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

2. 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.

3. 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

5. 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).

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

7. 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

8. Methods Data Description – Medical Examiner
All vehicle fatalities in Maryland
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

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

10. 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%)

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

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

13. Maryland Opioid Involved Crash Deaths
Ranges from deaths, mean=26

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

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

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

17. Incidence of Opioid-Involved Crashes by County

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

19. 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

20. 25% of deaths involved multiple categories of substances
Stimulants, benzodiazepines, antidepressants

21. Over half of all crash deaths involve at least 1 substance

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

24. 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

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

26. 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

27. Questions? Contact: Johnathon Ehsani Assistant Professor
Johns Hopkins Bloomberg School of Public Health