Online Program

Heroin-related death time trends suggest intervention opportunities, st. louis metro area, 1990-2012

Tuesday, November 5, 2013 : 9:14 a.m. - 9:32 a.m.

Maayan Simckes, MPH, Communicable Disease Services, Multnomah County Health Department, Portland, LA
Sarah Patrick, MPH, PhD, Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, MO
Jane Turner, MD, PhD., Department of Pathology, Saint Louis University, St. Louis, MO
Jing Wang, PhD, Department of Biostatistics, Saint Louis University College of Public Health and Social Justice, Saint Louis, MO
Background: Heroin trafficking is a global concern and alarming effects can be seen locally. St. Louis City is an end market for a number of illicit drugs, including heroin, so identifying possible points of intervention for preventing heroin overdose is a major public health priority. Methods: Cases analyzed were accidental heroin-related deaths forwarded to the St. Louis City Medical Examiner (ME) office with morphine in blood or urine. Logistic regression analyses were used to observe time-related trends associated with these deaths from 1990 to 2012. Results: The ME office confirmed 585 heroin-related deaths from 1990-2012, from a nadir of 5 in 1990 to an apex of 90 in 2011; 57% of deaths occurred in the last 5 years. Yet, 2012 marked a statistically significant decrease in deaths from 2011 (χ²=4.00, p<0.05). Seasonal differences were noted. More people died in April (χ²=4.19, p<0.05) and July (χ²=4.56, p<0.05) than other months. Weekly trends evidenced a significant peak on Saturdays (χ²=8.36, p<0.05). The bimodal trend showed a peak on Wednesdays that did not reach statistical significance. Discussion: The 28% reduction in deaths from 2011 to 2012 may be due to a number of factors related to aggressive community outreach regarding heroin deaths. Temporal trends indicate potential intervention pathways for further research, including heightening awareness among first responders, increasing police surveillance at high-risk times, and scheduling community education and outreach accordingly. Conclusion: Heroin-related deaths, while apparently decreasing in 2012, remain a concern in the St. Louis metro area and time trend analysis may indicate important intervention opportunities.

Learning Areas:

Other professions or practice related to public health
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Identify yearly, monthly, and day-of-week trends in heroin-related deaths in the St. Louis metro area.

Keyword(s): Other Drugs, Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I recently completed my MPH in epidemiology and served as a graduate research assistant in the department of epidemiology. I met extensively with the Assistant Medical Examiner (ME), reviewed ME reports, and conducted literature review on heroin research to assist in data collection and analysis for the present study. I am also presently a CDC/CSTE Applied Epidemiology Fellow at the Multnomah County Health Department conducting further research on the topic of opioid overdose deaths.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.