Statistical Methods and Analysis

Introduction

Between 2008 and 2016, in Durham, opiate-related deaths nearly doubled (Durham Public Health 4). Although the opioid crisis has impacted many communities across North Carolina it has significantly impacted resource stripped communities who are unable to provide for the appropriate medical resources. Durham County was once one of these communities. However, with a transformation in leadership and partnerships across the healthcare sector, Durham County has begun to pave a path outside of the opioid crisis. Therefore, Durham provides an excellent case study through statistical analysis for understanding the evolution of the opioid crisis, not only within North Carolina but across the Untied States.

Methodology

The dataset used is drawn from the NC Opioid and Substance Use Action Plan Data Dashboard. This dashboard provides easily accessible raw data for state, regional, and county level metrics for partners across North Carolina. Data collected by the dashboard for % Opioid death was gathered from the North Carolina State Center for Health Statistics, Vital Statistics, and death certification from 1999-present. Data collected by the dashboard for Naloxone reversals was gathered by the North Carolina Hard Reduction Coalition from 2013-present (North Carolina Department of Health and Human Services 6). 

General Variables Used:

• % Opioid Death Per Year in Durham: Percent of Opioid deaths per year in Durham County between 2000 and 2020. This data reflects the percentage of unintentional opioid deaths using prescription opioids, heroin, fentanyl, or fentanyl analogous. 

• Community Naloxone Reversals: Amount of Naloxone reversals in Durham County between 2014 and 2020. This data reflects the number of overdose reversals using Naloxone reported by the North Carolina Hard Reduction Coalition. Reversals were done by community members and do not include first responders’ administration of naloxone.

Code Used to Create analysis

Discussion and Analysis

Analysis of Figure 5

The relationship between percent illicit opioid death and year appears to have a positive correlation. Between 2010 and 2015 there appears to be an exponential increase in the percent rate of illicit opioid death. Between 2015 and 2020 this exponential increase appears to plateau out yet still appears to be increasing. On the other hand between 2000 and 2005 the rate of percent increase does not seem to be increasing as fast as it does between 2010 and 2015 and 2015 and 2020. 

 This rapid increase in opioid overdose deaths correlates directly with the national second and third opioid overdose waves as described by the CDC and elaborated upon within the Economics of the Opioid Crisis section within our project. The second wave, which began in 2010, saw rapid increases in overdose deaths due to heroin and other prescription medications. The third wave, which began in 2013, saw rapid increases in overdose deaths involving synthetic opioids, such as fentanyl (CDC 4). Thus, combined with the “inaccessibility of Naloxone” and “a lack of a centralized opioid database”, Mr. Patel mentions, there are many possible contributing factors that may have led to this rapid increase in opioid overdose death between 2010-2015. 

Analysis of Figure 6

The relationship between community naloxone reversals and year appears to have a strong positive, linear correlation from 2014 to 2019. Between 2019 and 2020 there is no change in the amount of community naloxone reversals administered. It should also be noted that before 2014 the dataset did not include any information about community naloxone reversals. 

The fact that the data begins in 2014 matches Mr. Patel’s interview as he mentions that around 2015 is when Durham County saw a shift in its approach to the opioid crisis. Continued increase between 2014 to 2019 could also be due to the starting of medication assisted treatment programs in Durham County. These programs help provide Suboxone and naloxone free of charge to patients who cannot afford it (Durham County Public Health 3). Widespread availability of these treatments along with renewed attention to the opioid crisis could be contributing reasons for this strong linear increase. The stagnation in community assisted Naloxone reversals between 2019 and 2020 could be due to the COVID-19 pandemic. Because of the presence of quarantining less patient interactions, and more focus on hospitalizations due to COVID, there may have been a lack of resources available to increase naloxone access during this time (North Carolina Department of Health and Human Services 3). 

Limitations of Data

This analysis and the data set must be understood through the lens of some of its limitations. One weakness of the dataset for % Opioid Death Per Year in Durham is that there is usually a six-month lag in reporting death data (North Carolina Department of Health and Human Services 6). Due to this lag of time, data collected may have truly occurred in a different month or year than reported. Another weakness of the dataset for % opioid death per year in Durham is that the county data is based on the county of residence. As a result, an individual who died in a different county than their residence would still count under their county of residence even though they died outside of it. 

One weakness of the dataset for the amount of community naloxone reversals is that the data is reliant upon reported reversals. As a result, there may be an undercount for the true amount of reversals that occurred during a given year. Furthermore, the amount of community naloxone reversals is based on the county of residence. As a result, an individual who received a reversal in a different county than their residence would still count under their county of residence even though they received treatment outside of it (North Carolina Department of Health and Human Services 6).