatal," says one of the reports. "If gabapentin is taken with an opioid there is a 49 percent higher risk of dying."

Another 49 percent statistic was the number of males suffering overdose following release from hospitals or jails within one month, compared to 42 percent who were not recently in an institution. Number of women suffering overdose after recent release and periods of abstinence was 70 percent.

Synthetic opioids doubled

Although nearly 70 percent of deaths in 2017 involved prescription opioids, the greatest increase has involved heroin deaths, from 55 in 2010 to 147 in 2017. In that same 7-year period, deaths involving "synthetic" opioids - predominantly fentanyl (and not including methadone, which is a synthetic) doubled from 50 to 92 cases.

Statistics are grouped by age and gender, and include recent release from hospital, jail/prison/detention center, psych hospital/institution, and supervised residential facility.

Following release from hospitals, 32 percent of fatalities were linked to prescription drugs vs. 3 percent illicit opioids. Following release from jail/prison, statistics were the opposite - 11 percent prescription drugs vs. 28 percent illicit opioids. Following release from psych institutions, statistics were exclusively prescription drugs, and were predictably the opposite - street drugs - following release from residential facilities.

The OFRC recommends more and better education for anyone working with substance use disorders, including more education for doctors and others charged with weaning patients off MAT drugs like methadone. Other recommendations include better monitoring of prescription opioids, more availability of naloxone, and more funding to help families, to increase interventions and to expand crisis services throughout the state.

People, not just statistics

Joey Thurgood, the Utah DOH's Opioid Fatality Review Coordinator, said the important thing is that the deaths aren't viewed as "data points, but as people." She added that a thorough review of individual opioid-related deaths "informs prevention efforts statewide" - knowing the circumstances of specific types and locations of opioid-related overdose deaths will help prevent similar fatalities in the future.

Utah, which some might expect to be somewhat removed from the violent effects of the opioid epidemic, is dealing with a serious situation. According to the National Institute on Drug Abuse (NIDA), the state's death rate is 15.5 deaths per 100,000 persons, well above the national average of 14.6 deaths per 100,000 persons.

The OFRC was created last year by the DOH's Violence and Injury Prevention Program to find ways to improve the current system and possibly keep more people from dying preventable deaths. The program is being funded through grants, and involves representatives from several agencies, including the Utah Department of Corrections, the Attorney General's Office, the Utah Department of Human Services, and the University of Utah Medical Center.

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