Unintentional Drug Poisoning Deaths, Michigan Residents, 1999-2009

Su Min Oh, PhD

Michigan Department of Community HealthBureau of Substance Abuse and Addiction Services

Background – United States

• In 2009, drug poisonings became the leading cause of injury death in the United States, surpassing motor vehicle crashes

• Majority of drug poisonings are unintentional

• Increase in poisonings largely due to opioid analgesics

Background - United States (cont.)

• From 1999 to 2002, the number of unintentional drug poisoning deaths involving

• Opioid analgesics - increased 91%• Cocaine - increased 23% • Heroin – increased 12 %

• In 2007, number of overdose deaths involving opioid analgesic exceeded overdose deaths with heroin and cocaine combined

Background - Michigan

• Unintentional poisonings became the leading cause of injury death in 2009

• Increase in prescriptions for opioid analgesics

Purpose of Study

Examine unintentional drug poisoning deaths involving opioid analgesics, heroin, and cocaine between 1999 and 2009 in Michigan

Methods

• Data used from 1999-2009 Michigan death certificate files

• Limited to Michigan residents

• Analysis limited to deaths with an underlying cause of death as unintentional drug poisoning• ICD-10 code of X40-X44

Methods (cont.)

• Types of drugs involved were identified using the following ICD-10 codes• Opioid analgesics (T40.2-T40.4)• Heroin (T40.1)• Cocaine (T40.5)• Other specified (T36-T50.8)• Unspecified (T50.9)

Methods (cont.)

• Rates age-adjusted according to the 2000 U.S. Census population and calculated per 100,000 population

• Differences in unintentional drug poisoning death rates were examined by descriptive factors

Number of Unintentional Drug Poisoning Deaths, Michigan, 1999-2009

Year

Num

ber o

f dea

ths

Age-Adjusted Unintentional Drug Poisoning Death Rates by Gender,

Michigan,1999–2009

Rate

per

100

,000

pop

ulati

on

Year

Male

Female

Total

Age-Adjusted Unintentional Drug Poisoning Death Rates by Race,

Michigan, 1999–2009

Rate

per

100

,000

pop

ulati

on

Year

Black

White

Unintentional Drug Poisoning Death Rates by

Age Groups, Michigan, 1999–2009

Rate

per

100

,000

pop

ulati

on

Year

15-24 years

65+ years

55-64 years

45 – 54 years

35– 44 years

25– 34 years

Unintentional Drug Poisoning Death Rates by

Major Drug Type, Michigan, 1999–2009

Unspecified

Opioid analgesic involvement

Other specified

Heroin only

Cocaine and heroin

Cocaine only

Crud

e Ra

te p

er 1

00,0

00 p

opul

ation

Year

Unintentional Drug Poisoning Death Rates involving Opioid Analgesics, Michigan, 1999–

2009

Crud

e ra

te p

er 1

00,0

00 p

opul

ation

Year

Only opioid analgesic

With cocaineWith heroin

Heroin & cocaine

Total

Michigan’s 2005 Population by Preparedness Regions

Detroit

Detroit

Unintentional Drug Poisoning Death Rates by Region, Michigan, 1999

Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

Unintentional Drug Poisoning Death Rates by Region, Michigan, 2009

Discussion

• Unintentional drug poisoning death rates increased over the past decade in Michigan

• Death rates due to opioid analgesics increased more than heroin and cocaine

• Increase in deaths closely paralleled the increased number of Rx opioid analgesics statewide

Limitations

• Utilization of vital statistics data • Validity and completeness of data

• Toxicology testing varies by region/county

• Limited access to Michigan’s Prescription Monitoring System

Michigan Initiatives

• Increased surveillance by Task Force formed during fentanyl outbreak

• RxOTC Drug Abuse Workgroup established in Feb. 2011• Broaden statewide media message• Broaden education and use of Screening, Brief

Intervention, Referral, and Treatment (SBIRT)• Increase access and use of PMP

Recommendations

• Increased awareness • Health care providers• Patients and parents

• Multifaceted strategies• Safe storage & disposal of drugs• At-risk populations

Acknowledgements

Michigan Department of Community HealthBureau of Disease Control, Prevention and Epidemiology• Kim Hekman, MPH• Lorraine Cameron, MPH, PhD

ReferencesWarner, M. Updates to Drug Poisoning Data Brief 2009 mortality data. Emerging Opioid Overdose Conference Call. March 2012.Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. Hyattsville, MD: National Center for Health Statistics; 2011.Centers for Disease Control and Prevention. Unintentional drug poisoning in the United States. CDC Issue Brief. July 2010. Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. Sep 2006; 15(9):618-627.Michigan 2009 Death Certificate Registry, Michigan Department of Community Health.Michigan Epidemiological Profile, Michigan Department of Community Health. March 2012.

Contact Information

Su Min Oh: ohs@michigan.gov

Bureau of Substance Abuse and Addiction Services:www.michigan.gov/mdch-bsaas

Substance Abuse Epidemiology:www.michigan.gov/substanceabuseepi