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Prescription Fentanyl’s role in fentanyl related drug overdoses: Matching overdose death data with prescription data

​Author: Tammy Anderson, Jascha Wagner, Guanwen Qi, Daniel O'Connell, Steve S. Martin

Abstract: In October 2017 the CDC estimated that Fentanyl was involved in almost 60% of all overdose deaths in the second half of 2016 (MMWR October 27th, 2017). Most reports suggest that illegally manufactured fentanyl (IMF) is the main culprit of current fentanyl-related harm, especially fentanyl overdose deaths. Yet, several new developments question the ‘benign’ effect of prescription fentanyl (PF) on the current opiate crisis. The abuse of PF patches, e.g. injection and ingestion, or freezing and sublingual absorbing, as well as the diversion of PF to the illegal market, may play an important role in the havoc wreaked by fentanyl. We matched fentanyl overdose deaths with prescription drug data to investigate the potential role of PF in overdose deaths. We find that 44% of all Delaware fentanyl overdose decedents (between January 2013 and March 2015) had a history of PF and 37% had a prescription within 60 days of their death.  On the contrary, only about 5% of those who died from overdoses to other drugs had a history of PF with only 1% having a prescription within 60 days of their death.  Since toxicology in Delaware cannot distinguish between IMF and PF, we explore plausible explanations for its role in overdose deaths including: (1) fentanyl prescribed in combination with other drugs may produce fatal drug interactions, (2) prescriptions for fentanyl and other drugs may exacerbate existing health problems, leading to death.  We use data to explore these explanations and offer further analysis by characteristics of decedents.

This paper was presented by Dr.. Tammy Anderson at the 2018 meeting of the American Public Health Association. See the presentation slides here.

Uneven Recovery: Exploring Relations Between the Recovery from the Great Recession and Changes to Neighborhood Level Crime Rates

​Author: Jascha Wagner

Abstract: This paper addresses two timely questions: How did neighborhoods recover from the financial crisis 2007-2008? And, how are differing recovery trajectories related to social inequalities and social problems? Combining Delaware neighborhood level data (census tracts) from the Federal Housing Finance Agency, the American Community Survey, and the Delaware Criminal Justice Information System, this paper shows first that the boom, bust, and recovery of the housing market, which we find at the core of the financial crisis, followed diverging trajectories with one cluster of Delaware neighborhoods still showing only very minor signs of recovery. Second, the paper shows that this segment disproportionately involves lower income neighborhoods with larger shares of Black and Hispanic residents. Third, the paper investigates associations between the clusters and changes in crime rates during the recovery period 2012-2016. The study finds that disparities in crime rates between neighborhood clusters increased over the crisis periods.

This paper was presented at the 2018 meeting of the American Society of Criminology.

Understanding Differences in Types of Opioid Prescriptions Across Time and Space: A Community-Level Analysis

​Authors: Tammy Anderson, Xiaoke Zhang, Steve S. Martin, Yiqian Fang, and Jiamin Li

Abstract: For the better part of the 21st century, opioid abuse and related consequences have beleaguered the United States. Effectively fighting the crisis may require a better understanding of potential differences among the types of opioids available as treating them as one homogeneous group may mask emerging trends and conflate more benign ones with those more troubling. The purpose of our study is to investigate changes in prescribing patterns of four groups of opioids (hydrocodone, oxycodone, fentanyl, and other) and how community-level factors explain their variation over time. We use a census tract–level data set with population, concentrated disadvantage, and prescription drug monitoring payment variables to address our goals. Findings show disparate prescribing patterns among the four types of opioids and considerable differences in the community factors that predict their change. Implications for future research and interventions follow.

Click here for the full paper

Understanding Geographic and Neighborhood Variations in Overdose Death Rates (2018)

Authors: Jascha Wagner, Logan Neitzke-Spruill, Daniel O'Connell, James Highberger, Steve S. Martin,  Rebecca Walker, & Tammy Anderson

Abstract: The current opioid epidemic continues to challenge us in new and potentially troubling ways. For example, research today finds more overdose deaths occurring in rural, rather than urban, geographic areas. Yet, studies have often ignored heterogeneities within these spaces and the neighborhood variations therein. Using geodemographic classification, we investigate neighborhood differences in overdose death rates by geographical areas to further understand where and among what groups the problem might be most concentrated. For deaths between 2013 and 2016, we find significant variation in rates among neighborhoods, defined by their socio-economic and demographic characteristics. For example, overdose death rates vary up to 13-fold among neighborhoods within geographic areas. Our results overall show that while the rural or urban classification of a geographic area is important in understanding the current overdose problem, a more segmented analysis by neighborhood’s socio-economic and demographic makeup is also necessary.

Click here for the full paper.

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  • Center for Drug & Health Studies
  • 257 E. Main Street Suite 110
  • University of Delaware
  • Newark, DE 19716, USA
  • Phone: 302-831-6107