Are We Aware of the Opioid Crisis? A Data Exploration of Opioid Abuse — Part 1
Hello Readers!
The following articles are going to be a part of a three part series on the opioid crisis in Canada and America. The opioid crisis has been declared a national emergency in both countries — and yet I find that not many people are aware of it as they should be.
I’d like to publish the following articles as a way to articulate why the opioid crisis is such a serious issue, and what we can do raise awareness. In order to provide evidence that this crisis is in fact a crisis, I will be using different statistical methods and visualizations to support my claims, along with research done around many different news articles and public health reports (all research will be cited at the end of each article).
Some of the questions I will be exploring are:
- What does overall Canadian and American data and research tell us?
- Presentation of data: can we make a comparison between one province and one state?
- How prevalent are prescription opioids?
- What steps can we take to raise awareness and action against opioid overdose?
Since this will be a length of this piece will be long, I want to dedicate a whole article to each question (grouping 3 and 4 together). I hope that you read the series and it really gets the gears going for you. By the end of each article, if you have any questions regarding anything I have explored, please be sure to reach out and let me know!
Note: Raw data and any coding will be uploaded on my Github page and link will be provided at the end of each article.
Let us dive in.
Living in Canada, one can often hear warnings of opioid overdose and the importance of packing Naloxone kits as a part of your First Aid kit on the radio or on TV. In fact, the effects of the opioid crisis are getting so severe that one can also view advertisements and warning around different social media platforms when browsing the internet. Naloxone is the main drug that will reverse the effects of an opioid overdose such that the individuals does not have to worry about reaching the emergency room too late. Although, what exactly are opioids and is the opioid crisis really a “crisis”?
Opioids are a group of drugs that are painkillers for severe pain. Some well-known opioids are morphine, codeine, heroin, and fentanyl that is rising in its popularity. When looking at how the science of these painkillers work, an opiate is like any foreign chemical substance would affect the brain. The opioid — let’s say morphine for example, travels through the bloodstream and into the brain where is attaches to receptors on the brain that would be responsible for emitting a chemical signal to the brain’s reward center — or a section of your brain known as the Nucleus Accumbens. When the reward center releases dopamine, the “pleasure” signal, we have a positive reaction to what is happening in our body. Although, this is where the problem with opioids comes into play. Drugs such as morphine, fentanyl, and heroin, will release dopamine in excess amounts, more than what is needed, to help us survive or provide that small amount of pleasure. With repeated usage of opioids, it becomes easier for someone to want repetitive dopamine release, and this is where an opioid addiction may form. In addition to this, individuals who have a predisposition to depression, and anxiety are more likely to become addicted to opioids. It is often found that people who take opioids and do not have a history of depression, anxiety or other mental illness, are less likely to become addicted to prescription opioids.
The Opioid Crisis in Canada and America
Part of opioid crisis blame is given to the over usage of prescription drugs that are being given out to unsuspecting patients. In order to strive for a pain free post-surgery experience, individuals may not have known that they may get addicted to some opioids.
Drugs such as fentanyl and heroin are so potent that they have the strength to not only cause physical side effects but mental ones as well. Individuals who abuse these drugs have dedicated their life to finding opiates for the cheapest price. While users know that there is no positive effect in their life, individuals still insist on buying and using these drug. This epidemic, which had started in Southern Ontario, has slowly progressed to major cities such as Mississauga and Toronto. Opioids are the most powerful killers in Ontario today, it is important to understand them and make progress to try to get them off the streets of Ontario.
Regarding our neighbours to the south, in 2017, U.S. President Donald Trump declared opioid abuse a national crisis. With many areas around America being affected by this crisis. In East Liverpool, Ohio, many neighbourhoods are overrun with opioid pills being sold like candy. Individuals exclaim that sitting on their porch is now impossible as they may run into someone either selling or using drugs right in front of them.
In America — What the Data Shows Us
Figure 1 shows us a significant increase in opioid usage, from American data, taken from DataUSA.io. A simple analysis done in Microsoft Excel shows us that the rate of opioid related deaths is increasing at a rate of 0.56 per year with the highest increases starting in 2009.
Author’s Note: Usually I use python for the analysis, but since there weren’t that many parameters to work with, data was clean, and I wanted to show simple trends, I opted to use Excel for the visualization. This is was done only on the visuals for this article.
Moving on, I then proceeded to explore states at random and settled at three which which could give us some insight into regions that are most affected. Firstly, since I had done research on an article based out of Ohio, I made sure to choose Ohio, then New York as it is quite diverse and densely populated, and lastly Massachusetts as a random choice.
Figure 2 shows us the average death rate for the three states. We can see that Massachusetts has the highest death rate average among the three states. On average, in an age adjusted population, around 11 individuals are dying per year in this state. Why is that so? The National Review has some insight into this data.
In early 2018, it is reported that almost one in four individuals from Massachusetts personally lost someone due to a fatal opioid overdose. Residents of Massachusetts are so aware of the problem that is occurring in their state, that 7 in 10 residents find this crisis to be a “very serious problem” — out-weighting concerns about tax reform or health-care costs. One of the main concerns is that this opioid epidemic is due to an over prescription of painkillers by doctors and hospitals, and another part is that the motivation for a quick recovery has decreased significantly. Since opioid addiction is co-morbid with depression, mental health awareness that comes post surgery may be decreased.
In Canada — What the Data Shows Us
Seeing an upward trend in the opioid overdose rate in USA, we then shift our focus to North of the border —Canada. What do we see with this opioid trends? Are the growing at a similar rate? Is there an increase or decrease in opioid related deaths and hospitalizations in Canada?
According to the Canadian Institute for Health Information site, around 16 Canadians are hospitalized every day for opioid poisoning. While the overall population death rate was unavailable — hospitalization rate gives us an insight on how many people are affected by an overuse of opioids on a daily basis.
The Canadian Institute for Health Information site articulates that seniors had some of the highest rate of usage of opioids, while the rates in young adults is rapidly growing as well. One of the main offenders is prescriptions drugs that are either used for too long after a diagnosis, or, prescriptions drugs not being returned back to the pharmacy to avoid younger children from using them.
As Figure 3 shows us, the rate of opioid poisoning is increases at a rate of 0.59 per year. Around 59% of Canada’s population is being hospitalized for opioid related poisoning. It is unclear whether this is due to recreational drug use or prescription drugs.
One of the most surprising observations that we can make from this data is it’s similarity to the American trends. While the parameters are different, we can still see an increase in both countries that opioid abuse and poisoning is in fact increasing, almost at a very similar rate as well. In the following articles, it would be beneficial to understand whether these statistics are significant in any way, and if we can make any prediction using this model.
Finally, similarly to the American data-set, I proceeded to then choose three provinces at random, and as well the territories that were represented as a single group (due to the low population).Figure 4 shows us the average hospitalization rate in each province. We find that British Columbia has the highest rate of opioid poisoning, with Alberta and Ontario following suite. BC sits at a hospitalization rate of 18.85 individuals per 100 000 people on average, while Ontario is at 11.58, and Alberta and the Territories is at 15.9 and 17.03 respectively.
Next, let us look at some demographic information about the opioid growth male vs. female, and how age is a factor.
Firstly, we see from Figure 5 that the highest opioid poisoning is in individuals over 65+. This goes back to the point that when opioids are prescribed for something such as pain management and/or post-surgery recovery, people do not often realize how easy it can be to become addicted to something that is seemingly helpful. We see an over prescription of opioid drugs to seniors, and then shifting our focus, we also see a rapid increase in opioid usage of youths age 15–24 at a rate of 0.7964 per year. Research says that this is in part due to recreational drug use by youths due to opioid prescriptions that are not kept in a safe space, improper disposal of drugs, and addiction due to mental health issues in the population.
Figure 6 articulates the gender demographic of opioid usage in Canada. We see similar increase trends in both male and female users. Although, it can be observed the females are more likely to be hospitalized due to opioid poisoning. The prediction here is that female users are more likely to seek out help and go into medical care for their symptoms than males are. Although, around 2016–2017, we see a converging in the male and female cases we see in the the demographic. Perhaps, due to the high volume of opioid users, more and more individuals have no choice but to go into hospital. More research and analysis will hopefully tell us more.
In part two of this series, I will be taking a closer look at data regarding Ontario and Massachusetts data. The choice of choosing Ontario is biased as I live in that province, however, we can see from the data above that it would be beneficial to also examine British Columbia and Alberta with a closer look.
The next article will look at the statistics more in depth, and try to predict how the opioid trend looks if we go the path that we are on at the moment. This is where I will try to apply python predictive modelling to the data, and aim to view the data from a more narrow perspective. I hope that you will join me, as this topic is very important and and the same time affects many people in North America.
Thank you for reading and see you in part two.
Raw Data:
References:
