In a new report released Wednesday, the Snohomish Health District estimates that between 5,000 and 10,000 people in Snohomish County are suffering from opioid use disorder. It’s likely that another 35,000 to 80,000 people are misusing opioids.
Determining the burden of disease goes deeper than tracking data and trends, the Health District said. It estimates how many people in a geographic area have a specific disease — in this case, how many people in Snohomish County have opioid use disorder or are misusing opioids.
“We focused on opioid misuse and opioid use disorder because they are considered the two ends of the spectrum for diagnosable patterns that can lead to overdose and death,” said Dr. Mark Beatty, health officer for the Snohomish Health District. “This data will aid the Health District and the Opioid Response Multi-agency Coordination Group with evidence-based decision making, assessment of interventions, and other planning purposes.”
According to a health district announcement, this data is the result of several months of in-depth research and analysis completed by Beatty. In his report, Opioid Use Disorder and Opioid Misuse in Snohomish County: Using Capture-Recapture to Estimate the Burden of Disease, Beatty applied a method originally created to estimate wildlife populations and recently used to estimate the prevalence of kidney disease.
From the health district announcement:
Disease burden estimates are challenging to complete in populations that are difficult to identify or pinpoint. It becomes increasingly more complex when diseases like opioid use disorder are not a notifiable condition, such as measles or whooping cough. While the published literature is sparse, it’s possible to use surveillance for opioid events in order to estimate the disease burden. This requires an additional method known as capture-recapture.
Source: Snohomish Health District
For this method, Beatty accessed FirstWatch—a proprietary record management system used for EMS calls across the county—to pull data for all overdose calls recorded in July 2018. During that month, there were 73 opioid-related overdoses identified. Utilizing data compiled by Providence Regional Medical Center Everett and the health district, made possible through a Centers for Disease Control and Prevention (CDC) grant funded through the Washington State Department of Health, Beatty then reviewed patients seen in the emergency department. Of those 29 overdose patients at the hospital, 18 were also found in the FirstWatch data. That number translates into approximately 1,400 individuals in Snohomish County hospitalized annually because of opioids.
Using a model published by the CDC that estimates for every one death there are 32 emergency department visits for misuse and abuse, Beatty modified the calculations using Snohomish County estimates identified from the capture-recapture study.
Source: Snohomish Health District
In order to confirm the results of this process, other independent datasets were utilized to test the model and develop ranges. When using data from those sources and applying them to the CDC model used in the burden of disease calculations, the results are as follows:
|Dataset||Deaths||Recovery Admissions||Emergency Dept. Visits||Opioid Use Disorder||Opioid Misusers|
|Burden of Disease with Capture-Recapture Method||44||400||1,400||5,600||37,000|
|2016 National Survey on Drug Use and Health||41||400||1,300||5,400||34,000|
|2017 Washington Syringe Exchange Health Survey||70||700||2,300||9,400||59,000|
|2017 Snohomish County Opioid-related Death Data||100||1,000||3,000||13,000||83,000|
|2018 Point-in-Time Study||90||900||3,000||12,000||80,000|
“Dr. Beatty’s work is another example of how Snohomish County continues to pave the way with collaborative approaches to stopping the opioid epidemic,” said Stephanie Wright, Board of Health chair and Snohomish County councilmember. “This report, and its groundbreaking work, provides a critical benchmark that we can all use to evaluate progress moving forward.”
Prior to June 2017, the only primary data available to monitor the opioid crisis in Snohomish County was overdose-related deaths, and it could take a year or longer to get preliminary numbers, the health district said. In July 2017, the health district embarked on several innovative ways to collect more data. These included two point-in-time surveys completed in July 2017 and July 2018. Each spanned seven days. The first year, 37 overdoses were reported, including three deaths. During the 2018 survey, 57 overdoses were reported, two of them fatal.
The work was supported by Snohomish County’s 1/10 of 1 percent Chemical Dependency and Mental Health sales tax funding.
“Heroin, fentanyl and other opioids continue to cause our community grave harm,” said Dave Somers, Snohomish County Executive. “By better understanding the negative impacts from opioids, we are better positioned to stop the suffering and crime. I applaud the efforts of the Snohomish Health District to keep us all better informed.”
Moving forward, the health district aims to gather better information on the supply and demand of treatment options. The goal is to refine estimates of people who express interest in treatment, survey the current treatment landscape, and identify gaps by comparing interest with available services.
You can find more information on efforts being done through the Opioid Response MAC Group, www.snohomishoverdoseprevention.com. This website and accompanying social media accounts were developed to be a one-stop shop for resources.