The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties

• Published in: The Journal of surgical research 2021-08, Vol.264, p.186-193
• Main Authors: Dittmer, Sarah J., Davenport, Daniel L., Oyler, Douglas R., Bernard, Andrew C.
• Format: Article
• Language: English
• Subjects: Emergency department; Firearm violence; Opioids; Rural; Substance abuse
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2021.02.011

•In this study, we explored the relationship between opioid overdose and firearm-associated emergency department visits in the years 2010-2017. Specifically, we analyzed county-level overdose and firearm-related Emergency Department visits in Kentucky using Office of Health Policy and US Census Bureau data.•Raw data was obtained from firearm related death certificates and high-dose prescription data from the Kentucky All Schedule Prescription Electronic Reporting (KASPER) records. A number of socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate.•Our study found that in addition to known nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties of Kentucky. Implementation of KASPER, a physician drug-monitoring program, was successful in curtailing high-dose opioid prescriptions, yet opioid overdoses continue to increase along with firearm violence in our rural state. The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (−0.28, P = 0.012), and percentage high school graduates (−0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and −0.32, P < 0.001, respectively) but were not significant in the multivariable model.