Indiana State Department of Health: County Opioid Profile
Events over the summer of 2017 increased public discourse about Bloomington’s place in the nationwide opioid addiction crisis. In the aftermath of the state’s sluggish response to the communicable disease outbreak that unfolded in Scott County in 2015, state officials and public advocates have taken steps to implement a statewide harm reduction strategy that leverages county health departments, law enforcement, and grassroots organizations to combat the spread of infectious diseases.
Presently there is no accurate way to estimate how many individuals in a given area are likely to be addicted to opiate drugs. Current standard practice uses a set of opioid health indicators to gauge the severity of a county’s opiate addiction. These indicators include: rate of newly identified Hepatitis-C cases per 100,000 persons, rate of newly identified HIV cases per 100,000, rate of opioid related drug poisoning per 100,000, rate of opioid related non-fatal emergency department visits per 100,000, and abuse treatment rate for opiates and other synthetics per 100,000.
Hepatitis C, Chronic Rate (2011 - 2015)
Confirmed and probable case investigations reported through the Indiana – National Electronic Disease Surveillance System (I-NEDSS) and are based on county where the case was investigated. Year is determined based on first positive laboratory specimen date. All rates per 100,000 population. Counts include those who were incarcerated in the Indiana Department of Corrections or Federal Bureau of Prison Facilities at the time the investigation was closed (Cass, Clark, Noble, Hendricks, Henry, Jefferson, LaPorte, Madison, Marion, Miami, Parke, Perry, Putnam, Sullivan, Vigo). More Information about Hepatitis C, Chronic.
Data Info: Statistical unit is Incidence Rate per 100,000. Data are suppressed when counts are <5. data-preserve-html-node="true" County level disease counts with cases status of confirmed or probable. Rates based on fewer than 20 cases are considered unstable. Year represents the year data was reported to CDC per MMWR Calendar year found at: https://wwwn.cdc.gov/nndss/downloads.html. Data prior to 2011 includes State and Federal Department of Corrections cases. 2017 data are through August 14.
Source: Indiana State Department of Health, Epidemiology Resource Center Variable ID: 'DISEASE060'
HIV/AIDS Prevalence Rate (2015)
Case investigations reported through the Statewide Monitoring and Surveillance System (SWIMSS) by county of residence. More Information about HIV/AIDS Prevalence.
Data Info: Statistical unit is Prevalence Rate per 100,000. Data are suppressed when counts are <5. data-preserve-html-node="true" 2010 rates based on 2010 Decenial Census, 2011 through 2015 rates based on county population estimate. Provisional data are as of March, 2017.
Source: Indiana State Department of Health, HIV/STD/Hepatitis Division Variable ID: 'STD008'
Deaths from Drug Poisoning Rate - Involving Opioid Pain Relievers
(2012 - 2016)
Deaths of Indiana residents caused by acute drug poisonings that involve prescription opioid pain relievers as a contributing cause-of-death. Prescribed opioid pain relievers include drugs such as hydrocodone, oxycodone, morphine, and fentanyl. Count and rate (statistic) are by county of residence. Rates based on counts less than 20 are considered unstable/unreliable (U) and should be interpreted with caution. Crude rate per 100,000 population. More Information about Deaths from Drug Poisoning - Involving Opioid Pain Relievers.
Data Info: Statistical unit is Crude Death Rate per 100,000. Deaths with any of the following ICD-10 codes as an underlying cause of death: X40-X44 (accidental poisonings by drugs), X60-X64 (intentional self-poisoning by drugs), X85 (assault by drug poisoning), or Y10-Y14 (drug poisoning of undetermined intent) AND with any of the following ICD-10 contributing cause-of-death codes: T40.2 (natural and semisynthetic opioids), T40.3 (methadone), or T40.4 (synthetic opioids, other than methadone). Rates are provided for 10 or more deaths. Note: To avoid over-counting the number of drug deaths, counts from these tables should not be added together. Multiple drugs can be listed on the death certificate for drug-poisoning deaths, and deaths can be included in more than one of these tables for deaths from certain drugs and drug types.
Source: Indiana State Department of Health, Division of Trauma and Injury Prevention; Vital Records Variable ID: 'DEATH055'
Non-Fatal Emergency Department Visits due to Opioid Overdoses Rate (2016)
Data reported by county of residence. ICD-10-CM Diagnostic Code: T40.0, T40.1 T40.2; T40.3; T40.4; T40.6. More Information about Non-Fatal Emergency Department Visits due to Opioid Overdoses (2016 and later).
Data Info: Statistical unit is Incidence Rate per 100,000. Data are suppressed when counts are <5. data-preserve-html-node="true" The U.S transitioned from ICD-9-CM to ICD-10-CM on Oct. 1, 2015. The reader should consider the change in coding systems when comparing results from analysis of ICD-10-CM coded data to those from ICD-9-CM coded data.
Source: Indiana State Department of Health, Division of Trauma and Injury Prevention Variable ID: 'DISCH012A'
Substance Abuse Treatment - Other Opiates and Synthetics Rate
(2011 - 2015)
The data represents episodes where services were received from state funded substance abuse treatment programs and can include multiple admissions for an on-going drug problem. An episode is defined as the period between the beginning of treatment (admission) for a drug or alcohol problem and the termination of services. An episode can span an indeterminate period of time. The episode date is state fiscal year. The provider determines when treatment is terminated for a given episode. If the problem reoccurs in the future and treatment is initiated again, a new treatment episode would begin.
Data Info: Statistical unit is Incidence Rate per 100,000.
Source: IPRC Variable ID: 'SACA031'
This time frame correlates with the Federal government’s effort to constrict the prescription of opioid pain relievers. With the creation of the INSPECT system (Indiana's Prescription Drug Monitoring Program) and increased oversight of prescribing practices, a black market emerged for opioid pain medication. Unlike recreational drugs like marijuana, opioids have a dramatic impact on brain chemistry. Research on medically-assisted treatment programs have repeatedly shown that opioid users are highly prone to relapse due to the drug's effect on the brain.
The combination of opioids being readily available and highly addictive has created a situation where, according to a 2016 report by the American Society of Addiction Medicine, over 2 million Americans have developed serious addiction to pain relievers prescribed by their doctor. In the wake of government reform efforts, many of these individuals were driven to source opiates from the black market. As the availability of prescription medications became scarce, many users turned to heroin. Due to its low cost, users began to inject. The use of injection drugs led to the aforementioned public health issues.
In addition to using county opioid health indicators to estimate addiction rates, data from local hospitals can be used to assess addiction rates in a local area. In the case of Bloomington such indicators can include opioid abuse rates by year, total number of newborns affected by drugs by year, and Naloxone use by medical facilities by year.
IU Health Opioid Profile
Monroe County was the fourth county in the state of Indiana to have a needle exchange program. On September 15, 2015, the Monroe County Commissioners voted to authorize a needle exchange program following the recommendation of Monroe County Health Department Administrator Penny Caudill and Indiana Attorney General Greg Zoeller. Due to cost and staffing constraints, Monroe County pursued a model whereby the needle exchange would be supervised by the county health department but operated by a grassroots organization. In terms of resources and scale this is a fundamentally different operation than what the Centers for Disease Control and Prevention (CDC) and Indiana State Department of Health (ISDH) conducted in Scott County.
Monroe County Needle Exchange
The Indiana Recovery Alliance (IRA) began administering a needle exchange service on February 14, 2016. Since then the IRA reports registering 1,731 users, 472 of whom were active in Q3 2017, down from a reported 811 active users in Q1 2017. Outside of Monroe County, the IRA operated or supported exchange programs in Lawrence and Madison Counties. As of November 2017, neither county has chosen to renew their authorization for a needle exchange. Due to the privacy protections afforded by law to program participants, it is difficult to determine how many participants travel from outside the home county to participate. Furthermore, it is difficult to determine how many experience housing insecurity, or whether they are Hep. C or HIV positive.
In its explanation of why Monroe County was selected as the new site for a medically assisted treatment (MAT) program (a methadone clinic), the state’s Family and Social Services Administration highlighted the presence of Indiana University as a source for workforce personnel. Spring Hill, the for-profit medical corporation that owns the company that will operate the local MAT clinic, uses just three basic demographic metrics to determine whether a MAT is appropriate for a given geographic market: median age, population density, and distance from an alternative treatment facility.
Overdoses in Monroe County
The most definitive data on Monroe County’s specific challenges related to the opioid crisis come from the Coroner’s Office. Since 2015, 54 people have died from drug overdoses. These deaths were dispersed across the county, with 15 individuals expiring within walking distance of Walnut Street. The vast majority of deaths occurred near private residences, and no deaths occurred in public parks. 14 victims lacked any criminal record, but most had some combination of drug-related charges. What all had in common was that their death was likely preventable; an administration of Naloxone may have had immediate, life-saving impact. In this respect, people who overdose in public spaces appear less likely to die from their overdose than those who use drugs in private spaces.