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BACKGROUND: The rate of opioid analgesic overdose deaths increased by 435% in Staten Island during 2000-2011, from 2.0 to 10.7 deaths per 100,000 Staten Islanders. From 2005 to 2011, disparities in the rate of opioid analgesic deaths widened between Staten Island and the other four New York City (NYC) counties; in 2011, the rate in Staten Island was approximately four times higher than all other counties. In response, the New York City Department of Health and Mental Hygiene (DOHMH) implemented a multi-pronged, citywide public health strategy, with some initiatives exclusive to Staten Island: development and dissemination of judicious opioid prescribing guidelines; one-to-one education of prescribers campaign to promote prescribing guidelines; engagement of local stakeholders; publicizing surveillance data through media; and airing of TV advertisements. Opioid analgesic overdose death rates were assessed after implementation of these multi-prong initiatives.
METHODS: Mortality data were derived from two linked data sources: NYC death certificates and toxicology files from the Office of the Chief Medical Examiner. Staten Island unintentional opioid analgesic drug poisoning rates were compared with the four other New York City counties combined. Rates were calculated using NYC population estimates, modified from US Census Bureau intercensal population estimates 2000-2012, and age-adjusted to Census 2000 US standard population. Rate changes were tested using z-tests and 95% confidence intervals comparisons based on gamma confidence intervals distribution.
RESULTS: After implementation of the multi-pronged approach, opioid analgesic mortality rates decreased for two consecutive years from 10.7 per 100,000 Staten Islanders in 2011 to 7.3 per 100,000 Staten Islanders in 2013, a decline of 32%. In comparison, the rate in all other counties did not change; the rate remained 2.6 per 100,000 New Yorkers, for 2012 and 2013.
CONCLUSIONS: DOHMH’s multi-pronged approach for opioid analgesics was followed by reduced overdose mortality in Staten Island – NYC’s hardest-hit county. Although it is not possible to determine the extent of each component’s contribution to the decrease, the data demonstrate that community-specific and more intensive initiatives may have been decisive contributors to the decrease in Staten Island, given the absence of simultaneous decreases citywide. These tailored and intensive approaches can be replicated in other jurisdictions with high rates of opioid analgesic mortality and in other NYC counties where increased rates of opioid involved overdose deaths were observed.