Maps

MapsBelow are county-level choropleth maps related to Ohio’s opioid epidemic. Each series of maps provide a long-term picture of the impact of the epidemic on Ohio’s communities. Common break points are used to make year-to-year comparisons easy, and a brief explanation within each map helps describe the meaning of the data.

Maps are typically updated once a year as data becomes available.

Treatment for Substance Use Disorders

This series of maps illustrates unduplicated clients receiving treatment for substance use disorders within a given state fiscal year (SFY). The data is from the Multi Agency Community Information Systems (MACSIS) and the Medicaid Information Technology System (MITS). It reflects only those clients who received services with public dollars. Private insurance and self-pay clients are not reflected in this data or the resulting maps. 

Each map in the series shows county percentages of unduplicated clients receiving treatment for a primary diagnosis related to a particular substance (or type of substance) in a given SFY. The county is the client’s county of residence, not necessarily the county where treatment was received. For example, the map Treatment for Opiate Use Disorder 2015 displays each county’s percentage of public-paid treatment clients residing in the county who received treatment for a primary diagnosis of Opiate Use Disorder during SFY 2015. Each client is counted only once within a SFY, regardless of number of treatment episodes. If a client is receiving treatment for more than one substance-related diagnosis, the client will be counted only within the map that covers the primary diagnosis.

To obtain the percentages, the number of unique clients who received services for a specific primary diagnosis is divided by the total number of unique clients who received treatment services. In cases where there were fewer than 25 clients with a primary diagnosis related to the substance during that SFY, the percentage is not displayed and the county is colored gray. In cases where there were between 25 and 49 clients with a primary diagnosis related to the substance during that SFY, the percentage is provided and the county is marked with gray diagonal lines. All other counties had 50 or more clients with a primary diagnosis related to the substance during that SFY.

Including the four most common substance use disorder diagnoses (opiates, cocaine, alcohol, and cannabis) in this series of maps gives a full picture of the population accessing public-paid treatment services in each county in a given SFY. For example, the four maps covering SFY 2015 display each county’s percentage of public-paid clients with primary diagnoses related to opiates, cocaine, alcohol, and cannabis, and also provide the statewide client percentages of 43.7%, 13.5%, 29.7%, and 7.5%, respectively. This means that of all the public-paid treatment clients in Ohio in SFY 2015, 43.7% had a primary diagnosis related to opioids, 13.5% had a primary diagnosis related to cocaine, 29.7% had a primary diagnosis related to alcohol, and 7.5% had a primary diagnosis related to cannabis (the remaining clients had primary diagnoses related to other substance categories, such as stimulants, etc.). This comparison can be made in each county and provides a more complete representation of the treatment population.


Prescription Opioid Doses Dispensed in Ohio

Prescription Opioid Doses Dispensed in Ohio

This series of maps illustrates prescription opioid doses dispensed per capita and per patient by county and calendar year, using data from the Ohio Board of Pharmacy’s automated prescription reporting system (OARRS).

Prescription Opioid Doses per Capita

“Doses per Capita” is a measure that gives the average number of doses dispensed per each individual resident in a county in a year. This is not based on whether each person received an opioid prescription; it includes all county residents. For example, if a county has a prescription opioid doses per capita measure of 50, it means that for every man, woman, and child living in the county, 50 doses of prescription opioids were dispensed in the county during that year.

All opioid oral solids, sublingual films and transdermal patches are included. One “dose” is defined as one pill, film or patch. All opioid solutions are excluded from the analysis. County rates are calculated based on patient residence and not on the county in which the prescription was filled. To calculate the doses per capita measure, the total number of prescription opioid doses dispensed to county residents within a calendar year is divided by the total number of county residents. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

For maps covering 2010 through 2019, a scale based on the opioid prescribing rates of the early 2010s was used. The same scale was used for each year to ensure that comparisons could be made from year to year. As prescribing rates for opioids have decreased through the decade, the map has increasingly used only the first categories of the scale, rather than all of them. Therefore, in 2019, a new scale has been created to reflect the lower opioid prescribing rates. Two maps were created for 2019: one using the previous scale (named 2010s Scale) and one using the updated scale (named 2020s Scale). Starting with the map for 2020, all Opioid Doses per Capita maps will use the updated 2020s Scale.

Prescription Opioid Doses per Patient

“Doses per Patient” is a measure that gives the average number of doses dispensed per each opioid prescription patient in a county in a year. This is based on county residents who had opioid prescriptions dispensed to them. For example, if a county has a prescription opioid doses per patient measure of 200, it means that for every individual living in the county who had an opioid prescription dispensed to him/her/them, 200 doses of prescription opioids were dispensed in the county during that year.

All opioid oral solids, sublingual films and transdermal patches are included. One “dose” is defined as one pill, film or patch. All opioid solutions are excluded from the analysis. County rates are calculated based on patient residence and not on the county in which the prescription was filled. To calculate the doses per patient measure, the total number of prescription opioid doses dispensed to county residents within a calendar year is divided by the total number of patients receiving the opioid prescriptions within the county. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

Benzodiazepine Doses Dispensed in Ohio

Benzodiazepine Doses Dispensed in Ohio

This series of maps illustrates prescription benzodiazepine doses dispensed per capita and per patient by county and calendar year, using data from the Ohio Board of Pharmacy’s automated prescription reporting system (OARRS).

Benzodiazepine Doses per Capita

“Doses per Capita” is a measure that gives the average number of doses dispensed per each individual resident in a county in a year. This is not based on whether each person received a benzodiazepine prescription; it includes all county residents. For example, if a county has a benzodiazepine doses per capita measure of 50, it means that for every man, woman, and child living in the county, 50 doses of benzodiazepines were dispensed in the county during that year.

All benzodiazepine oral solids are included. One “dose” is defined as one pill. County rates are calculated based on patient county of residence and not on the county in which the prescription was filled. To calculate the doses per capita measure, the total number of prescription benzodiazepine doses dispensed to county residents within a calendar year is divided by the total number of county residents. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

For maps covering 2010 through 2019, a scale based on the benzodiazepine prescribing rates of the early 2010s was used. The same scale was used for each year to ensure that comparisons could be made from year to year. As prescribing rates for benzodiazepines have decreased through the decade, the map has increasingly used only the first categories of the scale, rather than all of them. Therefore, in 2019, a new scale has been created to reflect the lower benzodiazepine prescribing rates. Two maps were created for 2019: one using the previous scale (named 2010s Scale) and one using the updated scale (named 2020s Scale). Starting with the map for 2020, all Benzodiazepine Doses per Capita maps will use the updated 2020s Scale.

Benzodiazepine Doses per Patient

“Doses per Patient” is a measure that gives the average number of doses dispensed per each benzodiazepine prescription patient in a county in a year. This is based on county residents who had benzodiazepine prescriptions dispensed to them. For example, if a county has a benzodiazepine doses per patient measure of 200, it means that for every individual living in the county who had a benzodiazepine prescription dispensed to him/her/them, 200 doses of benzodiazepines were dispensed in the county during that year.

All benzodiazepine oral solids are included; one “dose” is defined as one pill. County rates are calculated based on patient county of residence and not on the county in which the prescription was filled. To calculate the doses per patient measure, the total number of prescription benzodiazepine doses dispensed to county residents within a calendar year is divided by the total number of patients receiving the benzodiazepine prescriptions within the county. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

  

Archived Historical Maps: 2003-2014

Charges for Drug Possession

Drug Possession Charges for All Drugs

This series of maps examines drug possession charges with data from the Department of Public Safety’s (ODPS) Ohio Incident-based Reporting System (OIBRS). The total number of drug possession charges (e.g., heroin, Rx opioids, methamphetamine, marijuana) is divided by the total number of county residents living in jurisdictions that report to OIBRS, and then multiplied by 10,000 to calculate the rate of drug possession charges per 10,000 persons. ODPS sends OIBRS data to the FBI on an annual basis as part of the Uniform Crime Reporting (UCR) Program. While law enforcement are not required to submit data to ODPS, the Department estimates that 60 percent of law enforcement agencies participate (e.g., major police depts., Ohio State Highway Patrol, university police depts.), which covers 75 percent of the population, and an estimated 85 to 90 percent of crime reported to law enforcement in Ohio. Nonetheless, some communities have not submitted data to ODPS; therefore, rates may be either underestimates or unavailable for some counties.

Drug Possession Charges for Opiates

This series of maps examines opiate possession charges with data from the Department of Public Safety’s (ODPS) Ohio Incident-based Reporting System (OIBRS). The total number of opiate possession charges (i.e., heroin, Rx opioids, non-prescription methadone) is divided by the total number of county residents living in jurisdictions that report to OIBRS, and then multiplied by 10,000 to calculate the rate of opiate possession charges per 10,000 persons. ODPS sends OIBRS data to the FBI on an annual basis as part of the Uniform Crime Reporting (UCR) Program. While law enforcement are not required to submit data to ODPS, the Department estimates that 60 percent of law enforcement agencies participate (e.g., major police depts., Ohio State Highway Patrol, university police depts.), which covers 75 percent of the population, and an estimated 85 to 90 percent of crime reported to law enforcement in Ohio. Nonetheless, some communities have not submitted data to ODPS; therefore, rates may be either underestimates or unavailable for some counties.

Disease Rates

Hepatitis C

This series of maps examines the rate of reported Hepatitis C (HCV) cases (past or present) with data from the Ohio Department of Health. The total number of HCV cases is divided by the total number of county residents, and then multiplied by 100,000 to calculate the HCV rate per 100,000 persons. Maps before 2013 only look at cases of non-acute HCV; whereas, maps 2013 and after will look at both acute and non-acute cases of HCV. The Ohio Department of Health did not have a dedicated HCV surveillance program between 2008 and 2012 due to different funding priorities; therefore, data from these years may significantly underestimate the rate of HCV at the state and county levels. HCV rates may be elevated each year due to the presence of correctional facilities in the following counties: Allen, Ashtabula, Belmont, Cuyahoga, Fairfield, Franklin, Hocking, Lorain, Madison, Mahoning, Marion, Montgomery, Noble, Pickaway, Richland, Ross, Scioto, Trumbull and Warren. Rate elevation will occur in these cases because the correctional facility was listed as the inmate’s county of residence.

HIV / AIDS

This series of maps examines the rate of all persons ever diagnosed and reported with HIV or AIDS who have not been reported as having died with data from the Ohio Department of Health. The total number of HIV/AIDS cases is divided by the total number of county residents, and then multiplied by 100,000 to calculate the HIV/AIDS rate per 100,000 persons. Limitations found in HCV data pertaining to a dedicated health surveillance program and correctional facilities do not apply to HIV/AIDS data.

Hospital Discharges for Neonatal Abstinence Syndrome

This series of maps examines neonatal abstinence syndrome (NAS) with data from the Ohio Hospital Association (OHA). The number of inpatient NAS hospitalizations per five-year period is divided by the number of live births per five-year period to Ohio residents, giving birth in Ohio to calculate the NAS rate. Weights are used in calculations to preserve patient confidentiality and adjust for rate instability in counties with few residents. Rates reflect county of residence and not county in which the patient was served. Persons not living in Ohio, but served by our system are excluded from the analysis. While OHA data is submitted from 99% of hospitals (over 200 institutions and 13 healthcare systems), rates may be slightly underestimated because data from new institutions may not be included in rate calculations.

Hospital Visits for Opiate Abuse, Dependence or Poisoning

Hospital Emergency Room Discharges

The series of maps examines hospital emergency room (ER) discharges for opiate abuse, dependence, or poisoning (i.e., persons have not been admitted for further care) with data from the Ohio Hospital Association (OHA). The number of discharges (not unique persons) per five-year period is divided by the total number of county residents per five-year period to calculate the weighted ER discharge rate. Calculations use weights to preserve patient confidentiality and adjust for rate instability in counties with few residents. Rates reflect county of residence and not county in which the patient was served. Persons not living in Ohio, but served by our system are excluded from the analysis. While OHA data is submitted from 99% of hospitals (over 200 institutions and 13 healthcare systems), rates may be slightly underestimated because data from new institutions may not be included in rate calculations.

Total Hospital Admissions

The series of maps examines total hospital admissions for opiate abuse, dependence, or poisoning (i.e., persons admitted from emergency rooms into inpatient or observation settings as well as those persons treated and released from emergency rooms) with data from the Ohio Hospital Association (OHA). The number of total admissions (not unique persons) per five-year period is divided by the total number of county residents per five-year period to calculate the weighted total admission rate. Calculations use weights to preserve patient confidentiality and adjust for rate instability in counties with few residents. Rates reflect county of residence and not county in which the patient was served. Persons not living in Ohio, but served by our system are excluded from the analysis. While OHA data is submitted from 99% of hospitals (over 200 institutions and 13 healthcare systems), rates may be slightly underestimated because data from new institutions may not be included in rate calculations.

Incarceration Rates for Drug Offenses

This series of maps examines incarceration rates for drug offenses with data from the Ohio Department of Rehabilitation and Correction. The total number of incarcerations related to drug offenses is divided by the total number of county residents, and then multiplied by 10,000 to calculate the drug offense incarceration rate per 10,000 persons. All prison facilities are required to submit data to ODPS, and data are considered complete. Data reflect snapshots of the prison census on a particular day, and do not reflect annual rates like other maps. Prison census data was unavailable for January 1, 2007 and 2008; therefore, data from July 2007 and 2008 was used in its place.

Medication Assisted Treatment with Buprenorphine

This series of maps examines distribution of drugs commonly used in medication assisted treatment (MAT) like buprenorphine, Suboxone® and Subutex® with data from The Ohio State Board of Pharmacy automated prescription reporting system (OARRS). The total number of MAT doses prescribed to Ohio residents is divided by the total number of county residents, and then multiplied by 100 to calculate the MAT rate per 100 persons. County rates are calculated based on county of patient residence and not on the county in which the script was filled. An estimated 97% of buprenorphine-containing  products are used on-label for MAT in this analysis. All buprenorphine solutions are excluded from the analyses because they are typically only used in hospital settings. Additionally, Butrans® is excluded because it is primarily used for pain management. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations. This map does not take into account another commonly used drug for MAT, methadone, because methadone is also frequently used for pain management; therefore, it is difficult to tease out the purpose of the medication dispensed.

Naloxone Statistics

Naloxone Administration Rates

This series of maps examines naloxone administration with data from the Ohio Department of Public Safety, EMS Incident Reporting System (EMSIRS). The total number of naloxone administrations for non-unique persons is divided by the total number of county residents, and then multiplied by 10,000 to calculate the naloxone administration rate per 10,000 persons. EMS data are required to be submitted to EMSIRS. However, there are minimal sanctions for failing to submit, so the data are limited by the number of individual EMS agencies submitting data and the accuracy of these submissions. EMSIRS staff estimate that roughly 90 percent of EMS providers participate in data collection annually. Data reflect administrations by basic EMTs, intermediate EMTs, and Paramedics, but do not include administrations given at health care settings (e.g., emergency rooms), by peace officers, or by private citizens. Data reflect unique administrations of naloxone and not doses; therefore, a person given two doses is only counted one time. That said, a person who receives administrations over multiple encounters (e.g., two times in one month) will be counted more than once.

Other Naloxone Figures

This series of maps examines various statistics about naloxone administration with data from the Ohio Department of Public Safety, EMS Incident Reporting System (EMSIRS). The first map examines the time it takes to transport persons administered naloxone to the hospital. Average times related to arrival at the scene, treating the patient at the scene, and transport to the hospital are summed at the county level to produce the average minutes to the hospital. The second map examines the percentage of EMTs unable to administer naloxone as of 2012. Data from this map will not be produced in the future because House Bill 170 allowed first responders and basic-level EMTs to administer naloxone. EMS data are required to be submitted to EMSIRS. However, there are minimal sanctions for failing to submit, so the data are limited by the number of individual EMS agencies submitting data and the accuracy of these submissions. EMSIRS staff estimate that roughly 90 percent of EMS providers participate in data collection annually. Data reflect administrations by basic EMTs, intermediate EMTs, and Paramedics, but do not include administrations given at health care settings (e.g., emergency rooms), by peace officers, or by private citizens. Data reflect unique administrations of naloxone and not doses; therefore, a person given two doses is only counted one time. That said, a person who receives administrations over multiple encounters (e.g., two times in one month) will be counted more than once.

Opiate Hot Spot Analysis by County

This series of maps examines clusters of unique clients in treatment who list heroin or prescription opioids as a primary drug of choice at the county level. Several hot spot analyses (Getis-Ord Gi*) are combined into each map based on data from Ohio Behavioral Health Module. Clusters colored red, pink, or blue in show statistical significance (confidence level = .90) in which there are greater than expected cases of persons listing heroin or prescription opioids as a primary drug of choice. Clusters with statistically significant clusters with fewer than expected cases are not displayed.

Opiate Hot Spot Analysis by Zip Code

This series of maps examines clusters of unique clients in treatment who list heroin or prescription opioids as a primary drug of choice at the zip code level. Several hot spot analyses (Getis-Ord Gi*) are combined into each map based on data from Ohio Behavioral Health Module. Clusters colored red, pink, or blue in show statistical significance (confidence level = .90) in which there are greater than expected cases of persons listing heroin or prescription opioids as a primary drug of choice. Clusters with statistically significant clusters with fewer than expected cases are not displayed. Major cities, highways, and county borders are added for points of reference.

Prescription Opioids

Heroin

Prescription Opioids per Capita

This series of examines per capita distribution of prescription opioids with data from The Ohio State Board of Pharmacy’s automated prescription reporting system (OARRS). The total number of prescription opioid doses prescribed to Ohio residents is divided by the total number of county residents to calculate the per capita rate. County rates are calculated based on county of patient residence and not on the county in which the script was filled. Per capita rates are only based on oral solids and transdermal patches. All opioid solutions and most buprenorphine combinations are excluded from the analyses except for Butrans, which is primarily used for pain management. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

Prescription Opioid Milligram Morphine Equivalents (MME)

MME per Capita

This series of maps examines general exposure to milligram morphine equivalents per capita with data from The Ohio State Board of Pharmacy’s automated prescription reporting system (OARRS). In contrast to maps showing quantity of opioids per capita, this map looks at the potency of opioids per capita. The potency of prescription opioids varies by strength and brand, so an equation for milligram morphine equivalents is used to transform pill potency into standardized units comparable to morphine. The formula to calculate milligram morphine equivalents considers drug strength, quantity, day’s supply and conversion factors available from the Centers for Disease Control and Prevention. The total number of milligram morphine equivalents per recipient is calculated, summed at the county level, and then divided by the total number of county residents to calculate the per capita rate. Per capita rates are only based on oral solids and transdermal patches. All opioid solutions and most buprenorphine combinations are excluded from the analyses except for Butrans, which is primarily used for pain management. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

MME per Prescription

This series of maps examines exposure to milligram morphine equivalents per prescription with data from The Ohio State Board of Pharmacy’s automated prescription reporting system (OARRS). The potency of prescription opioids varies by strength and brand, so an equation for milligram morphine equivalents is used to transform pill potency into standardized units comparable to morphine. The formula to calculate milligram morphine equivalents considers drug strength, quantity, day’s supply and conversion factors available from the Centers for Disease Control and Prevention. The total number of milligram morphine equivalents per script is calculated, summed at the county level, and then divided by the total number of scripts to calculate the MME per script rate. Per script rates are only based on oral solids and transdermal patches. All opioid solutions and most buprenorphine combinations are excluded from the analyses except for Butrans, which is primarily used for pain management. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

MME per Patient

This series of maps examines patient exposure to milligram morphine equivalents per patient with data from The Ohio State Board of Pharmacy’s automated prescription reporting system (OARRS). The potency of prescription opioids varies by strength and brand, so an equation for milligram morphine equivalents is used to transform pill potency into standardized units comparable to morphine. The formula to calculate milligram morphine equivalents considers drug strength, quantity, day’s supply and conversion factors available from the Centers for Disease Control and Prevention. The total number of milligram morphine equivalents per recipient is calculated, summed at the county level, and then divided by the total number of patients receiving opioids to calculate the per patient rate. Per patient rates are only based on oral solids and transdermal patches. All opioid solutions and most buprenorphine combinations are excluded from the analyses except for Butrans, which is primarily used for pain management. Rates are likely underestimated because data from drugs dispensed at physician offices and the Veteran’s Administration are not included in the calculations.

Primary Drug of Choice for Persons in Treatment

Prescription Opioids 

This series of maps examines the primary drug of choice among unique clients with data from the OhioMHAS Ohio Behavioral Health Module (OHBH). The number of unique clients with prescription opioids listed as the primary drug of choice is divided by the total number of unique clients to calculate the percentage persons with prescription opioids as the primary drug of choice. OHBH data submission is required by law; however, data submission is not tied to billing practices and there are minimal sanctions for failing to submit, so some under-reporting of cases is likely. Agencies have up to one-year to submit billing data, meaning this data may significantly lag behind other metrics. Data reported to the Department only reflects information for clients whose treatment was provided via public dollars, thus private insurance and self-pay clients are not reflected in this data.

*Data source label corrected in maps from 2012 - 2008, updated November, 2015


Heroin

This series of maps examines the primary drug of choice among unique clients with data from the OhioMHAS Ohio Behavioral Health Module (OHBH). The number of unique clients with heroin listed as the primary drug of choice is divided by the total number of unique clients to calculate the percentage persons with heroin as the primary drug of choice. OHBH data submission is required by law; however, data submission is not tied to billing practices and there are minimal sanctions for failing to submit, so some under-reporting of cases is likely. Agencies have up to one-year to submit billing data, meaning this data may significantly lag behind other metrics. Data reported to the Department only reflects information for clients whose treatment was provided via public dollars, thus private insurance and self-pay clients are not reflected in this data.

*Data source label corrected in maps from 2012 - 2008, updated November 2015

Property Crime Rates

Property Crimes (i.e., burglary, motor vehicle theft, larceny and theft)

This series of maps examines property crimes with data from the Department of Public Safety’s (ODPS) Ohio Incident-based Reporting System (OIBRS). The total number of property crimes (i.e., burglary, motor vehicle theft, larceny and theft) is divided by the total number of county residents living in jurisdictions that report to OIBRS, and then multiplied by 10,000 to calculate the property crime rate per 10,000 persons. ODPS sends OIBRS data to the FBI on an annual basis as part of the Uniform Crime Reporting (UCR) Program. While law enforcement are not required to submit data to ODPS, the Department estimates that 60 percent of law enforcement agencies participate (e.g., major police depts., Ohio State Highway Patrol, university police depts.), which covers 75 percent of the population, and an estimated 85 to 90 percent of crime reported to law enforcement in Ohio. Nonetheless, some communities have not submitted data to ODPS; therefore, rates may be either underestimates or unavailable for some counties.