Drug Deaths in Jefferson County 2015

Annual Drug
Report
2015
Jefferson County
Coroner/Medical Examiners
Office
Jefferson County Coroner/Medical Examiners Office

1515 6th Avenue South, Suite 220
Birmingham, Alabama 35233
Office: 205-930-3603
Fax: 205-930-3595
Email: Coroner@jccal.org
Published: February 2016

Jefferson County, Alabama
Annual Drug Report
2015
Contents
Introduction ......................................................................................................................................2
Mission ..........................................................................................................................................2
Overview .......................................................................................................................................2
General Statistics and Notable Trends.............................................................................................3
2015 Overdose Deaths .......................................................................................................................4
Map: Drug Deaths by Law Enforcement Jurisdiction ........................................................................4
Means of Death..............................................................................................................................5
Map: 2015 Means of Death .................................................................................................................. 6
Historical Summary: Means of Death, 2005-2015 ................................................................................ 7
Manner of Death ............................................................................................................................8
Historical Summary: Manner of Death, 2010-2015 .............................................................................. 8
Heroin............................................................................................................................................9
Historical Summary: Heroin, 2010-2015 ............................................................................................... 9
Fentanyl ....................................................................................................................................... 10
Historical Summary: Fentanyl, 2010-2015 .......................................................................................... 10
Map: 2015 Heroin and Fentanyl .................................................................................................... 11
Prescription Medication and Prescription Opioid .......................................................................... 12
Prescription Medication Deaths: 2015 ............................................................................................... 12
Prescription Opioid Deaths: 2015 ....................................................................................................... 12
Most Common Prescription Medications Causing Death: 2010-2015................................................ 13
Historical Summary: Prescription Opioids and Prescription Medications, 2010-2015 ....................... 14
Illicit Drugs/Poisons...................................................................................................................... 14
Ethanol (alcohol) .......................................................................................................................... 15
Historical Summary: Ethanol (alcohol)................................................................................................ 15

Annual Drug Report
2015
Introduction
The Jefferson County Coroner/Medical Examiner's Office is notified by law enforcement agencies and
medical facilities to investigate approximately 25% of the deaths occurring in Jefferson County.
Pursuant to State of Alabama, Act No. 79-454, notification is made when there is suspicion of criminal
violence or criminal neglect, when death occurs in suspicious or unusual circumstances, when deaths
are thought to result from trauma or violence, in any prison or penal institution, when in police custody,
or deaths due to disease constituting a hazard to public health when requested in writing by the County
Health Officer.
Mission
The mission of the Jefferson County Coroner/Medical Examiners Office is to establish the identity of
human remains and to determine the cause, manner, and circumstances surrounding death in all
sudden and unexpected deaths occurring within Jefferson County, Alabama.
Overview
The data in this report represent all overdose deaths investigated by the Jefferson County Coroner/
Medical Examiners Office in the 2015 calendar year where the direct cause of death was due to an
overdose/toxic level of illicit drug(s), prescription medication(s), prescription opioid(s), ethanol (alcohol),
or other poison(s). This report does not reflect data on other types of deaths where drugs or ethanol
contributed to the death, but was not the direct cause of death. An example of a death that would not
be included in this report would be a motor vehicle fatality where the decedent/driver of the vehicle
was intoxicated, but the immediate cause of death was trauma due to the collision.
For the purpose of this report overdoses have been categorized into the following four Means of Death:
Drug - refers to all overdoses where the direct cause of death was due to illicit drug(s) or, the direct
cause of death was due to prescription medication(s) and/or prescription opioid(s) in combination
with illicit drug(s). For the purpose of this report illicit drugs refers to illegal street type drugs (i.e.
cocaine, heroin, methamphetamine, etc.).
Prescription Medication - refers to all overdoses where the direct cause of death was due to only
prescription medication(s).
Prescription Opioid refers to all overdoses where the direct cause of death was due to only
prescription opioid(s).
Ethanol (alcohol) refers to all overdoses where the direct cause of death was due to ethanol
(alcohol). This includes both acute alcohol intoxication (5 deaths) and chronic alcoholism (22
deaths).

Annual Drug Report
2015
Often drug overdoses are found to be a combination of illicit drugs, prescription medications, ethanol
(alcohol), and/or other poisons; therefore a single death might be represented multiple times in this
report. Because of this it is important to recognize that in the following graphs and tables the totals for
each of the drugs represents the number of occurrences that particular drug was found to be either the
single cause of death or a component in conjunction with another drug(s) that combined was the cause
of death.
General Statistics and Notable Trends

There was a 14% decrease in the total drug deaths this past year, from 257 drug deaths in 2014 to 221
drug deaths in 2015.
There was a 15% decrease in accidental deaths, from 252 deaths in 2014 to 213 deaths in 2015. There
was a 133% increase in suicidal deaths, from 3 deaths in 2014 to 7 deaths in 2015, but these numbers
are small.
There was a decrease in two of the four Means of Death categories:
Drug - 30% decrease, from 191 deaths in 2014 to 133 deaths in 2015.
Prescription Medication 58% decrease, from 34 deaths in 2014 to 14 deaths in 2015. There
was a decrease across all drugs in the prescription medication category with the exception
fluoxetine (Prozac).
Prescription Opioid 131% increase, from 32 deaths in 2014 to 74 deaths in 2015, largely due to
a significant increase in fentanyl deaths. There was a decrease across all prescription opioid
drugs, with the exception of fentanyl.
Ethanol (alcohol) - 50% increase in deaths due to ethanol (alcohol), from 18 deaths in 2014 to 27
deaths in 2015.
There was a 96% increase in deaths due to fentanyl, from 25 deaths in 2014 to 49 deaths in 2015. Note
that in some cases fentanyl and heroin were present together. This may be because the decedent was
using both fentanyl and heroin, or it may be that fentanyl is replacing heroin in part or in whole in a
dose purchased illicitly.
There was a 29% decrease in deaths due to heroin, from 138 deaths in 2014 to 97 deaths in 2015.
There was a 2% increase in deaths due to cocaine, from 37 deaths in 2014 to 38 deaths in 2015.
There was a 70% decrease in deaths due to methamphetamine, from 17 deaths in 2014 to 5 deaths in
2015.
White males in their 30s were found to have the highest mortality rate across all drug categories with
the exception of prescription medication and ethanol (alcohol). White males in their 50s were found to
have the highest mortality rate in both prescription medication and ethanol (alcohol) categories.

Annual Drug Report
2015
2015 Overdose Deaths

Map: Drug Deaths by Law Enforcement Jurisdiction
Figure 1: N=221, represents all 2015 overdoses by law enforcement jurisdiction.

Annual Drug Report
2015
Means of Death
Table 1: N=221, represents all 2015 overdoses, Means of Death: drug, Rx opioid, and Rx medication;
number of deaths in right-hand column.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Age
31
18
27
26
12
16
21
11
23
12
9
15
0-19
20-29
30-39
40-49
50-59
60-69
70+
Race
2
42
72
51
38
16
0
W
B
H
A
I
165
55
1
0
0
Gender
M
F
154
67
Law Enforcement
Adamsville
Bessemer
Birmingham
Brighton
Fairfield
Fultondale
Gardendale
Homewood
Hoover
Hueytown
Irondale
Jefferson County
Leeds
Midfield
Mountain Brook
Pleasant Grove
Tarrant
Trussville
Vestavia Hills
Warrior
1
4
94
2
2
6
1
12
9
7
5
56
3
1
1
4
2
5
3
3
Division
Birmingham
Bessemer
Figure 2: N=221, represents all 2015 drug, Rx opioid, and Rx medication overdoses.
Rx medication
14
6%
2015 Means of Death

Total deaths: 221
Rx opioid
74
34%
Drug
133
60%
Drug
Rx opioid
Rx medication
185
36

Annual Drug Report
2015
Map: 2015 Means of Death

Figure 3: N=221, represents all 2015 drug, Rx opioid, and Rx medication overdoses.
= Drug, 133 deaths, 60%

= Prescription opioid, 74 deaths, 34%
= Prescription medication, 14 deaths, 6%

Annual Drug Report
2015
Historical Summary: Means of Death, 2005-2015

Table 2: 2005-2015, Overdoses by Means of Death.
Prescription
Opioid
Total
Drug
Deaths
Year
Drug
Prescription
Medication
2005
39
25
13
77
2006
56
41
21
118
2007
39
56
16
111
2008
21
24
45
90
2009
58
46
28
132
2010
23
37
29
89
2011
55
38
24
117
2012
91
25
14
130
2013
106
31
18
155
2014
191
34
32
257
2015
133
14
74
221
Figure 4: 2005-2015, Overdoses by Means of Death.

250
2005-2015 Means of Death
200
150
100
50
0
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2005
39
2006
56
2007
39
2008
21
2009
58
2010
23
2011
55
2012
91
2013
106
2014
191
2015
133
Rx-Opiod
13
21
16
45
28
29
24
14
18
32
74
Rx-Medication
25
41
56
24
46
37
38
25
31
34
14
Drug

2015
Annual Drug Report
Manner of Death
Figure 5: N=221, represents all drug, Rx opioid, and Rx medication overdoses in 2015.
140
2015 Manner of Death
130
120
100
73
80
60
40
20
0
Accidental
10
Drug
Rx medication
Rx opioid
130
10
73
Suicide
Undetermined
Historical Summary: Manner of Death, 2010-2015

Figure 6: 2010-2015, represents all drugs, Rx opioid, and Rx medication overdoses.
2010-2015 Manner of Death

1000
252
100
82
213
144
124
110
10
10
2
1
7
2
1
2010
2011
2012
2013
2014
2015
2010
82
2011
110
2012
124
2013
144
2014
252
2015
213
Suicide
10
Undetermined
Accidental

Annual Drug Report
2015
Heroin
2015 Heroin deaths = 97
Table 3: N=97, represents all cases in 2015 where heroin as a single component or combined with other
drugs was the cause of death; number of deaths in right-hand column.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Age
6
8
14
17
4
6
5
3
11
11
6
6
0-19
20-29
30-39
40-49
50-59
60-69
70+
Race
1
27
31
21
14
3
0
W
B
H
A
I
Gender
78
19
0
0
0
M
F
Law Enforcement
75
22
Bessemer
Birmingham
Brighton
Fultondale
Homewood
Hoover
Hueytown
Irondale
Jefferson County
Midfield
Pleasant Grove
Tarrant
Trussville
Vestavia Hills
Warrior
Division
1
50
1
4
6
4
2
1
20
1
1
2
1
1
2
Birmingham
Bessemer
Historical Summary: Heroin, 2010-2015

Figure 7: 2010-2015, includes all cases where heroin as a single component or combined with other
drugs was the direct cause or contributing factor in the death.
160
138
2010-2015
Heroin
140
120
97
100
80
58
60
30
40
20
58
12
0
2010
2011
2012
2013
2014
2015
Cause of death
Contributory to death
2010
12
2011
30
2012
58
2013
58
2014
138
2015
97
84
13

Annual Drug Report
2015
Fentanyl
2015 Fentanyl deaths = 49
Table 4: N=49, represents all cases in 2015 where fentanyl as a single component or combined with
other drugs was the direct cause of the death; number of deaths in right-hand column.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Age
15
8
4
5
1
3
5
2
5
0
0
1
0-19
20-29
30-39
40-49
50-59
60+
Race
1
8
26
9
5
0
W
B
H
A
I
Gender
40
9
0
0
0
M
F
Law Enforcement
33
16
Birmingham
Fairfield
Fultondale
Homewood
Hueytown
Irondale
Jefferson County
Leeds
Pleasant Grove
Trussville
Vestavia Hills
Warrior
Division
17
1
3
3
1
3
13
1
1
2
3
1
Birmingham
Bessemer
Historical Summary: Fentanyl, 2010-2015

Figure 8: 2010-2015, includes all cases where fentanyl as a single component or combined with other
drugs was the direct cause or contributing factor in the death.
60
49
2010-2015:
Fentanyl
50
40
30
25
20
10
3
2013
2014
2015
0
2010
Cause of death
Contributory of death
10
2011
2012
2010
3
2011
1
2012
1
2013
3
2014
25
2015
49
44
5

Annual Drug Report
2015
Map: 2015 Heroin and Fentanyl

Figure 9: N=146, represents all 2015 heroin, fentanyl, and heroin/fentanyl combined deaths.
= Heroin, 97 deaths
= Fentanyl, 49 deaths
= Heroin/Fentanyl combination, 8 deaths. In the above listed heroin and fentanyl
deaths, eight (8) of those deaths the direct cause of death was found to be due to a
heroin and fentanyl combination.
11

Annual Drug Report
2015
Prescription Medication and Prescription Opioid

Prescription Medication Deaths: 2015
Table 5: N=14, refers to all 2015 overdoses where the direct cause of death was due to only prescription
medication(s); number of deaths in right-hand column.
Month
Age
January
February
March
April
May
June
July
August
September
October
November
December
3
0
1
1
0
0
3
1
3
0
0
2
0-19
20-29
30-39
40-49
50-59
60+
Race
0
1
3
4
6
0
W
B
H
A
I
13
1
0
0
0
Gender
M
F
9
5
Law Enforcement
Birmingham
Hoover
Hueytown
Irondale
Jefferson County
Division
3
2
2
1
6
Birmingham
Bessemer
10
4
Prescription Opioid Deaths: 2015

Table 6: N=74, represents all 2015 overdoses where the direct cause of death was due to only
prescription opioid(s); number of deaths in right-hand column.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Age
20
7
7
5
7
7
7
4
6
1
1
2
12
0-19
20-29
30-39
40-49
50-59
60-69
70+
Race
1
11
28
16
13
5
0
W
B
H
A
I
60
14
0
0
0
Gender
M
F
44
30
Law Enforcement
Bessemer
Birmingham
Fairfield
Fultondale
Gardendale
Homewood
Hoover
Hueytown
Irondale
Jefferson County
Leeds
Mountain Brook
Pleasant Grove
Trussville
Vestavia Hills
Warrior
2
18
2
2
1
4
3
2
3
24
3
1
3
3
2
1
Division
Birmingham
Bessemer
61
13

Annual Drug Report
2015
Most Common Prescription Medications Causing Death: 2010-2015

Table 7: 2010-2015, Rx medications and Rx opioids. A single death might contain multiple drugs
therefore; a single death might be represented multiple times in this table. The total for each drug
represents the number of occurrences for that calendar year where that particular drug was found to be
either the single cause of death or a component in conjunction with another drug(s) that combined was
the cause of death. Also, the deaths represented in this table might be a result of a combination of
prescription drug(s) and illicit drug(s). Often drug overdoses are found to be a combination of both
prescription and illicit drugs.
Prescription Medications
Opioids:
Hydrocodone
Hydromorphone (Dilaudid)
Fentanyl
Methadone
Morphine
Oxycodone
Tramadol
Benzodiazepines:
Alprazolam (Xanax)
Clonazepam ((Klonopin)
Diazepam (Valium)
Barbiturates:
Butalbital
Phenobarbital
Antidepressants:
Citalopram (Celexa)
Nortriptyline (Palmelor)
Velafaxine (Effexor)
Other:
Acetaminophen (Tylenol)
Amphetamine
Carisoprodol (Soma)
Fluoxetine (Prozac)
Gabapentin
Promethazine (Phenergan)
Quetiapine (Seroquel)
Sertraline (Zoloft)
Trazodone (Oleptro)
Gamma-Hydroxybutyrate (GHB)
13
2010
2011
2012
2013
2014
2015
8
0
3
22
10
4
2
7
0
1
13
17
8
0
8
0
1
11
12
4
1
12
2
3
21
5
13
6
28
0
25
21
7
21
5
11
1
49
17
3
11
3
5
0
3
3
0
1
7
0
2
12
1
7
32
0
11
8
0
5
0
0
0
0
0
0
1
0
1
1
0
0
4
2
0
2
1
0
1
0
0
1
1
2
2
0
0
0
0
0
2
3
1
3
0
0
1
0
0
1
1
0
3
2
0
0
0
0
0
0
2
1
0
1
0
1
0
0
0
1
1
0
2
1
0
3
2
0
1
0
1
2
4
1
1
4
2
3
1
1
0
1
0
4
0
1
1
0
0
0

2015
Annual Drug Report
Historical Summary: Prescription Opioids and Prescription Medications, 2010-2015

Figure 10: 2010-2015, Rx opioid and Rx medication.
100
90
80
70
60
50
40
30
20
10
0
2010-2015
88
74
66
66
62
49
39
38
37
29
24
18
14
2010
2011
32 34
31
25
2012
14
2013
2014
2015
2010
29
2011
24
2012
14
2013
18
2014
32
2015
74
Rx-medications
37
38
25
31
34
14
Total
66
62
39
49
66
88
Rx-opioids
Illicit Drugs/Poisons
Figure 11: 2005-2015, illicit drugs and poisons.
256
2005-2015
Illicit drugs/
Poisons
138
128
58
64
1012
16
18
12
17
5
38
8
4
97
37
30
32
58
2
11
2011
2012
2
1
1
2010
2013
2014
2015
Ethylene Glycol (antifreeze)
2010
1
2011
0
2012
0
2013
0
2014
0
2015
0
Difluoroethane (refrigerant)
Methamphetamine
17
Cocaine
10
12
18
37
38
Heroin
12
30
58
58
138
97
14

Annual Drug Report
2015
Ethanol (alcohol)
Table 8: N=27, represents all 2015 deaths where the Means of death was ethanol (alcohol) and includes
both chronic alcoholism and acute alcohol intoxication. Five (5) of the deaths represented here were
due to acute ethanol (alcohol) intoxication; number of deaths in right-hand column.
Month
January
February
March
April
May
June
July
August
September
October
November
December
Age
2
2
3
3
4
1
5
1
2
2
1
2
0-19
20-29
30-39
40-49
50-59
60-69
70-79
80+
Race
0
1
1
8
11
5
1
0
W
B
H
A
I
U
Gender
18
9
0
0
0
0
M
F
U
18
9
0
Jurisdiction
Bessemer
Birmingham
Fultondale
Jefferson County
Leeds
Vestavia Hills
Division
2
14
1
6
1
4
Birmingham
Bessemer
Historical Summary: Ethanol (alcohol)

Figure 12: represents all 2010-2015 deaths where the means of death was ethanol (alcohol) and,
includes both chronic alcoholism and acute alcohol intoxication.
2010-2015 Ethanol (alcohol)

30
27
25
20
18
15
16
16
16
2010
2011
2012
2013
2014
2015
2010
15
2011
16
2012
16
2013
16
2014
18
2015
27
15
10
5
0
Ethanol (alcohol)
15
25
2

Drug Deaths in Jefferson County 2015

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Annual Drug

Jefferson County Coroner/Medical Examiners Office

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

General Statistics and Notable Trends

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

2015 Overdose Deaths

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

2015 Means of Death

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Map: 2015 Means of Death

= Drug, 133 deaths, 60%

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Historical Summary: Means of Death, 2005-2015

Figure 4: 2005-2015, Overdoses by Means of Death.

2005-2015 Means of Death

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

2015 Manner of Death

Historical Summary: Manner of Death, 2010-2015

2010-2015 Manner of Death

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Historical Summary: Heroin, 2010-2015

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Historical Summary: Fentanyl, 2010-2015

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Map: 2015 Heroin and Fentanyl

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Prescription Medication and Prescription Opioid

Prescription Opioid Deaths: 2015

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Most Common Prescription Medications Causing Death: 2010-2015

Published: February 2016

Jefferson County Coroner/Medical Examiners Office

Annual Drug Report

Historical Summary: Prescription Opioids and Prescription Medications, 2010-2015

Ethylene Glycol (antifreeze)