Snapshot of Lancaster County Jessica Klinkner, MPH CHES Lancaster General Health/Penn Medicine

Protective Factors for Substance Misuse and Abuse Community Peer/Individual Rewards for Prosocial Involvement Interaction with Prosocial Peers Prosocial Involvement Family Family Attachment Belief in the Moral Order Opportunities for Prosocial Involvement Religiosity School 58% Have 3 or more Protective Factors Prevention is a science. The risk and protective model of prevention is a proven way of reducing substance abuse and its related consequences. Protective factors, also known as “assets,” are conditions that buffer youth from risk by reducing the impact of the risks or changing the way they respond to risks. Protective factors exert a positive influence and buffer against the negative influence of risk, thus reducing the likelihood that adolescents will engage in problem behaviors. Protective factors identified through research include strong bonding to community, family, school, and peers, and healthy beliefs and clear standards for behavior. Protective bonding depends on three conditions: • Opportunities for young people to actively contribute • Skills to be able to successfully contribute • Consistent recognition or reinforcement for their efforts and accomplishments Good news: 58% of students have 3+ of these protective factors Source: 2015 Pennsylvania Youth Survey

Risk Factors for Substance Misuse and Abuse Low Neighborhood Attachment Low Commitment Toward School Perceived Availability of Drugs Rebelliousness Laws & Norms Favorable Toward Drug Use Gang Involvement Perceived Risk of Drug Use Family History of Antisocial Behavior Attitudes Favorable Toward Drug Use Poor Family Management Attitudes Favorable Toward Antisocial Behavior Parental Attitudes Favorable Toward Drug Use Sensation Seeking Parental Attitudes Favorable Toward Antisocial Behavior Rewards for Antisocial Behavior Friend's Use of Drugs Family Conflict Interaction With Antisocial Peers Academic Failure Depressive Symptoms “known to predict increased likelihood of drug use, delinquency, school dropout, and violent behaviors among youth, risk factors are characteristics of community, family, and school environments, and of students and their peer groups. For example, children who live in families with high levels of conflict are more likely to become involved in delinquency and drug use than children who live in families characterized by lower levels of conflict.” 36% of Lancaster County youth are at risk—6th % 8th grade (5+ risks) 10th & 12th grade (7+ risks) 36%Total Risk Source: 2015 Pennsylvania Youth Survey

Lancaster County Youth Heroin Use: 0.4% Narcotic Prescription Drug Use: 5.7% 42.4% took them from a family member living in their home 46.8% received them from a friend or family member 21.7% bought them from someone Narcotic use—10% of 12th graders Source: 2015 Pennsylvania Youth Survey

Lancaster County Youth 26% of youth state that it is “Sort of Easy” or “Very Easy” to access prescription pain drugs Overdose deaths in 2016—2 under 18 16 y/o male 17 y/o male Source: 2015 Pennsylvania Youth Survey

An estimated 32,866 people aged 12+ may be in need of substance abuse treatment at any given time. The prevalence estimate is reached by taking the population count for each age group from the US Census and calculating a percentage based on the 2012-2013 National Survey on Drug Use and Health (NSDUH). This yields an estimate of the number of persons in that age group who may be in need of substance abuse treatment at any given time. Age group Population Estimated rate of prevalence for this age group Prevalence 12+ 444,709 8.28% 36,822 Source: Lancaster County Drug and Alcohol Commission 2016 Treatment Needs Assessment Summary

9-1-1 EMS Overdose/Poisoning Related Calls Annualized for the remainder of 2017 Overdose/poisoning related Emergency Medical Service calls have increased 37% since 2010. -Lancaster County-Wide Communications Center 8910 calls since 2010 737 through end of June Annualized it will be 1474, about 30 calls more than 2015 Source: Lancaster County-Wide Communications

Emergency Overdose Reports 2014-2016 January 2014-November 2016 Represents about 4600 calls Source: Lancaster County-Wide Communications

Successful Naloxone Reversals by Police Officers in Opioid Overdose Events 2 state police, 182 Municipal/regional police Similar to Chester County, lower than counties on our northern border. York second highest in the state at 476. Does not paint a complete picture—does not include EMS. Currently no unified data reporting process for EMS—something that this Coalition would like to see happen to have a more realistic picture of what is happening within the County. Source: Pennsylvania Department of Drug and Alcohol Programs, Rev. 7/12/17

Hospitalization Rate for Opioid Overdose, 2016 Number per 100,000 residents 29.6 hospitalizations per 100,000 residents 127 total in 2016, 61 for admitted for heroin and 66 for prescription drug Higher than Berks, Chester, and York Source: Pennsylvania Health Care Cost Containment Council, Research Brief

Drug Related Overdose Deaths 2016 The rate of drug-related overdose deaths in Pennsylvania increased from 26.7 per 100,000 in 2015 to 36.5 per 100,000 in 2016, far exceeding the national average (16.3 per 100,000). Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Drug Related Overdose Deaths 2016 With a death rate of 22.3, Lancaster County ranks 43rd out of 67 counties, but 11th in the number of deaths (117). Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Change In Overdose Deaths 2015-16 For this report, only drug-related overdose deaths ruled accidental or undetermined (if provided and toxicology was present) were analyzed. Suicides were excluded due to previous studies demonstrating the toxicology, demographic information, genetic predisposition, and other factors of suicide decedents are dissimilar to those of accidental overdose. Between 2015 and 2016, there was a 37 percent increase in the number of drug-related overdose deaths in Pennsylvania. The change in deaths (percent) from 2015 to 2016 varied across the counties and ranged from a 37.5 percent decrease to a 300 percent increase. Figure 3 depicts the counties in the highest 25 percent, upper 25-50 percent, lower 25-50 percent, and lowest 25 percent of percent change from 2015 to 2016. Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Change In Overdose Deaths 2015-16 2014-2015 there was a 33% increase Overall, the state had a 37% increase Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Most Frequent Drug Category in Overdose Deaths, 2015-2016 Fentanyl/FRS/NPSOs 52% Heroin 45% Benzodiazepines 33% Prescription Opioids 25% Cocaine 27% Ethanol 20% Overall, 130 percent increase in the number of fentanyl mentions from 2015-2016 (really picked up in last 4 months of 2016) Heroin increased 23% Sources: Analysis of Drug Overdose Deaths in Pennsylvania, 2015. Prepared by the DEA Philadelphia Division. Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Most Frequent Drug Category in Overdose Deaths, 2016 Fentanyl/FRS/NPSOs 52% Heroin 45% Benzodiazepines 33% Prescription Opioids 25% Cocaine 27% Ethanol 20% Overall, 130 percent increase in the number of fentanyl mentions from 2015-2016 (really picked up in last 4 months of 2016) Heroin increased 23% Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Deaths by Drug Category By Quarter 2016 Totals 46 Fentanyl/Fentanyl related substances mentions/non-prescription synthetic opioid mentions 61 Heroin mentions 34 Prescription Opioid mentions (most common: Oxycodone--in PA 70% of PO mentions were from decedents 75+ old) 33 Benzodiazepine mentions (Most common: Xanax) Source: Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh.

Total Overdose Deaths 2014-2017 Annualized for the remainder of 2017 Total number of overdose deaths in the county is rising. As of June 24th there were 80 overdose deaths which was the total annual deaths in 2015 Projected values show 160 deaths by the end of 2017 Sources: Pennsylvania State Coroners Association Report on Overdose Death Statistics, 2014 Analysis of Drug Related Overdose Deaths in Pennsylvania, 2015. Prepared by the DEA Philadelphia Field Division Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh. Lancaster County Coroners Office

Overdose Deaths by Gender 2014-2017 Male Female 2014 29 27 2015 49 30 2016 78 39 2017 70 28 Sources: Pennsylvania State Coroners Association Report on Overdose Death Statistics, 2014 Analysis of Drug Related Overdose Deaths in Pennsylvania, 2015. Prepared by the DEA Philadelphia Field Division Analysis of Overdose Deaths in Pennsylvania, 2016. Prepared by the DEA Philadelphia Division and the University of Pittsburgh. Lancaster County Coroners Office

2017 Overdose Fatalities: a Closer Look 71% Male Median Age: 37 Majority White (estimated) 29 out of 60 municipalities 2015 73% White 2016 Approximately 88% White (PA 77%) Source: Lancaster County Coroner’s Office

Given the current statistics related to overdose and overdose deaths in Lancaster County, it’s frightening to imagine where we would be without the efforts currently underway. It’s also clear that so much more needs to be done. As one group, we are better able to collect and analyze real-time data pertaining to drug overdose deaths, emergency department treatment and hospitalizations, as well as reduce redundancies and streamline our efforts. Joining Forces is the result of considerable time and research to identify the best evidence-based practices that not only allow us to better understand why people are susceptible to addiction, but also how we capitalize on proven outcomes to better facilitate recovery.