Running head: PREVENTING OPIOID OVERDOSE IN HILLSBOROUGH 1

Preventing Opioid Overdose in Hillsborough County

Paige Guers

University of South Florida

PREVENTING OPIOID OVERDOSE IN HILLSBOROUGH 2

Preventing Opioid Overdose in Hillsborough County

This paper will describe the county of Hillsborough, Florida based on data provided from

County Health Rankings. Data will be prioritized by health indicators of strength and health

indicators of need. The indicators of strength include the rate of premature death, diabetic

monitoring, and rates of preventable hospital stays. The indicators of need include rates of

sexually transmitted infections, excessive drinking, and drug overdose deaths. As the United

States of America is in the midst of an opioid overdose epidemic, I have developed a health

policy proposal in efforts to prevent further overdoses from occurring.

Hillsborough (HB) County Florida is made up of the cities of Tampa, Temple Terrace,

and Plant City. Hillsborough has a population size of 1,316,298 people over a 1,266 mi area of

land. It is predominately urban, as only 3.5% live in a rural area. When compared with statistics

provided on countyhealthrankings.org, the socioeconomic factors of HB are generally equal to

the state of Floridas average. Of the total 67 counties in Florida, HB is ranked number 28 in

Overall Rankings in Health Outcomes. For example, the Florida average percent of children

under the age of 18 in poverty is 24%, while the percentage in HB is only 23% (County Health

Rankings, 2016). Seventy-four percent of the population of HB who are aged twenty-five years

or older, which is lower than the state average of 75%. The major health care systems located in

Hillsborough County and Baycare Health System Inc and Tampa General Hospital. Health care

centers and/or primary care providers are easily accessible in HB. The ratio of the population to

primary care physicians is 1,230:1 which is much better than the Florida average of only 1,390

people to one physician (County Health Rankings, 2016).

Health indicators of strength in Hillsborough County according to County Health

Rankings involve the rate of premature death due to good health monitoring. The rate of
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Premature death, or the years of potential life lost (YPLL) before age 75, in HB is 6,900. Even

though this is higher than the Florida average of 6,800 YPLL, this data shows a positive trend in

the County (County Health Rankings, 2016). The YPLL in Hillsborough has been steadily

decreasing since 2003. The total number of deaths has increased (the population also increased

by 120,000), but the years of potential life lost has decreased meaning the population is living

longer. The rates of premature mortality reflect the intent to focus attention on the deaths that

could have been prevented (County Health Rankings, 2016).

Evidence shows that chronic disease self-management (CDSM) programs have improved

health outcomes by providing education and behavioral interventions to support patients active

management of their chronic condition. These programs focus on the adoption and maintenance

of health-promoting behaviors to reduce disability and delay the progress of chronic disease.

Supporting statistics from County Health Ranking include rates of diabetic monitoring and

preventable hospital stays. There has been an increase in the percentage to 83% of diabetic

patients aged 65-75 in Hillsborough County who monitored their blood sugar control in the past

year using HbA1C levels (County Health Rankings, 2016). When patients hyperglycemia is

monitored and controlled, complications can be delayed or prevented. A potential outcome of

CDSM programs is the decrease in the number of preventable hospital stays. There is a hospital

discharge rate of 58 per 1,000 Medicare enrollees who were hospitalized for a diagnosis treatable

in outpatient service (County Health Rankings, 2016). The conditions included in this ranking

are: convulsions, chronic obstructive pulmonary disease, bacterial pneumonia, asthma,

congestive heart failure, hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary

infection, and dehydration (County Health Rankings, 2016). The decrease of hospitalizations

suggests a greater quality of care provided in the outpatient setting.

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Leading health indicators of need in Hillsborough County include drug use, alcohol use,

and risky sexual behavior and are often seen together. Supporting data from County Health

Rankings are rates of sexually transmitted infections (STIs), excessive drinking, and drug

overdose deaths.

Another related behavior is the rate of excessive drinking. This is a measure of adults

who report drinking more than 4 (for women) or 5 (for men) alcoholic drinks on a single

occasion, or who drink more than 2 drinks per day on average (County Health Rankings, 2016).

Excessive drinking is a rick factor for alcohol poisoning, hypertension, myocardial infarction,

STIs, unintended pregnancy, fetal alcohol syndrome, sudden infant death syndrome, suicide,

interpersonal violence, and motor vehicle crashes (Centers for Disease Control and Prevention,

2004). Excessive drinking is the cause of approximately 80,000 deaths annually (Centers for

Disease Control and Prevention, 2013). Thirty-three percent of motor vehicle crash deaths in HB

are attributed with alcohol involvement, higher than the Florida average of 29% (County Health

Rankings, 2016).

The rate of sexually transmitted infections in Hillsborough County has had an increase of

over 100 cases since 2007. There have been 560.9 newly diagnosed chlamydia cases per

100,000 population in HB compared to the state average of 415.1 (County Health Rankings,

2016). Correspondingly, there is a rate of 560 diagnosed cases of the human immunodeficiency

virus (HIV) in HB per 100,000 population. According to the CDC, people who have STIs are

more likely to get and spread HIV. These and other risky behaviors can impact the healthcare

system tremendously. Additionally, HIV, Hepatitis B and C can be spread more easily through

injection drug use. Hepatitis C diagnoses indicate that some of the highest rates are also in

counties where heroin indicators are the highest (Hepatitis C Prevalence, 2012).
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The mortality rate of drug overdoses in Hillsborough and the Florida average are 13 per

100,000 population. According to County Health Rankings, drug overdose deaths are the

number of deaths due to drug poisoning, which covers accidental, intentional, and undetermined

poisoning by: 1) nonopioid analgesics, antipyretics and antirheumatics, 2) antiepileptic, sedative-

hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, 3) narcotics and

psychodysleptics [hallucinogens], not elsewhere classified, 4) other drugs acting on the

autonomic nervous system, and 5) other and unspecified drugs, medicaments and biological

substances. Per 100,000 deaths in the population of Hillsborough County, 13 are due to drug

poisoning (County Health Rankings, 2016). The United States is encountering an epidemic of

deaths due to drug overdoses. The rate of drug overdose deaths has increased by 79%

nationwide since 2002 (Centers for Disease Control and Prevention, 2014).

Drug overdose is now the leading cause of accidental injury death in the United States

(U.S. Food and Drug Administration, 2014). The economic costs to society have been estimated

to surpass $20 billion every year (Inocencio et al., 2013). People who use heroin are frequently

at risk for overdose due to unpredictable changes in dose or formulation, for example

adulteration with fentanyl. The effects of this narcotic are indistinguishable from those of

heroin, with the exception that some forms are possibly hundreds of times more potent.

Fentanyl-related overdose deaths have increased, involving fentanyl manufactured and

distributed illicitly as part of the street drug market (U.S. Centers for Disease Control and

Prevention, 2015).

A primary level of the prevention of drug overdose is the prevention of inappropriate

prescription opioid initiation. Doctors should assess a patients overdose risk before prescribing

such drugs (Network, 1993). Additionally, in family practice, the primary prevention should be
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directed at children and adolescents at risk. The physician should emphasize the realistic risks of

drug abuse, alcohol abuse, and smoking. Controlled substances in households may be

accidentally or intentionally taken. Seventy percent of youth get their prescription drugs from

family or friends. Two-thirds of young adult heroin users were hooked on prescription opiates

before trying heroin, and only 3% who have never used pained killers have ever used heroin

(Banta-Green).

A secondary level of prevention is to be alert for early signs of drug abuse or for a history

suggestive of drug abuse to detect the early stages of disease relapse (Banta-Green, 2013). If

possible, the use of benzodiazepines should be avoided in patients with any substance abuse

history. if not, only small amounts with no refills for a short course of therapy should be

provided (Network, 1993). However, recovering addicts may have legitimate physical conditions

that require opiate analgesics for pain management or may have other legitimate indications for

psychotropic medications. Withholding such indicated treatment may cause an even greater risk

for relapse than giving an appropriate prescription for controlled amounts of opiates. If unsure

about a patient or situation, the healthcare providers should consult with another physician

experienced in the treatment of pain, addiction, and mental disorders (Banta-Green, 2013). The

most common means of relapse prevention is frequent monitoring and counseling, plus

environmental and family encouragement of abstinence. Other evidence based services include

specialized group therapy (Network, 1993).

Tertiary Prevention of drug overdose related deaths is medication assisted treatment.

Medications for opioid addiction include buprenorphine, buprenorphine-naloxone combination

products, methadone, and naltrexone (Lim et al., 2016). If take-home-naloxone were to be

available for anyone who is a regular user of opioids or who lives with someone who is, many
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overdoses could be treated sooner. Naloxone is a prescription drug that reverses an opioid

overdose. Naloxone is an antidote to opiates including heroin and prescription drugs such as

morphine, codeine, oxycodone, methadone, and Vicodin (Banta-Green et al., . Overdose of an

opioid may cause breathing to slow down or stop and it can be difficult to wake them from this

state (Green et al., 2008). Persons with chronic medical illnesses involving organs responsible

for metabolizing substances and respiration such as the lungs, kidneys, liver, and brain, may be

at an additional risk for the compromise of the bodys ability to handle opioids (Banta-Green,

2013). Therefore, it is extremely important to teach those at risk for witnessing an overdose

event how to recognize and intervene. Many overdoses are noticed by others, allowing time to

get help. But often help can come too late because witnesses dont recognize the symptoms of

an overdose as deadly (Banta-Green et al., 2013). Naloxone can be given by intramuscular (IM)

injection or with a nasal spray and generally works within 5 minutes (Green et al., 2008) It can

provide a window of opportunity to save a life before emergency medical help arrives.

Along with a prescription of take-home naloxone, distribution programs can provide

overdose prevention and recognition training. There are no affects of naloxone to a person who

has not been using opiates. The availability of naloxone does not increase drug use, and cannot

be used to get high (Green et al., 2008). If a person is not having an overdose but has been using

opioids, naloxone will put them into an immediate state of withdrawal.

A policy I propose is to decrease the number of deaths related to opioid related

overdoses. The CDC has identified addiction to prescription pain medicines as the strongest risk

factor for heroin addiction. Therefore, medical professionals hold receive adequate training on

appropriate prescribing practices and the risks associated with the medications in order to

address this issue. The Federal Government needs to ensure that proper training is provided to
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health care providers who are prescribing narcotics. Additional plans to improve access to

medication-assisted treatment (MAT). MAT is the use of FDA-approved medications in

combination with counseling, other behavioral therapies, and patient monitoring to provide

treatment for opioid use disorders. These treatment plans include the use of medications such as

buprenorphine, buprenorphine-naloxone combination products, methadone, and naltrexone.

These medications, in combination with counseling, may provide treatment for opioid use

disorders (Obama, 2015). These programs need to be more available across the country, as

currently only a small amount of citizens are able to receive treatment. Programs such as these

may also serve as models for reviewing prescribing guidelines and recommendations for the

treatment of chronic pain (Obama, 2015). For example, studying the use of methadone in pain

treatment versus other opioid pain relievers.

Agencies should be permitted by law to provide training on appropriate and effective

prescribing of all opioid medications as part of their Federal responsibilities. This training

applies to all employees who are health care professionals and hose who prescribe narcotics, and

should address the best practices for appropriate prescribing of pain medications, principles of

pain management, the potential misuse of controlled substances, and proper methods for disposal

of such medications (Obama, 2015). The training of providers should be required to include

continuing education programs to keep consistent guidelines on pain medication prescribing

which includes training within 18 months of this policy implementation and a refresher course

every 3 years. This policy will decrease the amount of prescription opiates that are abused and

provide treatment for with an opiate use disorder.

In order to provide positive health outcomes in Hillsborough County, treatment must

become readily available. Medication assisted treatment has been proven to be more effective
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than drug-free treatment plans. Additionally medication, such as naloxone, must be easier for the

public to access and use. Medical professionals must receive proper training on appropriate

prescribing practices.
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References

Banta-Green, C., (2013). Opioid overdose prevention from primary to tertiary prevention:

Programs, epidemiology, and evaluation. Alcohol and Drug Abuse Institute.

Banta-Green, C. J., Beletsky, L., Schoeppe, J. A., Coffin, P. O., & Kuszler, P. C. (2013). Police

Officers and Paramedics Experiences with Overdose and Their Knowledge and

Opinions of Washington States Drug OverdoseNaloxoneGood Samaritan Law.

Journal of Urban Health: Bulletin of the New York Academy of Medicine, 90(6), 1102

1111. http://doi.org/10.1007/s11524-013-9814-y

Centers for Disease Control and Prevention. Sociodemographic differences in binge drinking

among adults-14 states, 2004. MMWR Morb Mortal Wkly Rep. 2009;58:301-304.

Centers for Disease Control and Prevention Web Site: Alcohol and Public Health. http://

www.cdc.gov/alcohol/index.htm. Updated January 7, 2013.

Centers for Disease Control and Prevention Web Site: Drug Poisoning Mortality, County Trends:

United States, 19992014. (2014). http://data.cdc.gov/NCHS/NCHS-Drug-Poisoning-

Mortality-County-Trends-United/pbkm-d27e

County Health Rankings. (2016). Hillsborough (HB). Retrieved from

http://www.countyhealthrankings.org/app/florida/2016/measure/factors/

Hepatitis C prevalence in King County Public Health Seattle & King County. HIV/AIDS

Epidemiology Report, First Half (2012): Volume 80.

Green, T. C., Heimer, R., & Grau, L. E. (2008) Distinguishing signs of opioid overdose and

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programs in the United States. Addiction 103(6):979- 89.

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Lim, J. K., Bratberg, J. P., Davis, C. S., Green, T. C., & Walley, A. Y. (2016). Prescribe to

Prevent. Journal of Addiction Medicine, 1.

Network therapy for addiction: A model for office practice. (1993). American Journal of

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Obama, B., Office of the Press Secretary. (2015). Addressing Prescription Drug Abuse and

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