The Opioid Overdose Epidemic Epidemiology and Trends Christopher M. - - PowerPoint PPT Presentation

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The Opioid Overdose Epidemic

Epidemiology and Trends

Christopher M. Jones, PharmD, MPH

CDR, US Public Health Service Centers for Disease Control and Prevention

National Center for Injury Prevention and Control Division of Unintentional Injury Prevention

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Patients with mental health or substance use disorders are at increased risk for nonmedical use and overdose from prescription opioids…appropriate screening, identification, and clinical management by health care providers are essential parts of both behavioral health and chronic pain management and overdose prevention. Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention February 20, 2013

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Trends and Epidemiology

 Nonmedical use  Relationship between opioids and heroin  Emergency department visits  Dependence and abuse  Overdose deaths  Economic costs and additional public health

consequences

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TRENDS IN USE

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Past year nonmedical use of opioid analgesics and heroin have increased in the US

SAMHSA NSDUH 2012 404 669 10,992 12,489

2,000 4,000 6,000 8,000 10,000 12,000 14,000 2002 2012 Number of users among persons ≥ 12 years old (numbers in thousands) Year Heroin Opioid analgesics

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Chronic nonmedical use of opioid analgesics has increased more than less frequent use

Jones CM. Frequency of prescription pain releiver nonmedical use, 2002-2003 and 2009-2010. Arch Intern Med. 2012 Sep 10;172(16):1265-7;

5 10 15 20 25 30 35 1-29 Days Past Year Nonmedical Use 30-99 Days Past Year Nonmedical Use 100-199 Days Past Year Nonmedical Use 200-365 Days Past Year Nonmedical Use Rate per 1,000 population ≥ 12 years old Frequency of Past Year Nonmedical Use 2002-2003 2009-2010

75% Increase

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Increase in heroin use has occurred among people who were past year nonmedical users

• f opioid analgesics

Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002– 2004 and 2008–2010. Drug Alcohol Depend. (2013), http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007 379 176 58 46 99 588 171 115 100 202

100 200 300 400 500 600 700 Overall Past Year Heroin Use No Past Year NMU Opioids 1-29 Days Past Year NMU Opioids 30-99 Days Past Year NMU Opioids 100-365 Days Past Year NMU Opioids Number of past year users among persons ≥12 years old (numbers in thousands) 2002-2004 2008-2010

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Frequent nonmedical users of opioids more likely to engage in risky use behaviors, US, 2008-2010.

Characteristic 1-29 Days of PYNMU of Opioid Pain Relievers 30-99 Days of PYNMU of Opioid Pain Relievers 100-365 Days of PYNMU

• f Opioid Pain Relievers

aOR (95% CI) aOR (95% CI) aOR (95% CI) Past Year Heroin Use referent 2.8 (1.7-4.5) 6.4 (3.7-11.1) Ever Inject Heroin referent 1.6 (0.9-2.9) 4.3 (2.5-7.3) Ever Inject Opioid Pain Relievers referent 3.8 (1.9-7.8) 13.3 (7.7-23.0) Past Year Heroin Abuse or Dependence referent 3.2 (1.7-6.1) 7.8 (4.7-12.8) Past Year Opioid Pain Reliever Abuse or Dependence referent 2.9 (2.3-3.8) 8.9 (7.1-11.3) Heroin Fairly or Very Easy to Obtain referent 1.4 (1.1-1.7) 2.1 (1.8-2.6)

Abbreviations: PYNMU, past year nonmedical use; aOR, adjusted Odds Ratio; 95% CI, 95% Confidence Interval

1Odds ratio adjusted for sex, age, race/ethnicity, total family income, and county type

Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002– 2004 and 2008–2010. Drug Alcohol Depend. (2013), http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007

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18-25 year olds have highest rates of chronic nonmedical use of opioid analgesics and heroin use

Jones CM. Frequency of prescription pain releiver nonmedical use, 2002-2003 and 2009-2010. Arch Intern Med. 2012 Sep 10;172(16):1265-7; SAMHSA NSDUH Public Use File 2011

1 2 3 4 5 6 7 8 12-17 18-25 26-34 35-49 50+ Rate per 1,000 population Age Group Past year chronic nonmedical use Past year heroin use

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EMERGENCY DEPARTMENT VISITS

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Increasing number of ED visits due to nonmedical use of opioid analgesics and use

• f heroin

SAMHSA DAWN ED Public Use Files 2004-2011

50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 2004 2005 2006 2007 2008 2009 2010 2011 Number of ED visits Year Opioid analgesics Heroin

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18-34 year olds have highest rates of ED visits due to nonmedical use of opioid analgesics and heroin use

SAMHSA DAWN ED Public Use Files 2011

50 100 150 200 250 12-17 18-24 25-34 35-44 45-54 55-64 65+ Rate per 100,000 population Age Group Opioid analgesics Heroin

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DEPENDENCE AND ABUSE

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Significant increases in number of people classified with and receiving treatment for dependence or abuse

• f opioid analgesics and heroin

SAMHSA NSDUH 2012 1,509 214 360 277 2,056 467 973 450

500 1,000 1,500 2,000 2,500 Abuse or dependence -

• pioid analgesics

Abuse or dependence - heroin Treatment - opioid analgesics Treatment - heroin Number of persons in the US 12 years and older (in thousands) 2002 2012

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18-25 year olds have highest rate of dependence or abuse of opioid analgesics and heroin

SAMHSA NSDUH Public Use Files 2008-2011

2 4 6 8 10 12 14 16 18 20 12-17 18-25 26-34 35-49 50-64 65+ Rate per 1,000 population Age Group Opioid Analgesic Heroin

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OVERDOSE DEATHS

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Drug overdose death rates continue to increase; unprecedented death rate

NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data 5 10 15 20 25 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Deaths per 100,000 population Year

Motor Vehicle Traffic Drug Poisoning (Overdose)

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11 years of increases in opioid analgesic

• verdose deaths; heroin deaths increasing in

recent years

CDC NCHS/NVSS Mutliple Cause of Death File 1999-2010

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number of deaths Year Opioid analgesics Heroin

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Opioid analgesics #1 drug involved in

• verdose deaths; heroin #5

Jones CM et al Pharmaceutical overdose deaths, United States, 2010. JAMA 2013 and CDC/NCHS NVSS MCOD 2010 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000

Ddeaths Drug Class

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Opioid analgesic death rates highest in 45-54; heroin highest in 25-34

CDC NCHS/NVSS Mutliple Cause of Death File 2010

2 4 6 8 10 12 12-17 18-24 25-34 35-44 45-54 55-64 65+ Deaths per 100,000 population Age Group Opioid analgesics Heroin

Additional risk factors

 Demographics

• Men
• Whites
• American Indians/Alaska Natives

 Socioeconomics and Geography

• Medicaid
• Rural vs urban

ECONOMIC COSTS AND ADDITIONAL PUBLIC HEALTH CONSEQUENCES

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Economic costs and additional public health consequences

 $72.5 Billion in healthcare costs  People who abuse opioids

generate, on average, annual direct health care costs 8.7 times higher than nonabusers

 Increase in hepatitis C  Other infectious disease

complications

 Neonatal abstinence syndrome

Coalition Against Insurance Fraud. Prescription for peril: how insurance fraud finances theft and abuse of addictive prescription drugs. Washington, DC: Coalition Against Insurance Fraud; 2007 White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005 Klevens, R.M., Hu, D.J., Jiles, R., Holmberg, S.D., 2012. Evolving epidemiology of hepatitis C virus in the United States. Clin. Infect. Dis. 55 (Suppl.), S3–S9. Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;9;307(18):1934-1940.

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 Of 75 patients who underwent AAROD at a NYC clinic

during January–September 2012, 2 died and 5 others experienced serious adverse events requiring hospitalization.

 To reduce morbidity and mortality associated with opioid

dependence, evidence-based approaches (e.g., medication-assisted treatment) should be used for its management.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a1.htm?s_cid=mm6238a1_e

Conclusions

 Abuse of opioids has increased over the last decade  Overdose deaths from these drugs exact significant

health, economic, and social consequences

 People with substance use disorders are at high risk

for overdose death

 This is a complex problem with multiple drivers

which requires a multi-pronged response strategy

 Expanding access to medication assisted treatment

is an essential component of this strategy

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Thank You

Christopher M. Jones - - cjones@cdc.gov

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.