Heroin, fentanyl fuel rising mortality rates in opioid deaths
Heroin, fentanyl and other adulterants continue to be involved in the vast majority of almost 1,600 opioid overdose deaths in suburban Cook County since 2016. That is a top-level finding of a report on the opioid epidemic released today by the Cook County Department of Public Health, or CCDPH, and the University of Illinois Chicago.
The report, which looked at data from 2016 through 2020, also identifies both positive and negative trends in opioid overdose mortality rates within racial, ethnic, economic, age and gender groups.
Despite data showing that only 8 percent of people who misuse opioids nationally use heroin and its illegal adulterants — including fentanyl and fentanyl analogs — the report shows that 82.9 percent of the overdose deaths from 2016 through mid-2020 in suburban Cook County involved heroin and/or fentanyl.
According to the report, the ZIP codes with the highest mortality rates were primarily located in the west and southwest suburbs and are adjacent to communities on the west side of Chicago – an area with similarly high mortality rates. The highest mortality rates were observed in ZIP codes that include the municipalities of Worth, Broadview, Maywood, and Forest Park. These ZIP codes, and others hit hardest by the opioid epidemic, have substantially lower median household incomes and higher poverty rates.
“The data presented in our report provide insights into opioid use in suburban Cook County that can be used to develop and deploy actionable, evidence-based prevention and harm reduction strategies, particularly in the most vulnerable communities,” said Lee Friedman, PhD, associate professor of environmental and occupational health sciences at the UIC School of Public Health and one of the report’s co-authors. “These findings highlight that while the opioid epidemic is widespread, it is far from uniform across different communities. We need to continue to investigate and consider these nuances to reduce the impact of opioids.”
“Fentanyl and heroin continue to be an incredibly lethal combination in opioid use and no group is immune to these factors in overdose deaths,” said co-author Alfreda Holloway-Beth, PhD ’14 and MS ’07 in Environmental and Occupational Health Sciences and CCDPH director of epidemiology. “Our study points to other trends worth further study and discussion.”
Among the key findings of the report:
- A sharp increase in opioid overdose mortality rates among Black/African-American residents, particularly middle-aged men ages 35 to 64 years of age. This increase mirrors national trends also showing a marked rise beginning in 2016.
- Most cases of opioid-related overdose (86.3 percent) reported by the Medical Examiner’s Office involved more than one drug exposure. Of the 1,576 deaths reported, 677 (43.0 percent) cases were also exposed to least one additional respiratory depressant or drug that causes excessive drowsiness, such as ethanol, barbiturates, or benzodiazepines. When used with opioids, these drugs increase the risk of respiratory arrest or ingestion of fluids into the lungs, which can cause lung infection or inflammation.
- Women represented a majority of cases in poison center and inpatient data. Men represented a majority of cases in the outpatient emergency department, or ED, visit and medical examiner data.
- Hospitalization and mortality rates were more than two times lower among Hispanic/Latinx residents compared to Black/African-American and white non-Hispanic residents. This corresponds with national mortality data, which shows the rate of opioid use is nearly equivalent between Black/African-Americans and Hispanic/Latinx residents.
- Although 71.7 percent of outpatient ED cases reported acute exposure to heroin, only 21.4% had a diagnosis for a substance use disorder. The data indicates that assessments for substance use disorders may not be occurring during most outpatient ED visits involving acute opioid intoxication, and is further indication that there’s a need to establish better systems for regular screening, referral, and initiation of substance use treatment in the ED setting.
“This report reveals not only surprising trends, but potential blind spots in our systems that can be improved to save lives,” said Kiran Joshi, MD, senior medical officer and co-lead for CCDPH. “We will use this analysis to inform our activities and customize intervention programs to target the needs of different groups with opioid use disorders. By sharing this data with community leaders and stakeholders, we can leverage our collective expertise and resources to address this crisis.”
The report focuses on cases of acute intoxication-overdose from January 2016 through June 15, 2020. It analyzed four health data systems to characterize the opioid epidemic among residents in CCDPH’s jurisdiction. Data included in the report were from the Illinois Poison Center, hospital outpatient ED visits that do not result in admission, hospital inpatient admissions, and the Cook County Medical Examiner’s Office.
The report can be found online.