Keep the Public of Chittenden County Informed About the Climate of Opioid Use and 1 more...less...

The Public are Informed About the Climate of Opioid Use in Chittenden County

Number of Opioid Overdose Incidents Responded to by District 03 (Chittenden Cty) EMS

9Sep 2017

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Story Behind the Curve

Though a wealth of information regarding opioid-related fatal overdoses has been identified and analyzed, quantifying the impact of non-fatal overdoses has been a much more difficult task, in Vermont and nationally. As the prevalence of Opioid Use Disorder (OUD) increases, efforts are being made to identify trends of OUD morbidity, in addition to mortality. A study published in the American Society of Interventional Pain Physicians' (ASIPP) Pain Physician Journal in 2016 details the results of a meta-analysis of prescription opioid overdose incidents. Using articles published between 1999 and 2014, the study found that between 1997 and 2005 the number of emergency department visits which involved non-fatal prescription opioid-related overdoses were 7 times the number of prescription opioid-related deaths. Additionally, while this study revealed that prescription opioid-related death rates increased from 0.08 to 0.38 per 100,000 individuals between 1993 and 2009, these rates were considerably lower than the rates for non-fatal events, which increased from 2 to almost 15 per 100,000 individuals in the same period. It is important to note that opioid-related overdose incidents which receive an EMS response are only a subset of emergency department visits. Indeed, the study acknowledges that "opioid overdose data from emergency department visits and national inpatient discharges may significantly under-represent the amount of harm from prescription opioids in the US." With this in mind, studies of emergency department data remain important when assessing trends in non-fatal opioid-related overdose incidents until more coordinated efforts to collect and analyse direct EMS data occur. By collecting local EMS data, as above, we may in the future determine a base-line rate of occurrence, and may be able to track such a rate along side mortality rates for a more fulsome view of opioid use in Vermont.

Understanding the effect of OUD beyond overdose deaths is an important element of creating an effective response to the increasing epidemic. As noted by the National Institute of Health (NIH), for every unintentional overdose death related to an opioid analgesic nationally, 9 persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report non-medical uses of opioid analgesics. At a state level, rates of opioid use and treatment per opioid-related fatal overdose are reported by the Vermont Department of Health, noting that for every overdose 1,482 people receive at least one prescription for an opioid analgesic, 235 used prescription pain relievers in a non-medical fashion, and 113 people receive at least one MAT service for OUD. As efforts to understand the volume of incidents that Emergency Medical Service (EMS) providers are responding to in Vermont increase, a baseline of information on opioid-related non-fatal overdoses in Chittenden County will take shape. Over time, this baseline can be used to assess if incidents are increasing in frequency, or decreasing, and can help to guide the actions of service providers.

Citation

This information is collected by EMS providers of Chittenden County and is stored in the Vermont EMS Statewide Incident Reporting Network (SIREN), a system that is maintained by the Emergency Preparedness, Response & Injury Prevention Division of the Vermont Department of Health of the Vermont Department of Health (VDH). Daily reports are produced and disseminated by the VDH which detail the number of EMS interaction across the state which are either overdose-related, or involve the administration of Naloxone, also known as Narcan. Each incident is recorded with the Emergency Responder's primary impression of the situation, the date on which it occurred, and the EMS catchment district that it occurred in, but contains no specific time, location, or other identifying information. Only incidents which occurred in Vermont EMS District 3 are reported here, as it is the district which most closely matches Chittenden County. More information on VT EMS districts can be found on the Complete list of EMS Districts and District Officials. Though combined reports are produced and disseminated daily, EMS providers may complete their incident reports up to 5 days after the initial incident. Because of this slight delay, the historic monthly aggregate numbers displayed may shift slightly within a brief period after they are reported.

It is important to note that values reported here are likely conservative in nature, as EMS providers often administer Narcan in instances when an individual's history of use is unknown, but do not always categorize such incidents as opioid-related. To account for this discrepancy, both "Overdose - Opioid" and "Overdose - All Drug Types" have been graphed together. To view both graphs side by side, click on the title of this metric, then click "Trend Line Comparison". Additionally, incidents reported are not identified as fatal or non-fatal, and should only be considered as a rough total of opioid-related incidents until specific fatal incidents can be confirmed at a later date.

Last Updated: October 2017

Strategy

By connecting information from Alliance members that respond to overdose incidents, the CCOA aims to help assess where additional resources may be needed within Chittenden County. By assessing what areas have the greatest density of overdoses incidents, and without identifying individuals, partner agencies can use information produced by the Alliance to better assign emergency and preventative resources to help where it is needed most. Additionally, by analyzing EMS information alongside emergency department information from UVM Medical Center, the Alliance hopes to facilitate discussion about strategies to better use overdose incidents as a gateway to treatment, and how to increase follow-up with individuals after such incidents. As noted by the Journal of Emergency Medical Services (JEMS), EMS providers are especially well equipped to provide data which is timely, geographically indexed, and which can be used as a valid surveillance system for opioid overdose incidents, and the Alliance hopes to use this to enhance the ability and efficacy of other service providers through coordinated data sharing.

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