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

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 72% 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.