Browsing by Author "Ballew, Alfarena"

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    Construction of a Database for Socio-Demographic, Medico-Legal, Anatomic, and Genomic Research into Suicide
    (Office of the Vice Chancellor for Research, 2015-04-17) Engle, Kaitlyn; Cook, Shannon; Levey, Daniel; Ballew, Alfarena; Yard, Michael
    Suicide is a potentially preventable tragedy. Over 180 cases of suicide a year occur in Marion County. We have created a database that permits integration of socio-demographic data, medico-legal information, anatomic images, and genomic results. We have collected over 50 cases to date. We will show results of analyses looking at method of suicide, toxicology results, and genomic biomarker correlates. It is hoped that this resource would permit the study of risk factors and the creation of predictive algorithms that may better identify people at risk, and lead to early intervention and prevention efforts.
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    Erratum to: Examining Fatal Opioid Overdoses in Marion County, Indiana
    (Springer-Verlag, 2017-04) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental Affairs
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    Examining Fatal Opioid Overdoses in Marion County, Indiana
    (Springer, 2017-04-01) Ray, Bradley; Quinet, Kenna; Dickinson, Timothy; Watson, Dennis P.; Ballew, Alfarena; School of Public and Environmental Affairs
    Drug-related overdoses are now the leading injury-related death in the USA, and many of these deaths are associated with illicit opioids and prescription opiate pain medication. This study uses multiple sources of data to examine accidental opioid overdoses across 6 years, 2010 through 2015, in Marion County, IN, an urban jurisdiction in the USA. The primary sources of data are toxicology reports from the county coroner, which reveal that during this period, the most commonly detected opioid substance was heroin. During the study period, 918 deaths involved heroin, and there were significant increases in accidental overdose deaths involving both heroin and fentanyl. In order to disentangle the nature and source of opioid overdose deaths, we also examine data from Indiana’s prescription drug monitoring program and the law enforcement forensic services agency. Results suggest that there have been decreases in the number of opiate prescriptions dispensed and increases in law enforcement detection of both heroin and fentanyl. Consistent with recent literature, we suggest that increased regulation of prescription opiates reduced the likelihood of overdoses from these substances, but might have also had an iatrogenic effect of increasing deaths from heroin and fentanyl. We discuss several policy implications and recommendations for Indiana.
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    Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011–2016
    (American Public Health Association, 2018-12) Lowder, Evan M.; Ray, Bradley R.; Huynh, Philip; Ballew, Alfarena; Watson, Dennis P.; School of Public and Environmental Affairs
    Objectives. To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths. Methods. We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings. Results. Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%. Conclusions. Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.