Governor Substance Use Disorder Taskforce Presentation

The Morbidity and Mortality of
Kansas’ Drug Epidemic
Fan Xiong, MPH
Senior Epidemiologist
Kansas Board of Pharmacy
Kansas Data-Driven Prevention Initiative Program
Kansas Department of Health and Environment, Bureau of Health Promotion
Presented to the Kansas Governor Substance Use Disorder
Task Force

Image Source: CDC. Available at:
https://www.cdc.gov/drugoverdose/epidemic/index.html

Image Source: Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50
years. JAMA psychiatry. 2014 Jul 1;71(7):821-6.
• In the 1960s to early 1990s,
heroin was the first choice of
opioids for abuse.
• After 1990s, prescription
opioid became the first choice
of opioid for abuse.

Source: Cicero TJ, Ellis MS, Harney J. Shifting patterns of prescription opioid and heroin abuse in the United States. New England Journal of Medicine. 2015 Oct 29;373(18):1789-90.
Most who reported prescription opioid abuse prior to heroin cited accessibility
and cost as primary factors for the heroin use/transition.

Image Source: Bronshtein, Natalia. “INTERACTIVE: Explore how illegal drugs have become cheaper and more potent over
time.” Available at: https://www.statnews.com/2016/11/16/illegal-drugs-price-potency. Accessed on October 9, 2017. Textboxes
and additional calculations was made by Fan Xiong, MPH. Data was cited as based on the U.S. Drug Enforcement
Administration’s System to Retrieve Information from Drug Evidence.
Heroin is cheaper and more potent than before.
1986 2000 2010
$200
$4001 gram = 1000 milligram

Meth and
Heroin have
recently
emerged.
Data Source: Kansas Bureau of Epidemiology and Public
Health Informatics, Kansas Department of Health and
Environment, Kansas Mortality Files 2005-2016.

Age-adjusted Emergency
Department Visit Rate per
100,000 Population;
Kansas 2007-2016
Age-adjusted
Hospitalization Discharge
Rate per 100,000;
Kansas 2007-2016
Non-Heroin
Opioid
Poisonings
Rate, 2007-
2016 12.6
19.1
7.7
13.4
0
5
10
15
20
25
30
35
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
23.1
31.2
15.7
17.9
0
5
10
15
20
25
30
35
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
2015 and 2016 data contains
ICD-10-CM diagnosis codes
and absolute rates may not
be comparable with previous
years.
Data Source: Kansas Hospital Association. 2007-2016 Emergency Admission Database Special Request and 2007-2016 Kansas Hospital Discharge Database.

Heroin Drug
Poisoning
Rate, 2007-
2016
0.4
1.71.4
3.1
0
0.5
1
1.5
2
2.5
3
3.5
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
100,000 Population;
Kansas 2007-2016
Age-adjusted
Rate per 100,000;
Kansas 2007-2016
0.8
2.1
1.1
3.2
0
0.5
1
1.5
2
2.5
3
3.5
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
and absolute rates may not
be comparable with previous
years.

Amphetamine
Drug Poisonings
Medical
Encounter Rate,
2007-2016
1.8
5.33.4
8.8
0
2
4
6
8
10
12
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
100,000 Population;
Kansas 2007-2016
Age-adjusted
Rate per 100,000;
Kansas 2007-2016
0.9
7.9
1.4
8.6
10.5
0
2
4
6
8
10
12
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Female Male
and absolute rates may not be
comparable with previous
years.

Data Source: 2010-2016 Kansas Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment,
Kansas Mortality Files. Only counties with at least 5 expected deaths per 100,000 population are shown due to unstable rates.
Annual Average Age-adjusted Drug Poisoning Mortality Rate per 100,000 population
by County, Kansas residents, 2010-2016

Annual Average Age-adjusted Opioid Poisoning Mortality Rate per 100,000 population
1,077 deaths from
2010 to 2016 were
opioid-related deaths
– any prescription
opioids, heroin, or
illicit opioid
contributed to the
death.

Annual Average Age-adjusted Opioid Poisoning Mortality Rate per 100,000 population
Six counties in Kansas had
a rate higher than the 2016
national average of 13.3.
This is potentially an
underestimate since there
are drug poisoning deaths
in Kansas that do not
specific a drug.

Why Is There
an Epidemic in
Kansas

Image Source: CDC.gov/drugoverdose
What are the key risk factors?

Image Source: http://www.preventoverdoseks.org/kpdo_data.htm
Patients with more than
90+ morphine milligram
equivalent (MME) per
day is a risk factor for
opioid poisoning and
developing an opioid use
disorder.
In 2017, there were 4
counties with at least
4.5% of residents with
more than 90+ MME per
day in 2017.

Image Source: http://www.preventoverdoseks.org/kpdo_data.htm
Patients with concurrent
prescriptions for opioids
and benzodiazepine is a
risk factor for opioid
poisoning and
developing an opioid use
disorder.
In 2017, there were 8
counties with at least
7.0% of county residents
with concurrent
prescriptions for opioids
and benzodiazepine in
2017.

Having a mental illness, history of alcohol use disorder, or other substance
use disorder is a risk factor for opioid poisoning and developing an opioid
use disorder.
Numerator: Respondents who reported they had
ever been told by a doctor, nurse or other health
professional that they have a depressive
disorder (including depression, major
depression, dysthymia, or minor depression).
Denominator: All respondents, excluding
unknowns and refusals.
County Level Prevalence of Depressive
Disorder, Kansas BRFSS 2015
County Level Prevalence of Binge
Drinker, Kansas BRFSS 2015
Numerator: Male respondents having five or
more drinks on one occasion in the past 30
days or females having four or more drinks
on one occasion in the past 30 days.
Denominator: All respondents, excluding
unknowns and refusals.

Who is
affected by the
epidemic?

Image Source: Huang X, Keyes KM, Li G. Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999–2014: An Age–Period–Cohort
Analysis. American journal of public health. 2018 Jan;108(1):131-6.
“Individuals
born between
1947 and 1964
and between
1979 and 1992
are
particularly
afflicted by
the opioid
epidemic.” –
Huang, et al.

Hospitalizations
due to Opioid
Related Use
Disorders*,
Kansas Hospital
Discharges,
Kansas residents,
2012-2016
*Excluding remission diagnosis
codes. Hospital discharges include
ICD-9-CM and ICD-10-CM diagnosis
codes for opioid abuse, dependence,
or use disorders. Since ICD-10-CM
has greater specificity, most hospital
discharges presented were from
2016.
Year of Birth

Patient Year of Birth
Number of K-TRACS Patients with Buprenorphine Opioid Labeled for
Medication Assisted Treatment by Year of Birth, Kansas residents,
2015-2017
Most patients with
Buprenorphine
opioid prescriptions
labeled for
Medication Assisted
Treatment (MAT)
were born after
1975.
Data Source: 2015-2017 K-TRACS.
Buprenorphine Opioid Labeled for
Medication Assisted Treatment were
selected based on FDA labeling for
indication and based on prescriptions
reported to K-TRACS
Only 5-years birth cohort with at
least 20 patients are shown.
NumberofKansasPatients

Kansans with a
year of birth
from 1945 to
1959 have a
correlation in
high-dose
opioids and non-
heroin opioid
poisoning.
Image Source: Kansas Health Statistics
Report. February 2018 Issue.

Prevalence of Selected Health
Factors by Birth Year among
Males, Kansas BRFSS 2011-2016
Number of Drug Poisoning Deaths by
Birth Year among Male Decedents, ,
Kansas residents, 2005-2016
Birth Year Birth Year

Prevalence of Selected Health
Factors by Birth Year among
Females, Kansas BRFSS 2011-2016
Number of Drug Poisoning
Deaths by Birth Year among
Female Decedents, Kansas
residents, 2005-2016
Birth Year Birth Year

Senior Epidemiologist
Kansas Board of Pharmacy
Kansas Department of Health and Environment
Topeka, Kansas
fan.xiong@ks.gov
785-296-6580
Contact

Governor Substance Use Disorder Taskforce Presentation

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