THE OPIOID EPIDEMIC
IN RICHLAND COUNTY, OHIO

A Richland Public Health Data Story

Figure 1.   Source: CDC WONDER, All Cause of Death; rate per 100,000 people

A National Crisis

Opioids are a class of drugs that include prescription medications (such as Oxycontin and Vicodin) as well as illegal substances (such as heroin and opium).  Opioids are usually prescribed for pain relief.  Opioids are physically addictive, and should only be used as prescribed. Misuse of opioids can lead to serious health problems or even death.

Increasingly, dangerous synthetic opioids, such as fentanyl and carfentanil are manufactured illegally, and are distributed alongside and/or mixed with heroin.

Opioid overdose deaths have increased drastically over the past 20 years.

Every day,  about 115 Americans die from opioid overdose (CDC, 2017).   The state of Ohio has been hit especially hard by this public health crisis (see Figure 1). For context, the opioid death rate in Ohio is over twice the national average.

Opioid overdose deaths have increased drastically over the past 20 years. In Ohio, the number of opioid deaths jumped from over 600 deaths in 2006 to over 3,600 deaths in 2016 - indicating an almost sixfold increase over the past 10 years (see Figure 2).

Within the state of Ohio, the opioid epidemic has affected some regions more than others.  While there is limited availability of data below the state level, it is clear that Richland County is one of the most severely impacted counties in the state.  In this data story, we will explore the issue of opioids in Richland County through vital statistics and community health assessment data.

About the Data

The data in this story is compiled from various primary and secondary sources. Much of the data is from the Centers for Disease Control & Prevention (CDC) national vital statistics database and the Richland County 2016 Community Health Assessment (CHA).  To protect personal information, no data is presented for groups of fewer than 10 individuals.

Figure 2.   Source: CDC WONDER, All Cause of Death;  rate per 100,000 people

Opioids in Richland County

Figure 3.   Source: CDC WONDER, All Cause of Death; Opioid death rate per 100,000 people

Figure 4.   Source: CDC WONDER, All Cause of Death; rate per 100,000 people

A Disparate Impact

As previously discussed, the rate of opioid deaths in Ohio is more than twice the national average.  However, matters have become even worse in Richland County.  From 2015 to 2016, Richland's opioid death rate skyrocketed from slightly above the state rate to over 1.5 times the state rate (see Figure 3).  This increase gives Richland one of the highest opioid death rates of any Ohio county (see Figure 4). 

The increase in opioid deaths correlates with findings from local data sources as well.  According to a local law enforcement collaborative, the METRICH (Metro-Richland County) Enforcement Unit (MEU), unintentional drug overdoses, including fatal overdoses, are on the rise, and have increased in Richland County from the first quarter of 2018 compared to 2017.  As of early April 2018, there were almost 100 unintentional overdoses in Richland County, one in five of which were fatal (Richland Source, 2018).

Figure 5. Source:   Richland County 2016 CHA

Community Health Assessment

The Richland County 2016 Community Health Assessment (CHA) asked Richland residents numerous questions that directly and indirectly relate to mental health and substance abuse.

Seven percent of adults reported using medication that was not prescribed for them (see Figure 5).  Further analysis revealed that respondents with an income of less than $25,000 and those who are African American were at a higher risk for doing so.  Of Richland County parents, 3% reported that they or someone in their household received mental health/substance abuse treatment. However, only 1% of adult respondents reported using recreational drugs in the past six months, and 1% of Richland County adults reported seeking treatment for drug abuse and/or detoxification of opiates, including heroin.  Richland's youth were also asked substance-related questions.  One in five youth reported having access to prescription drugs not prescribed to them, and 3% reported having access to heroin.

In addition to direct mental health and substance abuse questions, Richland residents were also asked about health perceptions and physical concerns that are potentially related to opioid abuse.  More than one-fourth (29%) of Richland adults reported being limited in some way because of a physical, mental or emotional problem, as compared to 21% in Ohio at large (see Figure 5).  This increased to 48% for those with incomes less than $25,000, emphasizing the vulnerability of lower income individuals.  For those who reported limitations, limiting problems included back or neck problems (42%); arthritis/rheumatism (34%); stress, depression, anxiety, or emotional problems (26%); walking problems (23%); chronic illness (21%); chronic pain (16%); fractures, bone/joint injuries (14%); mental health illness/disorder (7%); drug addiction (1%); and substance dependency (1%).  These responses indicate that a significant proportion of the community may be vulnerable to the draw of opioid use.

Figure 6.   Source: ACS 2016 5-year estimates.

Figure 7.   Sources: EpiCenter Opioid Overdose Reports, analyzed by Richland Public Health;  U.S. Census Bureau, ACS 2016 5-year estimates.

Poverty and Overdose Rate

According to the National Institute on Drug Abuse (NIDA), socioeconomic factors can contribute to one's risk for drug use and addiction (2017).  Lower income areas have been disparately impacted by the crisis, and people who live in poverty are especially vulnerable to consequences of addiction, including overdose (NIDA, 2017).  According to NIDA, related factors to this link include limited access to care, lower education levels, and psychological stress secondary to economic challenges. 

We sought to assess whether there is a correlation between poverty and overdose by location in Richland County.  This was done by collecting and analyzing overdose data (both fatal and non-fatal cases) from multiple local health data sources via the EpiCenter public health information system, establishing overdose rates using Census Bureau population estimates, and juxtaposing this information with Census Bureau income data by zip code (see Figures 6 & 7).  The results are striking.  The zip code with the highest poverty level (41.4%) also had the highest overdose rate (654 per 100,000).  This was zip code 44902.  The correlation also appears to be present in other zip codes throughout the county.  This data will be tracked over time and re-assessed in early 2019 to further validate this finding.  

The poverty level and overdose rate for zip code 44902 were much higher than that of any other zip code in the county.  In addition, the population in this zip code has other characteristics that stand out from the surrounding Mansfield metro area.  These include: one-fifth the rate of post-secondary educational attainment (3.3% with bachelor's degree or higher, vs. 11% in Mansfield metro area); nearly double the fertility rate (9.8% in past year, vs. 5.4% in Mansfield metro area); more than double the rate of multiracial individuals (9%, vs. 4% in Mansfield metro area); and over three times the number of black individuals (29%, vs. 7% in Mansfield metro area).  These statistics paint a sobering picture of the social and health disparities experienced by communities of color.

Community Resources

The opioid epidemic is a priority health issue for Richland County, Ohio, and the nation at large.  It is a focus area for many health interventions, including the Richland County 2017-2020 Community Health Improvement Plan (CHIP).  While this issue is widespread and complex, there are numerous  resources for the citizens of Richland County to prevent and treat substance abuse and its complications.  Major community resources include:

Abraxas residential treatment center

Catalyst Life Services

Family Life Counseling Mansfield

Foundations for Living residential treatment for youth

Healing Hearts counseling center

-  Local health systems (Avita Health System and OhioHealth)

-   Mansfield Urban Minority Alcoholism and Drug Abuse Outreach Program (UMADOP)

National Alliance on Mental Illness (NAMI) Richland County

-  Project DAWN (Deaths Avoided with Naloxone) program at Richland Public Health

-  Richland County Mental Health & Recovery Services (MH&RS)

-  The Silver Lining Group

- Third Street Family Health Services

-  The Village Network

...and countless others

SOURCES:

Centers for Disease Control (2017). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017.  Available at: wonder.cdc.gov

METRICH reports overdoses increasing in Richland County (2018, April 10), Richland Source. Retrieved from:  richlandsource.com

National Institute on Drug Abuse (2017, October 25). Addressing the opioid crisis means confronting socioeconomic disparities. U.S. Department of Health and Human Services. Retrieved from: drugabuse.gov

Richland County Partners Community Health Assessment Collaborative (2017). “Richland County Community Health Assessment 2016.” Mansfield, OH. February, 2017. Retrieved from:  richlandhealth.org

Richland Public Health (2018). EpiCenter Health Monitoring System 2017 opioid overdose report aggregation and analysis. Division of Nursing.

U.S. Census Bureau (2016). American Community Survey 5-year estimates. Retrieved from:  factfinder.census.gov