1. Nhial Tutlam, PhD, MPH 2017 CSTE Annual Conference June 5, 2017
Surveillance of Naloxone Use in Saint Louis County Based on Reports from Emergency Responders
Nhial Tutlam, PhD, MPH
2017 CSTE Annual Conference
June 5, 2017

2. Background
The United States is currently experiencing an epic epidemic of overdose deaths involving opioids1
Opioid related deaths have increased by 200% between 2000 and
Drug poisoning deaths just involving heroin have increased by 55% from the year 2000 to 20103
Magnitude of the problem is acute in some regions of the country

3. Background
In particular, the Midwest region appears to be the epicenter of the epidemic
11 fold increase in age-adjusted drug-poisoning deaths involving heroin between 2000 and 20135
In St. Louis County, deaths involving heroin increased from 7.9 to per 100,000 population in from 2010 to 20146
The heroin poisoning death rate in St. Louis County in 2014 was 3.6 times the national rate6

4. Figure 1. Age-adjusted rates for drug-poisoning deaths involving heroin: St. Louis County, Midwest, and
United States,
DeClue R, Dalidowitz L. Drug-Poisoning Deaths Involving Heroin, St. Louis County Missouri. Chronic Disease Epidemiology (CDE) program profile, no 1.
St. Louis County, MO: Department of Public Health. February 2016.

5. DeClue R, Dalidowitz L. Drug-Poisoning Deaths Involving Heroin, St
DeClue R, Dalidowitz L. Drug-Poisoning Deaths Involving Heroin, St. Louis County Missouri. Chronic Disease Epidemiology (CDE) program profile, no 1.
St. Louis County, MO: Department of Public Health. February 2016.

6. The Pilot Project
Set up surveillance system employing first responders
Form coalitions of first responders based on geographic regions
Use standardized data collection form across the county
Downloadable web link will be distributed to first responders to enter data on the scene
Data stored and analyzed in a centralized REDCap database at DPH

7. Results So far Number of Doses Administered Number of Reversals
Number Died
Repeat Administration
61* 51 5
1 x 3
*One dose was administered in St. Louis City Zip code

9. Conclusions
So far, the naloxone administration cluster in the same geographic areas where heroin-related death rates are high
Interventions targeted at these areas can help reduce the growing problem of overdoses in our jurisdiction
Formation of collisions of first responders will provide robust infrastructure to address this and future drug-related crises in our area

10. References
Centers for Disease Control Prevention, CDC grand rounds: prescription drug overdoses-a US epidemic. MMWR. Morbidity and mortality weekly report, (1): p. 10.
Jones, C.M., K.A. Mack, and L.J. Paulozzi, Pharmaceutical overdose deaths, united states, Jama, (7): p
Rudd, R.A., et al., Increases in drug and opioid overdose deaths—United States, 2000– American Journal of Transplantation, (4): p
National Center for Health Statistics. Heroin-related deaths in the US. 2014; Available from:
Hedegaard, H., L. Chen, and M. Warner, Drug-Poisoning Deaths Involving Heroin: United States, 2000–2013. NCHS Data Brief, no National Center for Health Statistics. March, 2015.
DeClue R and L. Dalidowitz, Drug-Poisoning Deaths Involving Heroin, St. Louis County Missouri. St. Louis County, MO: Department of Public Health. February 2016.