Prepared for the 2018 Maryland Highway Safety Summit April 24th, 2018 Opioid-involved Fatal Crash Deaths in Maryland 2006-2017 Prepared for the 2018 Maryland Highway Safety Summit

Johns Hopkins Center for Injury Research and Policy Mission: The Johns Hopkins Center for Injury Research and Policy is a collaborative of experts who: Conduct innovative research; Translate discoveries into effective solutions; and Train today’s practitioners and tomorrow's leaders.

Collaborators Office of the Chief Medical Examiner in Maryland: David Folwer Michael Eagle William Spencer-Strong Baha’i Institute of Higher Education: Sharmin Jeddi Andisheh Alichi Johns Hopkins Center for Injury Research: Johnathon Ehsani NIH Certificate in Public Health: Michelle Duren

Drivers who died within 1 hour of a motor vehicle crash in 6 states (CA, HI, IL, NH, RI, WV) that conducted toxicological testing for nonalcohol drugs on more than 80% of all fatally injured drivers between Jan 1995, and Dec 31, 2015. Prescription opioids detected in fatally injured drivers increased from 1.0% (95% confidence interval [CI]=0.5, 1.4) in 1995 to 7.2% (95% CI = 5.7, 8.8) in 2015 (Z = –9.04; P < .001).

Pooled data indicated that use of prescription opioids more than doubled the risk of MVC involvement (summary OR = 2.29, 95% CI = 1.59-3.48) Chihuri and Li. (2017). Use of prescription opioids and motor vehicle crashes: A meta analysis. Accident Analysis and Prevention. 109 (123-131)

Aims Describe prevalence of opioid-involved crash deaths Examine trends over twelve-year period Establish patterns of geographic variation within Maryland Describe prevalence of other substances/poly-drug involved crash deaths

Methods Data Description – Medical Examiner All vehicle fatalities in Maryland 2006-2017 Included: All driver fatalities Excluded: Suicides, homicides, non-roadway deaths (e.g. ATVs, boats) Opioid-involved crashes determined by toxicology Tested for 217 substances (34 opioids) Data included 17 variables – age, race, gender, county

Methods Data Description – Maryland Data Census data 2010: age distribution, county population State of Maryland: Annual vehicle miles by county 2007-2016 Statistical Analysis Chi-Square tests to compare proportions Cochran-Armitage test for trend

Frequency and Percent of Opioid-Involved Crash Deaths in Maryland (2006-2017) Non-Opioid Involved Crashes Opioid Involved Crashes Gender Female 579 (20%) 75 (24%) Male 2254 (80%) 241 (76%) Race White 1657 (58%) 258 (82%) African American 918 (32%) 48 (15%) Hispanic 156 (6%) 4 (1%) Asian 47 (2%) 1 (<1%) Other 55 (2%) 5 (2%) Total 2833 (100%) 316 (100%)

Comparing Age Distribution of Opioid and Non-Opioid Crash Deaths to MD Population

Comparing Age Distribution of Opioid and Non-Opioid Crash Deaths to MD Population

Maryland Opioid Involved Crash Deaths Ranges from 16-40 deaths, mean=26

Maryland Opioid Involved Crash Deaths 15 of 34 opioid substances are classified as prescription; e.g. fentanyl, hydrocodone, methadone

Maryland Opioid Involved Crash Deaths, Within 1 Hour Not statistically significant; range = 9 to 20, mean=15 deaths

Maryland Opioid Involved Crash Deaths, Within 1 Hour Implications for prevention - role of prescriber counselling for driving and opioid use

Incidence of Opioid-Involved Crashes by County

Rate of Opioid-Involved Crashes by County (by population) Census data of Maryland county population

Rate of Opioid-Involved Crashes by County (by vehicle miles travelled) Maryland State Highway Administration provided total daily miles of vehicle travel based on traffic data counts collected through permanent automatic traffic recorders on public roadways. The data were averaged from 2007 to 2016

25% of deaths involved multiple categories of substances Stimulants, benzodiazepines, antidepressants https://link.springer.com/article/10.1186/s40621-017-0107-x

Over half of all crash deaths involve at least 1 substance

Opioid-involved crash deaths are on average around 20% of the level of alcohol deaths

Summary Major Findings Prevalence of opioid-involved crashes ~10% No significant increase in opioid-involved crash deaths Middle-age over-represented Rural counties over-represented Majority of crash deaths involve substances Alcohol remains the leading substance implicated in impaired-driving 25%+ of crash fatalities involve poly-substance use

Limitations Single data source Small numbers of opioid-involved crashes deaths Opioid-involvement does not mean impairment Medical examiner data may underreport certain deaths

Implications and Future Work Drugged driving demands attention Link with Emergency Medical Services data Develop thresholds for opioid-impairment Share findings with colleagues to inform prevention

Questions? Contact: Johnathon Ehsani Assistant Professor Johns Hopkins Bloomberg School of Public Health johnathon.ehsani@jhu.edu