Epidemic Fentanyl Deaths in Maryland: A Public Health Intervention Involving Geographic Information Systems and Collaboration with the Drug Enforcement Administration

Abstract

An ongoing epidemic of illicit fentanyl overdose deaths started in Maryland in July 2013. The records of the Office of the Chief Medical Examiner for the state of Maryland were searched to identify these deaths from July 2013 to February 2015. A geographic information system was used to map and analyze the spatial and temporal distribution of the deaths in Maryland. A total of 266 fentanyl-related deaths were identified. The number of deaths per month generally increased from July 2013 to June 2014, decreased precipitously in August 2014, and rose steadily until the end of the study in February 2015. Deaths began in Baltimore City and then spread throughout the state. A statistically significant cluster ("hot spot") of deaths was centered in Baltimore City. Greater death densities were also centered on other cities. A high-density band of deaths extended from Baltimore City towards Annapolis. Deaths extended past cities and into the surrounding suburbs; this effect was most pronounced around Baltimore City. Deaths in Baltimore City appeared concentrated in certain neighborhoods. However, the activity moved between various neighborhoods over the course of the study. Review of the above data with the United States Drug Enforcement Administration's Baltimore Office (DEA) allowed some of the above trends to be explained in terms of illicit drug production, transportation and distribution. The DEA is implementing a new strategy to combat illicit narcotic distribution and use in Maryland.

Keywords: Fentanyl; Forensic pathology; Geographic information system; Overdose.

Figure 1

Map of Maryland showing geographic features of interest including: county and Baltimore City borders; cities with populations greater than 10 000 (with highlighting of Baltimore City, Annapolis, and Salisbury); Washington D.C.; Interstate-95; and the Delmarva Peninsula, which is bordered to the west by the Chesapeake Bay and to the east by the Delaware Bay and Atlantic Ocean.

Figure 2

Map of Maryland showing spatial distribution of fentanyl-related deaths during the study period.

Figure 3

Map of Maryland showing spatial and temporal distribution of fentanyl-related deaths during the study period.

Figure 4

Number of fentanyl-related deaths per month during the study period.

Figure 5

Number of fentanyl-related deaths per month during the first 13 months of the study period. A linear least squares regression line is shown in black.

Figure 6

Number of fentanyl-related deaths per month during the last seven months of the study period. A linear least squares regression line is shown in black.

Figure 7

Map of Maryland showing a heat map of the fentanyl-related deaths. The density of deaths increases from the cool colors (blue) to the hot colors (red).

Figure 8

Map of Maryland showing hot spots of fentanyl-related deaths. Statistically significant hot spots are shown in red (> 99% confidence) and orange (> 95% confidence).

Figure 9

Map of Maryland showing a heat map of the fentanyl-related deaths (excluding deaths in Baltimore City). The density of deaths increases from the cool colors (blue) to the hot colors (red).

Figure 10

Map of Baltimore City showing spatial and temporal distribution of fentanyl-related deaths during the study period. Deaths in the counties immediately adjacent to Baltimore City can also be seen. The same color scheme was used to for displaying the time interval in which each death occurred as shown in the legend of Figure 3.

Figure 11

Maps of Baltimore City showing a heat map and hot spots of the fentanyl-related deaths. Heat map density of deaths increases from the cool colors (blue) to the hot colors (red). Statistically significant hot spots are shown in red (> 99% confidence) and orange (> 95% confidence).

Figure 12

Map of Baltimore City showing a heat map of the fentanyl-related deaths during three separate time intervals. The density of deaths increases from the cool colors (blue) to the hot colors (red).

Figure 13

Map of a portion Baltimore City showing a heat map of the fentanyl-related deaths during two separate time intervals. The density of deaths increases from the cool colors (blue) to the hot colors (red). A street map is included in these maps; three streets are bold to allow for easier comparison of the maps and to highlight the neighborhoods involved by high density of deaths.

Figure 14

Spatial distribution and heat maps of Baltimore City showing emergency medical services dispatches for all suspected heroin/opioid overdoses during a two-week interval in August 2015.