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The Epidemiology of Unintentional Drug Poisoning in the United States. Len Paulozzi, MD, MPH SEOW Audio Conference December 12, 2007. Unintentional drug poisoning mortality rates, US, 1970-2004. Prescription drugs. Crack cocaine. Heroin. Methodology. - PowerPoint PPT Presentation
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Centers for Disease Control and Prevention National Center for Injury Prevention and Control
Centers for Disease Control and Prevention National Center for Injury Prevention and Control
The Epidemiology of Unintentional Drug Poisoning in the United StatesThe Epidemiology of Unintentional
Drug Poisoning in the United States
Len Paulozzi, MD, MPH
SEOW Audio ConferenceDecember 12, 2007
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Unintentional drug poisoning mortality rates, US, 1970-2004
Unintentional drug poisoning mortality rates, US, 1970-2004
0
1
2
3
4
5
6
7
8
'70
'72
'74
'76
'78
'80
'82
'84
'86
'88
'90
'92
'94
'96
'98
'00
'02
'04
Year
Cru
de
rate
per
100
,000
Heroin
Crack cocaine
Prescription drugs
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MethodologyMethodology
Mortality counts are based on death certificate information only.
Coroners and medical examiners determine person’s intent and drug(s) responsible.
“Unintentional” poisoning deaths include “accidental” ingestion, overmedication, and overdoses of drugs used nonmedically (“drug overdoses”).
Unless otherwise indicated, suicides and deaths of undetermined intent are not included.
Most mortality statistics can be generated for single states using WISQARS or WONDER
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Unintentional drug poisoning mortality rates by major drug type, US, 1990-1998
Unintentional drug poisoning mortality rates by major drug type, US, 1990-1998
0
0.2
0.4
0.6
0.8
1
1.2
'90 '91 '92 '93 '94 '95 '96 '97 '98
Rate
per
100,0
00 p
ers
on
s
opiates
other
unspecified
cocaine
psychotropic
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Unintentional drug poisoning mortality rates by major drug type, US, 1999-2004
Unintentional drug poisoning mortality rates by major drug type, US, 1999-2004
0
0.5
1
1.5
2
2.5
3
3.5
'99 '00 '01 '02 '03 '04
Rate
per
100,0
00 p
ers
on
s
narcotics (opiates &cocaine)
other & unspec
psychotropics
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Unintentional deaths from “narcotics” and “other/unspecified drug” by major type of drug,
US, 1999-2004
Unintentional deaths from “narcotics” and “other/unspecified drug” by major type of drug,
US, 1999-2004
0
1000
2000
3000
4000
5000
6000
7000
8000
'99 '00 '01 '02 '03 '04
Nu
mb
er
of
death
s
narcotic analgesic
cocaine
heroin
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Unintentional deaths from “narcotics” and “other/unspecified drugs” by type of opioid analgesic,
US, 1999-2004
Unintentional deaths from “narcotics” and “other/unspecified drugs” by type of opioid analgesic,
US, 1999-2004
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
'99 '00 '01 '02 '03 '04
Nu
mb
er
of
death
s
opium derived
methadone
other syntheticnarcotic
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Unintentional drug poisoning mortality rates by sex and age group, US, 2003-2004
Unintentional drug poisoning mortality rates by sex and age group, US, 2003-2004
02
46
81012
1416
1820
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age Group
Rate
per
100,0
00
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Unintentional poisoning mortality rates by race, US, 2004
Unintentional poisoning mortality rates by race, US, 2004
7.546.94
8.6
1.07
0
1
2
3
4
5
6
7
8
9
10
White Black AIAN API
Ag
e-a
dju
ste
d r
ate
per
100,0
00
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Unintentional and undetermined drug poisoning Unintentional and undetermined drug poisoning mortality rates by state, US, 2004mortality rates by state, US, 2004
2.3-6.8 6.9-8.6 8.7-16.7
Rate per 100,000 population
7.2
6.8
3.8
2.7
7.2
4.2
2.3
2.3
3.7
7.1
6.1
7.1
6.6
7.4
11.1
6.2
14.6
5.4
5.9
8.3
11.9
6.6
6.08.2
11.6
HI7.2
8.2
13.5
7.5
8.3
7.4
11.0
11.2
16.7
10.4
11.4
9.4
11.1
7.9
13.5
10.5
NH 7.9VT 6.7MA 9.3RI 8.5CT 8.5NJ 5.9DE 5.9MD 10.7DC 14.7
6.9
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Age-adjusted rates of unintentional and undetermined drug poisoning mortality by urban-rural category and
year, US, 1999--2004
Age-adjusted rates of unintentional and undetermined drug poisoning mortality by urban-rural category and
year, US, 1999--2004
0
2
4
6
8
10
`99 `00 `01 `02 `03 `04
Ra
te p
er
10
0,0
00
Large CentralMetro
Large FringeMetro
Medium Metro
Small Metro
Micropolitan(non-metro)
NonCore (non-metro)
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Unintentional drug poisoning mortality rates and total sales of opioid analgesics in morphine
equivalents by year in the U.S.
Unintentional drug poisoning mortality rates and total sales of opioid analgesics in morphine
equivalents by year in the U.S.
0
1
2
3
4
5
6
7
8
'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06
Ra
te p
er
10
0,0
00
0
100
200
300
400
500
600
700
800
Mg
pe
r p
ers
on
Deaths/100,000 Opioid sales (mg/person)
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Sales of opioids by type, US, 1997 thru 3rd quarter, 2006
(DEA ARCOS data)
Sales of opioids by type, US, 1997 thru 3rd quarter, 2006
(DEA ARCOS data)
0
20
40
60
80
100
120
140
'97 '98 '99 '00 '01 '02 '03 '04 '05 '06
Year
Mg
/pers
on
oxycodone
hydrocodone
codeine
morphine
methadone
meperidine
fentanyl
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Estimated numbers of new nonmedical users in past year by type of drug, US, 1990-2003
(NSDUH 2002-2004)
Estimated numbers of new nonmedical users in past year by type of drug, US, 1990-2003
(NSDUH 2002-2004)
0
500
1000
1500
2000
2500
3000
90 91 92 93 94 95 96 97 98 99 00 01 02 03
Nu
mb
ers
in
1000's
Pain relievers
Tranquilizers
Cocaine
Stimulants
Heroin
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Prevalence of nonmedical use of prescription pain relievers in past year among persons aged 18 or older
by education level, US, 2002-2004
Prevalence of nonmedical use of prescription pain relievers in past year among persons aged 18 or older
by education level, US, 2002-2004
5.3
4.5
5.3
2.9
0
1
2
3
4
5
6
< HS HS Some college College grad
Perc
en
t w
ith
use
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Prevalence of nonmedical use and dependence/abuse of prescription pain relievers among persons aged 12
or older by period of use (NSDUH, 2005)
Prevalence of nonmedical use and dependence/abuse of prescription pain relievers among persons aged 12
or older by period of use (NSDUH, 2005)
13.4
4.9
1.90.6
0
2
4
6
8
10
12
14
16
Lifetime Past Year Past Month
Perc
en
t
Nonmedical use
Dependence/abuse
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Epidemiology of opioid use versus opioid abuseEpidemiology of opioid use versus opioid abuse
Although females are more likely to use opioids, males are more likely to abuse and overdose with them.
Although people over 65 are most likely to use opioids, people in 20s and 40s are most likely to abuse them.
Many people dying of prescription overdoses have a history of substance abuse.
Therefore, overdoses are more likely to represent abuse than overmedication.
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Lessons learnedLessons learned
Regulated prescription drugs taken mostly by mouth can produce a larger overdose epidemic than illicit drugs of uncertain strength taken intravenously, such as heroin.
Just as a drug that is efficacious in clinical trials may not be effective in the community, drugs “safe” in terms of abuse in controlled settings may be abused in the community.
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Some examples of how federal agencies are addressing the problem
Some examples of how federal agencies are addressing the problem
CDC started surveillance using existing data and is supporting some etiologic and evaluation work.
FDA placed “black boxes” on OxyContin (2001) and methadone (2006).
DEA stepped up efforts against drug diversion. DOJ provided funding for state prescription drug monitoring
programs through the Hal Rogers Program since FY2002. Congress passed the National All Schedules Prescription
Electronic Reporting Act (NASPER) in 2005 to fund additional prescription monitoring programs.
White House Office of National Drug Control Policy issued a Synthetic Drug Control Strategy in May, 2006.
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Thank youThank you
Contact information:– Len Paulozzi, MD, MPH– Division of Unintentional Injury Prevention,
National Center for Injury Prevention and Control, CDC
– 770-488-1394– [email protected]
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Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety 2006; 15:618-627.
Paulozzi LJ, Ballesteros MF, Stevens JA. Recent trends in mortality from unintentional injury in the United States. Journal of Safety Research 2006; 37:277-283.
Paulozzi LJ. Sharp rise in opioid analgesic involvement in drug abuse deaths in the American metropolitan areas. American Journal of Public Health 2006; 96:1755-1757.
Paulozzi LJ. Opioid analgesics and rates of fatal drug poisoning in the United States. American Journal of Preventive Medicine 2006; 31:506-511.
Kaplan J, Kraner J, Paulozzi LJ. Alcohol and other drug use among victims of motor-vehicle crashes -– West Virginia, 2004—2005. MMWR 2006;55:1293-1296.
Paulozzi LJ, Annest J. Unintentional poisoning deaths – United States, 1999-2004. MMWR 2007;56:93-96.
Paulozzi LJ. QuickStats: Percentage change in death rates for the leading causes of unintentional injury, by mechanism of injury --- United States, 1999—2004. MMWR 2007;56:309.
Paulozzi LJ, Annest J. US data show sharply rising drug-induced death rates. Injury Prevention 2007;13:130-132.
Paulozzi LJ. Overdoses are injuries too. Inj Prev 2007; 13:293-294. Colliver, JD, et al. (2006) Misuse of prescription drugs: Data from the 2002, 2003, and
2004 National Surveys on Drug Use and Health (DHHS Pub. No. SMA 06-4192). SAMHSA, National Survey of Drug Use and Health (2006) Results from the 2005
National Survey on Drug Use and Health: National Findings (OAS, NSDUH Series H-30, DHHS Pub. No. SMA 06-4194). Rockville, MD.