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

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 1

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 2

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 3

TRENDS IN USE 4

Past year nonmedical use of opioid analgesics and heroin have increased in the US 14,000 Number of users among persons ≥ 12 years old 12,489 12,000 10,992 (numbers in thousands) 10,000 8,000 Heroin 6,000 Opioid analgesics 4,000 2,000 669 404 0 2002 2012 Year SAMHSA NSDUH 2012 5

Chronic nonmedical use of opioid analgesics has increased more than less frequent use 35 Rate per 1,000 population ≥ 12 years old 30 25 20 75% 2002-2003 15 Increase 2009-2010 10 5 0 1-29 Days Past Year 30-99 Days Past Year 100-199 Days Past Year 200-365 Days Past Year Nonmedical Use Nonmedical Use Nonmedical Use Nonmedical Use Frequency of Past Year Nonmedical 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; 6

Increase in heroin use has occurred among people who were past year nonmedical users of opioid analgesics 700 Number of past year users among persons ≥12 588 600 years old (numbers in thousands) 500 379 400 2002-2004 300 2008-2010 202 200 176 171 115 100 99 100 58 46 0 Overall Past Year No Past Year NMU 1-29 Days Past 30-99 Days Past 100-365 Days Past Heroin Use Opioids Year NMU Opioids Year NMU Opioids Year NMU Opioids 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 7

Frequent nonmedical users of opioids more likely to engage in risky use behaviors, US, 2008-2010. 1-29 Days of PYNMU of 30-99 Days of PYNMU of 100-365 Days of PYNMU Opioid Pain Relievers Opioid Pain Relievers of Opioid Pain Relievers Characteristic 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 referent 3.8 (1.9-7.8) 13.3 (7.7-23.0) Relievers Past Year Heroin Abuse or referent 3.2 (1.7-6.1) 7.8 (4.7-12.8) Dependence Past Year Opioid Pain Reliever referent 2.9 (2.3-3.8) 8.9 (7.1-11.3) Abuse or Dependence Heroin Fairly or Very Easy to referent 1.4 (1.1-1.7) 2.1 (1.8-2.6) Obtain Abbreviations: PYNMU, past year nonmedical use; aOR, adjusted Odds Ratio; 95% CI, 95% Confidence Interval 1 Odds 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 8

18-25 year olds have highest rates of chronic nonmedical use of opioid analgesics and heroin use Past year chronic nonmedical use Past year heroin use 8 7 6 Rate per 1,000 population 5 4 3 2 1 0 12-17 18-25 26-34 35-49 50+ Age Group 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 9

EMERGENCY DEPARTMENT VISITS 10

Increasing number of ED visits due to nonmedical use of opioid analgesics and use of heroin 400,000 350,000 300,000 Number of ED visits 250,000 200,000 Opioid analgesics Heroin 150,000 100,000 50,000 0 2004 2005 2006 2007 2008 2009 2010 2011 Year SAMHSA DAWN ED Public Use Files 2004-2011 11

18-34 year olds have highest rates of ED visits due to nonmedical use of opioid analgesics and heroin use Opioid analgesics Heroin 250 200 Rate per 100,000 population 150 100 50 0 12-17 18-24 25-34 35-44 45-54 55-64 65+ Age Group SAMHSA DAWN ED Public Use Files 2011 12

DEPENDENCE AND ABUSE 13

Significant increases in number of people classified with and receiving treatment for dependence or abuse of opioid analgesics and heroin 2,500 Number of persons in the US 12 years and older 2,056 2,000 (in thousands) 1,509 1,500 2002 973 2012 1,000 467 450 500 360 277 214 0 Abuse or dependence - Abuse or dependence - Treatment - opioid Treatment - heroin opioid analgesics heroin analgesics SAMHSA NSDUH 2012 14

18-25 year olds have highest rate of dependence or abuse of opioid analgesics and heroin Opioid Analgesic Heroin 20 18 16 14 Rate per 1,000 population 12 10 8 6 4 2 0 12-17 18-25 26-34 35-49 50-64 65+ Age Group SAMHSA NSDUH Public Use Files 2008-2011 15

OVERDOSE DEATHS 16

Drug overdose death rates continue to increase; unprecedented death rate Motor Vehicle Traffic Drug Poisoning (Overdose) 25 20 Deaths per 100,000 population 15 10 5 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data 17

11 years of increases in opioid analgesic overdose deaths; heroin deaths increasing in recent years 18,000 16,000 14,000 12,000 Number of deaths 10,000 Opioid analgesics 8,000 Heroin 6,000 4,000 2,000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year CDC NCHS/NVSS Mutliple Cause of Death File 1999-2010 18

Opioid analgesics #1 drug involved in overdose deaths; heroin #5 18,000 16,000 14,000 12,000 Ddeaths 10,000 8,000 6,000 4,000 2,000 0 Drug Class Jones CM et al Pharmaceutical overdose deaths, United States, 2010. JAMA 2013 and CDC/NCHS NVSS MCOD 2010 19

Opioid analgesic death rates highest in 45-54; heroin highest in 25-34 Opioid analgesics Heroin 12 10 Deaths per 100,000 population 8 6 4 2 0 12-17 18-24 25-34 35-44 45-54 55-64 65+ Age Group CDC NCHS/NVSS Mutliple Cause of Death File 2010 20

Additional risk factors  Demographics  Men  Whites  American Indians/Alaska Natives  Socioeconomics and Geography  Medicaid  Rural vs urban

ECONOMIC COSTS AND ADDITIONAL PUBLIC HEALTH CONSEQUENCES

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. 23

 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 24

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

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. 26