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10/24/12
1
A Decade of Pain
Opioid treatment and mortality in Minnesota, 2000-‐2010
Presented by
• Rick Moldenhauer, MS, LADC, ICADC, LPCC • State Opioid Treatment Authority, Alcohol and Drug Abuse Division, DHS
• P.O. Box 64977, St. Paul, MN 55164-‐0977 • Phone: (651) 431 2474 • Email: Richard.moldenhauer@state.mn.us
Data Streams;
• DAANES Annual Reports, Calendar Years 2000-‐2010 (treatment info), in some cases 2007-‐2010 where noted
• MDH Vital Sta\s\cs Sec\on (mortality data)
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highlights
• In MN, between Calendar Year (CY) 2000-‐2010 there were 1986 death cer\ficates issued with opioid as a primary or contribu\ng cause of mortality
Please remember…..
Numbers=People
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Total opiate related deaths in MN, 2000-‐2010
0
50
100
150
200
250
300
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
total opiate deaths
total opiate deaths
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
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Total opiate related deaths in MN, 2000-‐2010 by gender
0
20
40
60
80
100
120
140
160
180
200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
male female
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
11
050010001500200025003000350040004500
1998
2000
2002
2004
2006
2008
opiates
All Tx Admission for Opiates, 1998-2009
Source: DAANES, PMQI 2010
Total opiate related treatment admissions in MN, 2007-‐2010 by percent, by gender
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
male female
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
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5
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Total opiate tx admissions MN, 2000-‐2006 by substance (at least 1-‐2x/
wk)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
2000 2001 2002 2003 2004 2005 2006
opiates heroin non-‐rx methadone
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
Use of opiate, tx admissions MN, 2007-‐2010 by substance (use in last 1 to 10 days)
0
2
4
6
8
10
12
14
16
18
20
2007 2008 2009 2010
opiates heroin non-‐rx methadone
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
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Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Primary use of opiate, tx admissions MN, 2007-‐2010 by percent, opioid
0
10
20
30
40
50
60
70
2007 2008 2009 2010
opiates heroin non-‐rx methadone
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
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Total opiate related deaths in MN, 2000-‐2010 by four largest race categories
0
50
100
150
200
250
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
white black Indian Asain
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
Total opiate related treatment in MN, 2000-‐2010 by percent; four largest race categories
0
10
20
30
40
50
60
70
80
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
white black Indian Asain
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
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22
Opiates by age group, 2000-2009
0
200
400
600
800
1000
1200
1400
1600
1998
2000
2002
2004
2006
2008
>17
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85<
Source: DAANES, PMQI 2010
23
Pregnancy status at admission 2000-2009, opiates
0
20
40
60
80
100
120
199819992000200120022003200420052006200720082009
pregnant
Source: DAANES, PMQI 2010
Total opiate related deaths in MN, 2000-‐2010 by select age categories
0
50
100
150
200
250
300
350
400
16-‐20 21-‐25 26-‐30 31-‐35 36-‐40 41-‐45 46-‐50 51-‐55 56-‐60 61-‐65 66-‐70
total
total 41.9 avg. age of death of opiates
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
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Total opiate treatment admissions in MN, 2007-‐2010 by percent, select age categories
0
5
10
15
20
25
30
35
40
under 18 18-‐24 25-‐34 35-‐44 45-‐54 55+
2007 2008 2009 2010
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
Total opiate treatment admissions in MN, 2007-‐2010 by percent, average age
29.5 30
30.5 31
31.5 32
32.5 33
33.5 34
34.5 35
2007 CY 2008 CY 2009 CY 2010
Ave age
Ave age
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
Heroin vs. other opiate admission 1998-2009
Source: DAANES, PMQI, MN DHS 2010
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Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Top coun\es for opioid mortality in MN, 2000-‐2010
• Hennepin………………….. 785 • Ramsey ……………………..215 • Anoka………………………..160 • Dakota………………………. 128 • St Louis……………………… 88
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
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Total opiate related deaths in MN, 2000-‐2010 by months
0
20
40
60
80
100
120
140
160
180
200
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
total
total
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
Raw numbers
Total opiate related treatment admission in MN, 2007-‐2010, by percent, by months
0
2
4
6
8
10
12
14
16
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
2007 2008 2009 2010
Sources: DAANES, PMQI 2012 and MDH VItal Stats, 2011
By percent
33
Opiate intoxication
• Directly related to volume and strength consumed
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34
miosis
• Constricting of the pupil, 2-3mm
35
Slurred speech
• Inability to enunciate words, broken sentence structure and vocabulary choice
36
fatigue
• That state, following a period of mental or bodily activity, characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability.
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37
Stupor or coma
• The partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation
38
Impairment in attention
• Inability to focus on objections or discussions, e.g. can’t “track”
39
Impairment in memory
• Inability to recall short or long term memory, may also have difficulty with recognition
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40
Opioid withdrawal
Rarely life threatening
• Looks like bad case of the flu
41
mydriasis
• Widening of the pupil, 7-8mm, slow and sluggish to respond
42
lacrimation
• Watering of the eyes, shedding tears
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43
rhinorrhea
• Flowing, nasal discharge
44
diaphoresis
• Perspiration, especially profuse perspiration, e.g. “sweating”
45
Nausea/emesis
• Upset stomach and vomiting
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46
diarrhea
• A morbidly frequent and profuse discharge of loose or fluid evacuations from the intestines e.g. “the shits, the hershey squirts, the green apple two-step”
47
Muscle aches
• Burning pain in the muscle body
48
fever
• A rise in body temperature above normal usually as a natural response to infection. Typically an oral temperature greater than 100.4 degrees Fahrenheit constitutes a fever.
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49
piloerection
• Erection of the hair, e.g. “hair standing on end”
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