Opioid Overdose Crisis in San Diego County

Drug abuse and its related problems are among society’s most pervasive health and social concerns. Causes of drug-induced deaths include dependent and non-dependent use of drugs (both legal and illegal use) and also poisoning from medically prescribed drugs. Addicted persons frequently engage in self-destructive and criminal behavior, which can result in injury or death. In addition, recreational drug-use can lead to unintentional overdose and death.




## Objectives :

Video Introduction

#Cautions: Two different coding classification systems were utilized:

Cause-of-death between 1999 to present were coded using the Tenth Revision of the International Classification of Diseases codes (ICD-10). Cause-of-death between 1989 and 1998 were coded using the Ninth Revision of the International Classification of Deseases Codes (ICD-9).

Drug Suppies

For the first time, a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — by manufacturers and distributors to pharmacies in every town and city — has been made public.

The Washington Post sifted through nearly 380 million transactions from 2006 through 2012 that are detailed in the DEA’s database and analyzed shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total opioid pill shipments to pharmacies. The Post is making this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities.




Top pharmacies from 2006 to 2012, in San Diego County, California.




sdpharmacy <- read.delim("C:/Users/Joe/Downloads/arcos-ca-san-diego-06073-pharmacy.tsv")
sdmanufacturer <- read.delim("C:/Users/Joe/Downloads/arcos-ca-san-diego-06073-labeler.tsv")
sddistributor <- read.delim("C:/Users/Joe/Downloads/arcos-ca-san-diego-06073-distributor.tsv")
#----------
top_pharmany <- top_n(sdpharmacy,20,total_dosage_unit)
top_pharmany <- select(top_pharmany,c(4:6))
kable(top_pharmany) %>%
  kable_styling(bootstrap_options = c("striped", "hover"),full_width = F) %>%
                row_spec(1:6,bold = T,color = "black",background = "lightgreen") %>%
                row_spec(7:13,bold = T,color = "black",background = "lightblue")
buyer_name buyer_city total_dosage_unit
OPTUMRX CARLSBAD 65887670
KAISER PERMANENTE PHRMCY 217 SAN DIEGO 8884400
RX SOLUTIONS, INC CARLSBAD 8165420
OMNICARE OF SAN DIEGO SAN DIEGO 6523160
KAISER PERMANENTE PHRMCY 230 LA MESA 5590820
WALGREEN CO. EL CAJON 5021730
KAISER FOUNDATION HEALTH EL CAJON 4937380
KAISER FOUND HEALTH PLAN INC SAN MARCOS 4663510
KAISER FOUND HLTH PLAN SAN DIEGO 4652610
GARFIELD BEACH CVS, L.L.C. SANTEE 4642589
MEDICAL CENTER PHARMACY SAN DIEGO 4338210
GARFIELD BEACH CVS, L.L.C. ESCONDIDO 4235700
GARFIELD BEACH CVS, L.L.C. EL CAJON 4042400
GARFIELD BEACH CVS, L.L.C. CARLSBAD 3848300
KAISER FDN HEALTH PLAN INC SAN DIEGO 3701590
GARFIELD BEACH CVS, L.L.C. EL CAJON 3519500
RON’S PHARMACY SERVICES SAN DIEGO 3516400
KAISER FDN HEALTH PLAN INC BONITA 3508500
GARFIELD BEACH CVS, L.L.C. OCEANSIDE 3100720
KAISER PERMANENTE PHRMCY 245 LA MESA 3094520

Top drug distributors in San Diego County

Data source : Washington Post.

a database maintained by the Drug Enforcement Administration that tracks the path of every single pain pill sold in the United States — by manufacturers and distributors to pharmacies in every town and city — has been made public.

The Washington Post sifted through nearly 380 million transactions from 2006 through 2012 that are detailed in the DEA’s database and analyzed shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total opioid pill shipments to pharmacies. The Post is making this data available at the county and state levels in order to help the public understand the impact of years of prescription pill shipments on their communities.

library(hpackedbubble)
## 
## Attaching package: 'hpackedbubble'
## The following object is masked from 'package:datasets':
## 
##     CO2
b1 <- filter(sdpharmacy, `total_dosage_unit` >=2500000 ) %>% select(c(4:7))
colnames(b1) <- c("Buyer","City","Dosage","Records")

hpackedbubble(b1$City,b1$Buyer, b1$Dosage,
              title = "Prescription_ Over 2.5 millions _ Top Cities ",
              pointFormat = "<b>{point.name}:City </b> {point.y} Prescriptions",
              dataLabelsFilter = 100,
              packedbubbleMinSize = "50%",
              packedbubbleMaxSize = "100%",
              packedbubbleZMin = 0,
              packedbubbleZmax = 1000, split = 1,
              gravitational = 0.02,
              parentNodeLimit = 1,
              dragBetweenSeries = 0,
              seriesInteraction = 0,
              theme = "sandsignika",
              titleColor = "black",
              width = "100%")

City of Pine Valley

Pine Valley: A rural community on a hillside area in San Diego County, with population of 2,000 people.

pinevalley <- sdpharmacy %>% filter(buyer_city=="PINE VALLEY") %>% select(buyer_name,total_dosage_unit)

kable(pinevalley,format = "html",caption = "City of Pine Valley with population of 2,000",
                           col.names = c("Pharmacy", "Count of Prescription ")) %>%
                   kable_styling(bootstrap_options = c("striped", "hover"),full_width = F) %>%
                   row_spec(1,bold = T,color = "black",background = "lightblue")
City of Pine Valley with population of 2,000
Pharmacy Count of Prescription
GRIZZLE, REX E DDS 12140
STARKEY, ALMEDA LOUISE DVM 100

City of Alpine

Alpine: A rural community on a hillside area in San Diego County, with population of 9,000 people.

alpine <- sdpharmacy %>% filter(buyer_city=="ALPINE") %>% select(buyer_name,total_dosage_unit)

kable(alpine,format = "html",caption = "City of Alpine with population of 9,000",
                           col.names = c("Pharmacy", "Count of Prescription ")) %>%
                   kable_styling(bootstrap_options = c("striped", "hover"),full_width = F) %>%
                   row_spec(1:3,bold = T,color = "black",background = "lightgreen")
City of Alpine with population of 9,000
Pharmacy Count of Prescription
THRIFTY PAYLESS INC. 2551830
LONGS DRUG STORES CALIFORNIA, L.L.C. 787800
NEW ALBERTSON’S, INC, 548000
LONGS DRUG STORE #757 9300
CLARK, GEORGE WESLEY MD 1400
HACKETT, JOHN D. DVM INC 600
CLARK, GEORGE WESLEY, MD 300
YANKOPOULOS, ALEXANDER R DVM 300
GULLICK, NICOLE 200
OROZCO, RODOLFO A DDS 100
DIEP, BRIAN MD 10

2006 to 2012 in San Diego County

608,164,349 pain pill prescriptions

155,915,480 of the pills were distributed by McKesson Corporation

245,662,610 were manufactured by SpecGx LLC.




Data Analysis on Opioid Crisis

Presentation by Joe Long