BACKGROUND: An epidemic of drug overdose deaths has been rippling across the United, particularly in the rural Appalachian state of West Virginia (WV). In 2015, WV ranked the highest in the nation for drug overdoses (with an incidence rate of 41.5 per 100,000) and drug overdose deaths. Drug overdose deaths often involve polypharmacy, simultaneous use of multiple substances (i.e. benzodiazephines, opioids, and stimulants). Analysis of overdose death data in WV by drug type(s) may highlight changing trends in use and geographic distribution of substance abuse across the state.
METHODS: Overdose death data (all overdose deaths and deaths associated with specific drugs) for WV residents from 2012-2015 were obtained from the West Virginia Health Statistics Center. Type of drug associated with death, county of residence, and zip code data were analyzed using descriptive statistics. County and zip code level data were mapped using ArcGIS for Office.
RESULTS: A total of 2,369 overdose deaths were reported in 54 (98.2%) of WV’s 55 counties during study period. The top five drugs associated with overdose deaths were alprazolam (n=815, 34.4%), oxycodone (n=739, 31.1%), heroin (n=538 22.7&), diazepam (n=535, 22.6%), and hydrocodone (n=515, 21.7%). Similar geographic distribution profiles were shown for alprazolam, diazepam, hydrocodone, and oxycodone associated deaths with Kanawha, Mercer, and Raleigh counties, counties in southern WV, ranking in the top five counties reporting deaths associated with these drugs. Heroin showed a different geographic profile with Cabell, Kanawha and Berkeley counties accounting for 47.3% (n=255) of heroin-associated overdose deaths. Zip codes in Berkeley and Cabell counties have been identified as having high heroin overdose death burden. Overdose deaths associated with amphetamine (n=156), gabapentin (n=294), fentanyl (n=290), and methamphetamine (n=102) all showed an increasing trend. These substances were most prevalent in WV’s southern counties, with Kanawha and Raleigh counties ranking in the top five counties reporting deaths associated with all four drugs. Overdose deaths associated with one or more benodiazephines and one or more opioids accounted for 2,127 (89.8%) deaths over the study period. Ten zip codes accounted for 450 (21.1%) of polypharmacy-associated benzodiazephine and opioid deaths.
CONCLUSIONS: A variety of substances are associated with overdose deaths in West Virginia, with benzodiazephines and opioids serving as the major contributors. County-level mapping provides some understand of where the burden of overdoses deaths lie within the state, but zip code level analysis may provide local and targeted intervention and prevention measures.