Mapping addiction

Written by Richard Leadbeater

Drug overdose has become the leading cause of accidental death in the United States, with 52,404 lethal drug overdoses in 2015. According to the American Society of Addiction Medicine, opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. With 78 Americans dying every day from an opioid overdose, drug-related deaths in the U.S. have become a national epidemic. The number of prescription opioids sold in the U.S. and the number of prescription opioid deaths have both quadrupled since 1999. Since then, over 165,000 people have died from prescription opioid overdoses. This trend has led the Centers for Disease Control and Prevention (CDC) to call prescription drug overdose deaths one of the four most serious epidemics facing the nation. 

Recognizing the challenge this epidemic presents for cities and counties across the nation, the National League of Cities and the National Association of Counties have launched a joint task force – the National City-County Task Force on the Opioid Epidemic. The task force seeks to explore how cities and counties can collaborate to address the opioid epidemic and increase awareness, elevate proven solutions, provide policy recommendations to local, state and federal governments and disseminate guidance and solutions to city and county officials.

Location Matters

One powerful tool which cities and counties have been using to address this epidemic is Geographic Information Systems (GIS). The intelligence that GIS brings to their understanding plays an integral role in helping communities meet the challenges of opioid addiction and overdose deaths. Integrating health data with geographic information gives health service managers an understanding of how, where, when, and why the epidemic is occurring and who it is impacting. A geographic view of opioid prescriptions is helpful to understanding the location of the crisis and the communities effected which allows communities to start to build the understanding required to know where to act. Cities and counties are coordinating with their state officials to share police and EMT data connected to this heroin crisis within a GIS platform.  The High Intensity Drug Trafficking Area Program (HIDTA) uses an open GIS platform to communicate and coordinate their drug fighting efforts. This platform is the infrastructure for the free flow of data between local law enforcement, health agencies, and communities. Now, organizations can analyze these large amounts of data collected by agencies around their communities.

Geospatial analytics takes data to the next level by correlating proximities of high numbers of overdose incidents with areas with inappropriate prescribing rates. Spatial analysis tools are a means to analyze data streaming from the field, see trends over space and time and model complex point data to analyze and identify at-risk areas.

By mapping local opioid data, communities can better understand their own vulnerability to the crisis. Geospatial intelligence gives health administrators a greater understanding of overdose issues at the neighborhood scale. They can better formulate very strategic, targeted and tailored efforts that are more effective.

GIS in Action

Many cities and counties across the country are engaged in meaningful work with GIS around the opioid crisis. Actions that communities can take to address the opioid crisis are to:

– Create public-facing maps that help citizens locate prescription drug drop boxes; 
– Map Naloxone locations; treatment facilities; 
– Show lives saved through the use of Narcan; 
– Analyze mortality data; and 
– Understand hospitalizations and prescriptions trends. 

Maps like these provide clues to help decision- and policy-makers target their epidemic intervention activities.

Here are some examples of how communities are using GIS to address each of these specific areas:

Prescription Drug Drop Boxes: Many people who become addicted to opiates find that they can easily access these from neighbors, friends and family, often through stealing them from their loved ones. It is important to educate people to safely dispose of these drugs. GIS site analysis tools assist health departments in selecting medication drop-off sites based on variables such as neighborhood demographics, site safety and accessibility. Maps are an effective, easy-to-understand method to start this conversation with citizens.

For example, the Tri-County Health Department in Colorado has created a prescription drop box map that allows them to dig deeper into their data and provide further analysis. They examine the amount of prescription drugs (measured in pounds) being dropped off at these locations, and that metric helps determine if their efforts in increasing awareness of this service are working. Also, by overlaying U.S. Census data onto the drop box map, they can determine where additional drop boxes may be needed. 

Naloxone Locations: Naloxone is a drug that when administered in an overdose situation can block the effects of or reverse an overdose. Making the public aware of where they can access this drug to save family members and friends is an important resource for any community. Northern Kentucky has created a map of their Naloxone locations which they update every six months to ensure the resources and information are relevant and up-to-date.

Treatment Facilities: Oftentimes, when a family has a loved one that needs help and is seeking treatment, they don’t know where to turn. While cities and counties may not want to advocate for a specific center, sharing treatment center locations is a necessary citizen service. Many communities also struggle with their treatment centers being filled to capacity with no beds available. GIS maps and dashboards can be used to show bed availability to communicate that information to the public. GIS analytics are also useful for determining the best locations to place treatment centers. Moreover, web apps help health service administrators monitor activities at these treatment centers by mapping clients served, case success rates and staff resources.

King County, Wash., has created a map which shows treatment locations and options such as needle exchange sites, mental health treatment agencies, opiate addiction treatment programs, public health clinics, emergency rooms and hospitals – all resources for families and individuals seeking treatment help.

Lives Saved with Narcan: Narcan/Naloxone is a drug being used by first responder and EMT teams. Dupage County, Ill., has created a public awareness map that helps their first responder teams understand what is happening in the field to better equip their personnel and enhance their readiness. Making this map public also helps educate the community of the scope of the opioid epidemic by displaying data related to fatal and non-fatal incidents.

Mortality Maps: An opioid mortality map is a tool for realizing and communicating drug-related problems as well as a baseline to show changes in deaths over time. Often one of the most meaningful ways to communicate the impact of opioid addiction on a community is by displaying mortality data. Maps like these help educate citizens, enabling them to see the scope of the epidemic. To study cause and effect, a health analyst can combine the mortality layer with Centers for Medicare and Medicaid Services (CMS) prescription claims data, Census demographic data and so forth. This insight can go a long way in securing needed project funding and evaluating intervention efforts. Data for opioid mortality maps may be obtained from vital records departments within public health agencies and the coroner’s office.

Utilizing county data on mortality, Lancaster County, Pa., has created an accidental drug overdose incident map to demonstrate the reach of the epidemic in their own community. 

Hospitalizations and Prescriptions; At least half of all opioid overdose deaths involve a prescription opioid. According to the CDC, prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths. Mapping the number of prescriptions made per provider helps give insight into locations of possible over-prescription. Maps show the location and number of patients’ prescription claims, prescriptions by provider and opioid drug poisonings.

Orange County, Calif., has created maps which display data on opioid prescriptions, hospitalizations and deaths to provide a more comprehensive picture of the issues their community is facing due to over-prescription. 

Location matters when it comes to helping communities handle the health epidemic of opioid addiction. Mapping data and available resources helps cities and counties plan for the most effective ways to service their citizens.  It provides a visual measurement of the success of such efforts. The opioid epidemic is a cross-cutting problem facing many aspects of government – health, police, fire, medical examiners, city and county management and others are all feeling the strain on resources that need to work together. GIS provides communities with a powerful ally in the effort to provide a comprehensive approach to combating the plague of opioid addiction.

Richard Leadbeater is the state government industry manager for Esri. Click here for more information on GIS tools.

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