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UC map identifies Ohio's opiate hot zones

Geography researchers teamed up with UC’s Winkle College of Pharmacy to investigate where prescription opiate overdoses were most prevalent in Ohio. Their findings could help health officials target intervention efforts.

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.

Exponential growth is common in infectious diseases. We’re seeing exactly same pattern in the opioid epidemic.

Diego Cuadros, UC assistant professor of geography

A map shows the rate of opioid fatalities in Ohio.

UC student Andres Hernandez mapped fatal opiate overdoses by ZIP code for a study he presented at the American Association of Geographers. The color categories show the rate of fatalities per 1,000 residents. Graphic/UC Geography

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.”

A closeup of an oxycontin tablet.

Oxycodone tablet. Photo/Psiĥedelisto/Wikimedia Commons

The ZIP code map shows that neighborhoods in Ohio’s biggest cities (Columbus, Cleveland and Cincinnati) had some of the highest rates of opiate overdoses. But high rates were also observed in ZIP codes in less populated corners of the state such as Gallia, Clermont and Richland counties.

UC researchers found that white males between the ages of 30 and 39 were most at risk of fatal overdose. But the study found that the rate of fatal overdoses among black males was increasing in the same age group.

“The epidemic is growing faster among black males between 30 and 39. The epidemic is emerging in this population,” Cuadros said.

Researchers are trying to understand why certain demographics are most at risk.

“Why this region? Why these ages?” Cuadros asked. “These are the questions we’re trying to answer.”

UC student Andres Hernandez gestures to a map of Ohio on his computer screen.

Geography student Andres Hernandez is studying Ohio's opioid epidemic in UC's Health Geography and Disease Modeling Laboratory. Photo/Jay Yocis/UC Creative Services

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.

The study is a powerful example of how combining research expertise across the campus from very different colleges — in this case, the College of Pharmacy and the College of Arts and Sciences — can lead to unique discoveries.

Neil MacKinnon, Dean of UC's Winkle College of Pharmacy

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.

An antiOD box designed by UC students.

AntiOD boxes contain naloxone and instructions on how to perform lifesaving measures. Photo/Andrew Higley/UC Creative Services

Cuadros said UC will use the researchers’ maps to inform a related project by UC’s College of Design, Architecture, Art, and Planning that will place overdose reversal medicine dispensers in libraries and other semi-public places. UC associate professor Claudia B. Rebola is distributing “AntiOD” dispensers she and her students designed that contain naloxone that good Samaritans can dispense to save victims of opiate overdose.

“We’re giving [Rebola] information about where in Greater Cincinnati her naloxone dispensers are needed most,” Cuadros said.

UC Winkle College of Pharmacy Dean Neil MacKinnon, a study co-author, said the maps also provide valuable information for health officials who are trying to address opiate addiction.

“The analysis by Dr. Cuadros and his graduate student Andres Hernandez uses spatial scan statistics to help pinpoint where in Ohio deaths due to opioid overdoses are the highest. This information could be of great value to local governments, public health agencies and others in deciding where to best place resources to combat this public health crisis,” MacKinnon said.

The project demonstrates the kind of cross-disciplinary research taking place every day at UC, MacKinnon said.

“The study is a powerful example of how combining research expertise across the campus from very different colleges — in this case, the College of Pharmacy and the College of Arts and Sciences — can lead to unique discoveries,” he said.

Study co-author Ana Hincapie, an assistant professor in UC’s College of Pharmacy, said the project exposed students from diverse backgrounds to different research perspectives.

“Now some of our health outcomes graduate students have taken courses in geography,” she said. “Likewise, geography students have gained a better understanding of other data sources generated by pharmacy that they could use. It’s been an excellent opportunity to collaborate with the geography department.”

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

UC student Andres Hernandez stands with his arms folded outside Braunstein Hall.

UC student Andres Hernandez has been studying the underlying causes of Ohio's prescription opiate epidemic. Photo/Jay Yocis/UC Creative Services

Next Lives Here

The University of Cincinnati is classified as a Research 1 institution by the Carnegie Commission and is ranked in the National Science Foundation's Top-35 public research universities. UC's graduate students and faculty investigate problems and innovate solutions with real-world impact. Next Lives Here.