More Kentucky youth received emergency care for self-harm in 2021 than in 2020, reversing decline in youths' intentional injuries

Ky. Injury Prevention Research Ctr. graph, adapted by Ky. Health News

By Melissa Patrick

Kentucky Health News

Fewer young people in Kentucky got emergency care in the first year of the pandemic for intentional injuries, but in the second year, the number rose, mainly due to a 15 percent increase in cases where youth, mostly girls, harmed themselves.

That's according to a report from the Kentucky Injury Prevention and Research Center on intentional injury-related emergency department visits among Kentuckians aged 10 to 24. It says people in this age group, which it calls youth, have an increased risk for these injuries that often require medical care. 

Intentional injuries are violence-related injuries, whether they be directed toward oneself, called self-harm or intentional injury in this report; or directed toward others, which this report refers to as assault.

The researchers found that from 2016 to 2021, Kentucky resident youth made 40,579 emergency-department visits for intentional injuries, amounting to about 6,763 visits per year. It notes that the median cost of an ED visit for self-harm injuries was $2,577 and for assault injuries was $1,644.

In those years, most of the intentional injury-related ED visits occurred in people aged 15 to 24, followed by those 10 to 14, the report says. And when it comes to self-harm, an overwhelming number of those ED visits, or 71%, involved girls or women. 

Slightly more male youths, 52%, visited EDs as a result of assault. Most self-harm injuries (58%) and assault injuries (63%) were among youth living in metropolitan areas.

Most injuries were among white youth, 84% for self-harm and 71% for assault. For Blacks, the numbers were 11% and 24%, respectively.  

The report also breaks down injury-related ED visits by the nature of the injury. The top two self-harm injuries in 2016-21 were drug poisoning, 50.3%, and cut or pierce, 31.5%. The top two assault injuries were striking by or against, 68%, and child or adult abuse, 10.7%. Only 2.1% of the ED visits for assault injuries were related to firearms. 

Among self-harm injuries, the most common types were poisoning (52%), open wounds (22%), and superficial injuries or contusions (11%). The most common types of assault injuries were superficial or contusion (30%), open wound (18%), other effects of external causes (15%), and fractures (13%).

The report also found that most Kentucky youth ED visits for injuries related to intentional harm were discharged to home or to self-care: 48.4% of those admitted for self-harm and 93.8% of those admitted for assault. It said 13.5% of the self-harm patients were discharged to an inpatient facility and 34.2% were discharged to a health-care facility.

The ED visit rate for youth self-harm injuries varied by region in Kentucky from 181 per 100,000 people in the Buffalo Trace Area Development District to 333.7 per 100,000 in the Kentucky River ADD. The Green River ADD had the second highest rate, at 305 per 100,000. 

The ED visit rate for youth assault injuries ranged from 385.4 per 100,000 in the Barren River ADD to 718.3 in the Kentucky River ADD. Two other ADDs were among the highest rates for this measure, KIPDA, at 705.2 per 100,000 and Green River, at 565.6 per 100,000.

Graph by Kentucky Injury Prevention Research Center; for a larger version, click on it.

Overdose deaths in Kentucky rose 5% in 2019; officials say fentanyl and methamphetamine were drivers of the increase

By Melissa Patrick

Kentucky Health News

Drug-overdose deaths in Kentucky rose 5 percent in 2019, after dropping by nearly 15% from 2017 to 2018, according to the state's latest annual report.

“We believe the increase is due to a rise in illicit fentanyl and its analogs within the drug supply. The problem is also exacerbated by the widespread availability of potent, inexpensive methamphetamine,” Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said in a news release.

The state recorded 1,316 overdose deaths in 2019. That was 69 more than in 2018, when 1,247 were recorded, but 250 fewer than in 2017 when the state recorded its highest number of overdose deaths ever, 1,566.

Toxicology reports show that fentanyl was involved in 759 of the overdose autopsies, or nearly 58% -- down from 61% in 2018, but up from 52% in 2017 and 47% in 2016. Acetylfentanyl, another version of the drug, was found in 419, and 4-ANPP, a controlled substance that is synthesized through a chemical reaction to make fentanyl, was found in 544.

The report says overdose deaths from heroin declined 12% in 2019, and those from alprazolam, an anti-anxiety medicine branded as Xanax, dropped 23%. Heroin-related deaths dropped to 166 in 2019 from 188 in 2018. Deaths involving alprazolam dropped to 165 in 2019 from 214 in 2018. 

Overdose deaths from methamphetamine, oxycodone and gabapentin increased in 2019. 

Methamphetamine, which has long plagued Kentucky, has been found in more overdose cases in each of the past three years: 357 in 2017, 428 in 2018 and 517 in 2019. "Meth, a stimulant, is less likely to kill someone immediately," note Alex Acquisto and Bill Estep of the Lexington Herald-Leader. "Instead, it corrodes the body and central nervous system over time. It’s not uncommon for meth to be cut with fentanyl in order to up its potency."

Oxycodone, another long-popular and troublesome drug in Kentucky, was involved in 54.5% more overdose deaths in 2019, rising to 170 from 110 in 2018. Deaths from gabapentin, which sells under the brand names Neurontin, Gralise and Horizant, and is often taken along with other illicit drugs to enhance their effects, increased 14.5%, to 292 in 2019 from 255 in 2018. 

“There is no doubt that the nationwide opioid crisis is hitting Kentucky at an alarming rate,” Mary Noble, secretary of the state Justice and Public Safety Cabinet, said in the release.

Counties under 20 are shaded yellow
because rates are considered unstable.

To make more useful comparisons with U.S. Centers for Disease Control and Prevention data, this year's report only includes Kentucky residents who died from a drug overdose, regardless of where the death occurred. 

Counties with fewer than 10 deaths are not included in the report's calculation of overdose rates, so the report has rates for only 29 counties. That's up from 2018, when 23 Kentucky counties had 10 or more overdose deaths.

Estill County (Irvine, Ravenna) had the highest rate of fatal overdoses in 2019, followed by Grant (Williamstown, Dry Ridge, Crittenden). Each had fewer than 20 overdose deaths, a level at which the report says the rate is "unstable and should be interpreted with caution."

Boyd (Ashland, Catlettsburg), Madison (Richmond, Berea), and Greenup counties each had more than 20 overdose deaths and ranked third through fifth.

Jefferson County had the largest number of overdose deaths with 319, an increase from 281 in 2018. Counties with significant decreases included Fayette, down 22; Kenton, down 13; and Campbell, down 11.

The age group in which Kentucky overdose deaths are most common continues to be 35 to 44. Next is 45-54, which ranked third in the 2018 report and traded places with the 25-34s in this year's report. 

State and federal efforts

The state and its partners have launched a number of efforts to battle the state's opioid and substance-abuse epidemic, including efforts to widely distribute naloxone, a medication that can reverse an overdose caused by an opioid drug; the KY Help Call Center (1-833-859-4357), which provides information on treatment options and open slots among treatment providers; and an online website that provides similar services called FindHelpNowKY.org.

The Kentucky State Police have launched the Angel Initiative, which allows anyone with a substance-use disorder seeking treatment to visit a KSP post, where they are directed to treatment. The state Department of Corrections has also overhauled the way it addresses substance abuse. 

The General Assembly has passed several opioid-control laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers and more funding for drug treatment and other response efforts.

“As our state plans for the future, the success of our initiatives depends on the involvement and support of grassroots coalitions, local and state agencies, as well as community and faith-based organizations throughout Kentucky,” said Ingram.  

Gov. Andy Beshear said, “I share the concerns of so many that in this battle against covid-19, which we must fight and must win, we cannot take our eyes off the increased risk of substance use and overdose deaths, I'm committed, with the Kentucky Office of Drug Control Policy, to monitor the trends associated with opioid and substance use and their impact on the public's health.”

Already in 2020, Kentucky has seen a surge in overdose encounters among hospitals and ambulance services, especially during the two months after Beshear declared a state of emergency due to the coronavirus pandemic. Researchers say the surge coincided with preliminary data that showed an uptick in overdose deaths during April and May. 

Data for the report were compiled from the Kentucky Office of the Medical Examiner, the Kentucky Injury Prevention & Research Center and the Kentucky Office of Vital Statistics.