Despite the rapid increase in opioid dependence, we know little about many of the factors affecting an individual’s likelihood of opioid overdose or the role of opioids in other deaths. Through IU’s Responding to the Addictions Crisis Grand Challenge initiative, Bernice Pescosolido, distinguished professor in the Department of Sociology, is taking a groundbreaking approach to these topics by combining information on individual deaths with community and health care data to uncover patterns in how, when and where the opioid epidemic is surging in Indiana.
Her research project, "Hidden mortality and multilevel influences in Indiana's opioid epidemic: hot spots and hot links," aims to reveal the full extent of the epidemic’s death toll, including deaths that have not been classified as overdose but may be connected to opioids, with the ultimate goal of providing information to health professionals and policymakers who seek to more effectively predict and respond to the crisis.
The key objectives of Pescosolido’s Grand Challenge research are to identify geographic “hot spots” in Indiana where higher rates of opioid deaths are occurring and “hot links” between these deaths and particular characteristics or behaviors of individuals, communities or health care providers.
Pescosolido and her collaborators will use an approach they previously pioneered to uncover hidden trends in another type of unexpected death, suicide. Like overdose, suicide is difficult to pinpoint as a cause of death and carries a high level of stigma, a negative perception of individuals associated with a particular attribute. The researchers will also examine where suicide and overdose overlap, particularly where apparent cases of accidental overdose may in fact be suicides. This investigation will reveal mental health challenges associated with opioid use that have not been fully explored.
To find these hot spots and hot links, Pescosolido’s team will combine information on individual deaths from the National Violent Death Reporting System with comparison data on living individuals from the American Community Survey. Indiana only recently joined the National Violent Death Reporting System, and the state voluntarily elected to track opioid overdose through this system, making this type of research possible for the first time. Additionally, the team has access to a large, representative data set on health care claims (with individual identifiers removed) that enables the researchers to observe community-specific trends in opioid prescriptions and practices such as “doctor-shopping” to obtain opioids.
This study overcomes a number of current data challenges limiting understanding of the epidemic. Whereas more common causes of death such as cancer and heart disease can be tracked over time through studies of large numbers of randomly selected people, the unanticipated and comparatively uncommon incidence of fatal overdose – along with the stigma of drug dependence – complicate efforts to observe and understand the epidemic’s progression.
Additionally, most studies examining overdose deaths have focused on differences between individuals who died from overdose and those who died from other causes. Such comparisons fail to address the more relevant question of why opioids are killing people who would otherwise live.
Pescosolido’s study also compares individuals who died from overdose to live individuals who are closely matched by geographic location, gender, age and other characteristics. By matching these features, the study aims to highlight differences in the behaviors or circumstances of individuals who died from overdose compared to their living counterparts, revealing any “hot link” patterns across these deaths.
The results of Pescosolido’s research can be used to help Hoosiers understand the factors affecting opioid use and death in their communities, including decoding trends in order to direct resources where they are most needed and anticipate where and how the epidemic is shifting over time.