UC map identifies Ohio's opiate hot zones

The prescription opiate epidemic is affecting parts of rural and suburban Ohio as much as its biggest cities, according to a new geography study by the University of Cincinnati.

UC’s Health Geography and Disease Modeling Laboratory looked at fatal opiate overdoses from prescription drugs between 2010 and 2016. They identified 12 clusters of fatalities in Ohio, most of them in or adjacent to its big cities.

But they also found high rates of fatalities in suburban and rural ZIP codes that rivaled or, in some cases, exceeded neighborhoods in the biggest cities in Ohio.

The interdisciplinary study was a collaboration between UC’s McMicken College of Arts and Sciences and and UC’s James L. Winkle College of Pharmacy. Researchers presented their findings this month at the American Association of Geographers conference in Washington, D.C.

“We wanted to take an epidemiological look at this problem. We wanted to know who was most at risk of overdose and where they were,” said Diego Cuadros, UC assistant professor of geography.

Now UC plans to use the maps to help Ohio health officials target intervention efforts to save lives.

The work demonstrates UC's commitment to research that makes an impact as outlined in its strategic plan, Next Lives Here.

Ohio has the second-highest rate of fatal overdoses from prescription opiates in the nation behind West Virginia. More than 12,000 patients in Ohio died from prescription opiate overdoses between 2010 and 2016. At least 4,000 more people died from fatal heroin overdoses during those years. But the study focused exclusively on deaths from prescription drugs.

“We call this disease mapping. We combine epidemiology with spatial analysis to visualize the epidemic,” Cuadros said.

Prescription opiate abuse behaves like an infectious disease in that it blooms in certain pockets, Cuadros said.

“Exponential growth is common in infectious diseases. We’re seeing exactly same pattern in the opioid epidemic,” Cuadros said. “And that’s very interesting because we’re not talking about something that’s infectious, but they have the same behavior.”

Researchers found no correlation between the unemployment or crime rates in the ZIP codes with the highest or lowest rates of opiate overdoses. They also found little correlation between the number of nearby pharmacies per capita and prescription overdoses.

But Cuadros said they did find a correlation between prescription opiate fatalities and mental health. Using statewide mental health surveys, researchers found higher rates of fatalities in ZIP codes where survey respondents reported more “mentally unhealthy” days, he said.

Globally, the prescription opiate epidemic is worst in countries such as the United States that have ready access to health care, said lead author and UC geography student Andres Hernandez. The United States leads the world in prescription opiate fatalities with 20 times the rate of No. 2 England and No. 3 Canada.

“All of these countries have good access to health care,” Hernandez said.

Hernandez said the fact that opiate deaths occur in clusters isn’t random.

“People tend to think the opiate epidemic isn’t like a biological epidemic — that you choose to have [it],” he said. “But it’s driven by socio-economic circumstances. It’s not a random pattern. There are a lot of potential causes. But now we know where the overdoses occur. That’s a start.”

Likewise, Hernandez said Ohio’s opiate overdoses represent a regional problem that affects neighboring states as well. West Virginia has the nation’s highest rate of fatal prescription opiate overdoses.

“It’s important to take a regional approach to this issue because a lot of patients cross state lines to get prescriptions,” he said.

The project was funded by a grant from the Ohio Department of Health.

Featured image at top: UC student Andres Hernandez is working in UC's Health Geography and Disease Modeling Laboratory. Photo/Jay Yocis/UC Creative Services