In the war against opioid addiction, there’s one weapon all agencies agree can help: Data.
All the emergency agencies track how many overdose calls they respond to and how many times they use naloxone to reverse the effects of opioid overdose. But there hasn’t been a way to look at all those numbers at once.
That’s changing. On Tuesday, Knox County Health Department epidemiologist Roberta Stern presented “preliminary data” about Knox County overdoses to the Naloxone Community Collaborative, a meeting attended by first responders from all local agencies as well as pharmacists and Metro Drug Coalition.
Some of it was expected. Males are more likely than females to overdose on opioid drugs. Whites are more likely than blacks – more than 10 times more likely, initial data shows.
But some of it was shocking. AMR, for example, gave naloxone 173 times in January alone – one agency, one month.
“That number gave even me pause,” said Karen Pershing, director of Metro Drug Coalition and leader of the collaborative.
With other local agencies, that means emergency responders gave naloxone more than 200 times in Knox County just in January – more than one-fourth of them during a holiday weekend spike.
Stern will aggregate the numbers from 2015 forward that AMR, Knoxville Fire Department, Knoxville Police Department and University of Tennessee Police Department (which has yet to dispense the drugs, as other agencies have arrived to do it) provide. If Knox County Sheriff’s Office begins to carry naloxone – which it expects to do pending a grant from BlueCross BlueShield Foundation, said Randy Nichols, special counsel to the sheriff – she’ll add those.
Stern expects numbers to change as she continues to get more detailed data from agencies, including Knoxville Police Department, Knoxville Fire Department, AMR (formerly Rural/Metro), and local hospitals.
Already, both AMR and KPD have prepared “heat maps” showing places countywide that receive the most OD calls. While some are expected – downtown by the shelters, public housing projects with known drug problems – the maps show no part of the county is immune.
“This is a problem we’re seeing all across Knoxville,” said Capt. D.J. Corcoran of KFD, whose first responders responded to 368 overdose last year and deployed naloxone 129 times. “I had looked this up at the end of last year and was surprised to discover the wide range of victims, rich or poor; black, white or brown; middle-age, young; pedestrians, motorists; homeowners or renters.”
So far this year, KFD has deployed naloxone 65 times. KPD has used it 14 times. AMR is averaging 40 calls a week. AMR’s number of hospital transports for ODs this January, 121, is more than triple the 38 OD patients the ambulance service transported to hospitals in January 2016 – and not all overdose patients, if given enough naloxone that they’re awakened and alert, will agree to be taken. While some states have statutes requiring people giving naloxone to go on the hospital, Tennessee has no such requirement.
Aggregated data can help identify people who are getting naloxone repeatedly, though the agencies said so far that’s a small number. It could help identify what drugs they’re using – Knox County Regional Forensic Center’s data show three-quarters of the drugs related to death are prescription, but it’s unclear if that’s the same for survivors.
“Part of the problem is that we don’t know what the meds they’re using are,” said Ken Loftis, operations manager for AMR. “They’re only reported through the forensic center," and it's too late to help those patients.
It could even show when people are most likely to OD. (Loftis said AMR’s numbers show 7-8 p.m. is peak call time, with the most overdose calls on Thursdays, followed by Wednesdays and Saturday).
The Forensic Center’s detailed report, which it released in August, showed the highest number of drug deaths in the 35-54 age range, but Stern’s early data indicates the “near-misses” might trend younger.
Pershing sees that as an opportunity to intervene by linking those who survive with naloxone to follow-up care. The data, she said, will allow agencies to better target their approach to the people and places most in need.
“How can we engage with them at the time and create something, change our current delivery system, where we’re not just popping them with naloxone and sending them on their way?” Pershing said. “Can we intervene, can we case manage, can we do something to keep that from continuing?”