Table 1.
Characteristics and bivariate comparisons of “Standard” and “Expanded” heroin deaths in San Francisco County 2006–2012 (n=816).
| All Opioid Overdose Deaths | “Standard” Heroin Deaths† | Opioid Analgesic Deaths | p-value | “Expanded” Heroin Deaths‡ | Opioid Analgesic Deaths | p-value | |
|---|---|---|---|---|---|---|---|
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| N (%)✜ | N (%)✜ | N (%)✜ | N (%)✜ | N (%)✜ | |||
| n | 816 (100.0) | 152 (18.6) | 664 (81.4) | 172 (21.1) | 644 (78.9) | ||
| EVIDENCE OF INJECTION DRUG USE | |||||||
| Evidence of Injection Drug Use* | 205 (25.1) | 112 (73.7) | 93 (14.0) | <0.001 | 123 (71.5) | 82 (12.7) | <0.001 |
|
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| DECEDENT DEMOGRAPHICS | |||||||
| Age (mean, SD) | 47.5 (11.8) | 44.8 (12.5) | 48.2 (11.6) | 0.005 | 45.1 (12.2) | 48.2 (11.7) | 0.006 |
| Race | |||||||
| White | 525 (64.3) | 96 (63.2) | 429 (64.6) | 0.534 | 109 (63.4) | 416 (64.6) | 0.695 |
| Black/African American | 170 (20.8) | 34 (22.4) | 136 (20.5) | 39 (22.7) | 131 (20.3) | ||
| Hispanic/Latino | 76 (9.3) | 11 (7.2) | 65 (9.8) | 13 (7.6) | 63 (9.8) | ||
| Other/Mixed | 45 (5.5) | 11 (7.2) | 34 (5.1) | 11 (6.4) | 34 (5.3) | ||
| Gender | |||||||
| Cis-Female | 239 (29.3) | 31 (20.4) | 208 (31.3) | 0.01 | 37 (21.5) | 202 (31.4) | 0.014 |
| Cis-Male | 571 (70.0) | 121 (79.6) | 450 (67.8) | 135 (78.5) | 436 (67.7) | ||
| Transfemale | 6 (0.7) | 00.0 | 6 (0.9) | 00.0 | 6 (0.9) | ||
| DECEDENT HISTORY | |||||||
| History of Heroin Use* | 172 (21.1) | 77 (50.7) | 95 (14.3) | <0.001 | 87 (50.6) | 85 (13.2) | <0.001 |
| History of Injection Drug Use | 186 (22.8) | 78 (51.3) | 108 (16.3) | <0.001 | 86 (50.0) | 100 (15.5) | <0.001 |
| DEATH SCENE DETAILS | |||||||
| Location Found | |||||||
| Private Residence | 419 (51.3) | 63 (41.4) | 356 (53.6) | 0.001 | 74 (43.0) | 345 (53.6) | 0.002 |
| SRO | 239 (29.3) | 49 (32.2) | 190 (28.6) | 55 (32.0) | 184 (28.6) | ||
| Public Space | 83 (10.2) | 29 (19.1) | 54 (8.1) | 30 (17.4) | 53 (8.2) | ||
| Other | 75 (9.2) | 11 (7.2) | 64 (9.6) | 13 (7.6) | 62 (9.6) | ||
| Who Found Victim | |||||||
| Cohabitant | 335 (41.1) | 53 (34.9) | 282 (42.5) | 0.095 | 63 (36.6) | 272 (42.2) | 0.081 |
| Non-cohabitant layperson | 117 (14.3) | 20 (13.2) | 97 (14.6) | 21 (12.2) | 96 (14.9) | ||
| Paramedic or Police Officer | 47 (5.8) | 11 (7.2) | 36 (5.4) | 12 (7.0) | 35 (5.4) | ||
| Passerby | 47 (5.8) | 15 (9.9) | 32 (4.8) | 17 (9.9) | 30 (4.7) | ||
| Residence Staff/Social Worker | 263 (32.2) | 50 (32.9) | 213 (32.1) | 55 (32.0) | 208 (32.3) | ||
| Prescription Opioids Found At Scene | 324 (39.7) | 25 (16.4) | 299 (45.0) | <0.001 | 28 (16.3) | 296 (46.0) | <0.001 |
| Found Beyond Resuscitative Efforts | 616 (75.5) | 107 (70.4) | 509 (76.7) | 0.277 | 121 (70.3) | 495 (76.9) | 0.179 |
| OTHER CAUSAL SUBSTANCES | |||||||
| Benzodiazepines Involved | 156 (19.1) | 9 (5.9) | 147 (22.1) | <0.001 | 10 (5.8) | 146 (22.7) | <0.001 |
| Cocaine Involved | 355 (43.5) | 97 (63.8) | 258 (38.9) | <0.001 | 110 (64.0) | 245 (38.0) | <0.001 |
| Methamphetamine Involved | 93 (11.4) | 25 (16.4) | 68 (10.2) | 0.034 | 28 (16.3) | 65 (10.1) | 0.03 |
| Prescription Opioids | |||||||
| Codeine Involved | 39 (4.8) | 00.0 | 39 (5.9) | <0.001 | 6 (3.5) | 33 (5.1) | 0.428 |
| Oxycodone Involved | 146 (17.9) | 3 (2.0) | 143 (21.5) | <0.001 | 6 (3.5) | 140 (21.7) | <0.001 |
| Hydrocodone Involved | 96 (11.8) | 5 (3.3) | 91 (13.7) | <0.001 | 5 (2.9) | 91 (14.1) | <0.001 |
| Morphine Involved | 222 (27.2) | 00.0 | 222 (33.4) | <0.001 | 18 (10.5) | 204 (31.7) | <0.001 |
| Methadone Involved ** | 334 (40.9) | 27 (17.8) | 307 (46.2) | <0.001 | 33 (19.2) | 301 (46.7) | <0.001 |
”Standard” heroin deaths include deaths designated as heroin deaths by the San Francisco Medical Examiner and deaths in which 6 – monoacetylmorphine was detected in the urine or serum toxicology.
”Expanded” heroin deaths include all “standard” heroin cases as well as those in which the toxicology report demonstrated a presence and suggestive ratio of morphine to codeine that has been shown to correlate with heroin metabolism, or in which the toxicology report demonstrated a presence of morphine and either 1) the death scene had characteristics suggestive of heroin (e.g. heroin found on the scene, witness reports of heroin use prior to death); 2) the death scene had evidence of injection drug use; or 3) the decedent had a noted history of heroin use.
Percentages calculated for n are out of the total number of opioid overdose deaths (i.e., row percentages), whereas percentages for all other characteristics are calculated out of the total number of each subcategory of opioid overdose death (i.e., column percentages).
As described in the text, these characteristics were included in our definition of “expanded” heroin deaths; associated percentages and p-values should be interpreted accordingly.
We cannot distinguish methadone prescribed for pain from methadone opioid replacement therapy.