Substance Use
Patterns of heroin overdose deaths: Evidence from Kentucky hospitalization data Venetia Aranha* Venetia Aranha Aranha Aranha Aranha University of Louisville, LMPHW
Background: Kentucky ranked fourth nationally in drug overdose deaths during 2016-2021. Our study examined patterns of heroin overdose deaths among hospitalized patients with heroin involvement during this period, which coincided with the implementation of harm reduction services and the COVID-19 pandemic in Kentucky. Methods: We analyzed inpatient hospitalizations from the Kentucky Health Facilities and Services (KHFS) database from 2016 to 2021 using ICD-10-CM codes for heroin overdose (T40.1). Adjusted odds ratios and 95% confidence intervals for heroin overdose mortality were estimated relative to 2019 using interrupted time series analysis (ITS), controlling for demographics, admission type, and the Charlson Comorbidity Index (CCI, adapted from Glasheen et al.). Heroin involvement was identified in any of the first 25 diagnosis fields. Results: Among hospitalized patients with heroin involvement, 8.75% died, indicating high in-hospital mortality. Deaths declined from 11.56% in 2016 and 11.08% in 2017 to 8.69% in 2018, followed by a post-pandemic rise from 5.56% in 2020 to 8.26% in 2021. Black patients had significantly lower odds of heroin-related deaths compared with White patients (OR = 0.40, 95% CI: 0.20–0.80). Overdose deaths were highest among patients with mild (10.68%) and severe (10.09%) CCI scores. Heroin overdose deaths were higher in 2017 (OR = 2.33, 95% CI: 1.44–3.98), declined in 2018 (OR = 1.71, 95% CI: 0.98–2.99), and then increased again after 2019, (2020 OR=1.08; 95% CI: 0.60–1.95) (2021 OR=1.70 95% CI: 0.97–2.98). Adjusted ITS model indicated the odds of heroin overdose deaths were elevated during the pre-intervention period (2016–2017) and decreased in the post-intervention period (2018–2021). Additionally, heroin overdose deaths were not affected by the COVID-19 pandemic. Conclusion: Our findings support the notion that harm reduction services should be continued and strengthened in order to combat the drug epidemic.