Apr 17, 2014 - Examine statewide data and produce materials to raise p .... DEATH RATE BY AGE GROUP, OVER TIME, OHIO ...
Ohio Department of Health
OHIO’S PRESCRIPTION DRUG OVERDOSE EPIDEMIC:: EPIDEMIC
APRIL 17, 2014
EPIDEMIOLOGY, CONTRIBUTING FACTORS AND ONGOING PREVENTION EFFORTS
PRESENTATION OVERVIEW • Epidemiology of drug overdose deaths in Ohio Ohi • Description of how this problem occurred in Ohio • Description of Ohio’s public health response • Lessons learned • Opportunities to become involved
ODH Violence and Injury Prevention Program
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• Questions and Answers
UPDATED STATE AND COUNTY DATA Examine statewide data and p produce materials to raise awareness about this issue: • Web page: http://www.healthyohioprogram.org/vipp/data/rxdata.aspx
ODH Violence and Injury Prevention Program
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• State and County level data factsheets • Presentations • Resources
NATIONAL DATA Number and Rate per 100,000 of Drug Overdose Deaths (all manners), U.S., 1999 – 2010* 35,000 30,000
, 36,450 450 37,004 36,010 36 010 36
14
34,425
12
Death Rate 29,813
Number
27,424 25,785 23,518
25,000 20,000
38,329
19,394
105 people died each day on average in the U.S. from drug overdose in 2010.
16 849 17,415 16,849
10 8 6
15,000 10,000
In 2010, more than 38,000 people died from drug overdoses in the U.S.,, and most of these deaths were caused by prescription drugs.
Rate e per 100,0 000
Number of D Deaths
40,000
4
5,000
2
0
0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 *Source: CDC, WONDER Compressed Mortality File, NCHS
ODH Violence and Injury Prevention Program
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Year
NATIONAL DATA:
All Poisoning g Deaths,, Drug g Poisoning g Deaths and Drug Poisonings involving Opioids, 1999 – 2010
38, 329
*Source: CDC, WONDER Compressed Mortality File, NCHS
5
16,651
Sources: 1SAMHSA Treatment Episode Data Set (TEDS); 2Drug Abuse Warning Network (DAWN); 3National Survey of Drug Use in Households (NSDUH)
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NATIONAL DATA: PUBLIC HEALTH IMPACT OF OPIOID OVERDOSE
DRUG OVERDOSE DEATH RATES (ALL MANNER) PER 100,000 (2010), UNITED STATES
11
7
Source: CDC NCHS ODH Violence and Injury Prevention Program
DEATH RATES PER 100,000 FOR DRUG POISONING (ALL MANNER), BY YEAR, OHIO VS. US, 1999-2012 20 18 16 Ratte Per 100,00 00
14 12 10 8 6 4 2
US Rate Ohio Rate
0
1Source:
ODH Office of Vital Statistics
ODH Violence and Injury Prevention Program
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Year
FATAL DRUG OVERDOSE BY INTENT, OHIO, 2009 2009-12 12 Assault, 11 440% from 1999-2012.
~5 deaths per day
1500
14.0 12.0 10.0
1000
8.0 6.0
500
Death Rate per 100,000
~1 per day
ODH Office of Vital Statistics,
2.0 0.0
Year 1Source:
4.0
ODH Violence and Injury Prevention Program
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0
Number of Deaths
Rate per 100,000 pe R ersons
Num mber of Unintentional Drug Overdose Death hs
2000
EPIDEMICS OF UNINTENTIONAL DRUG OVERDOSES IN OHIO, 1979-20121,2,3 2000
Prescription drugs led to a larger overdose epidemic than illi it drugs illicit d ever have. h
1500
Heroin & Rx opioids Prescription Pain Medication (opioids)
1000
Crack Cocaine
500 Heroin
Source: 1WONDER (NCHS Compressed Mortality File, 1979‐1998 & 1999‐2005) 22006‐2011 ODH Office of Vital Statistics, 3Change from ICD‐9 to ICD‐10 coding in 1999 (caution in comparing before and after 1998 and 1999)
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0
PRESCRIPTION DRUGS OVERDOSE TYPE OF DRUGS AND REASONS FOR USE
Types of drugs • D Drugs that depress breathing th t d b thi • Opioid analgesics – pain relievers • Sedative/hypnotics Sedative/hypnotics • Usually multiple drugs involved • Often combined with illicit drugs g • Original Original use of drug might have been their use of drug might have been their intended purpose: relief of pain or anxiety • Development of tolerance Development of tolerance • Escalated use for “high” ODH Violence and Injury Prevention Program
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Reason for use
Unintentional drug overdose deaths of Ohio residents by specific drug(s) involved, by year, 2000-20121,2 Still more deaths from prescription opioids than from cocaine, heroin, and marijuana combined. 900
Number o of Deaths s
800
cocaine
700
benzodiazepines
600
heroin
500 400
prescription opioids
300 200 100 -
ODH Violence and Injury Prevention Program
2Multiple
substances are usually involved in one death.
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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
PROPORTION OF ALL UNINTENTIONAL DRUG OVERDOSE DEATHS INVOLVING SELECTED , 1Source: ODH Office of Vital Statistics DRUGS OHIO, DRUGS, OHIO 20121,2 substances are usually involved in one death.
M lti l d Multiple drug iinvolvement* l t*
53 1% 53.1% 66.5%
all opioids** prescription opioids
36.4%
heroin
35.5%
methadone
6.4%
benzodiazepines
16 2% 16.2%
cocaine
17.0%
alcohol hallucinogens barbiturates
14.7% 1.6% 0.3%
* Includes only deaths where the number of substances was specified; number unspecified in 20% of 2012 overdose deaths. **Includes involvement of prescription opioids and/or heroin. ODH Violence and Injury Prevention Program ***No specific drug was identified
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2Multiple
ODH Violence and Injury Prevention Program
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USE OF MULTIPLE DRUGS
PROPORTION OF ALL UNINTENTIONAL DRUG OVERDOSE DEATHS INVOLVING SELECTED , 1Source: ODH Office of Vital Statistics DRUGS OHIO, DRUGS, OHIO 20121,2 substances are usually involved in one death.
p drug g involvement* Multiple
53.1%
all opioids**
66.5%
prescription opioids
36.4%
h i heroin
35 5% 35.5%
methadone
6.4%
benzodiazepines
16.2%
cocaine
17.0%
alcohol hallucinogens barbiturates other/unspecified drugs only***
14.7% 1 6% 1.6% 0.3% 20 %
* Includes only deaths where the number of substances was specified; number unspecified in 20% of 2012 overdose deaths. **Includes involvement of prescription opioids and/or heroin. ***No specific drug was identified
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2Multiple
Number of Drugs involved in Drug Overdose Deaths,, Ohio Residents,, 2012 ((N=1,914) , ) •
In 20% of deaths, the specific number of drugs was unknown.
•
Multiple drugs are involved in most overdoses.
•
Most (42%) involved 2-5 drugs.
•
36% had only 1 drug listed on the DC; 64% had more than 1 6-8 Drugs, 44
3-5 Drugs 381
1 Drug, 680
1Source:
ODH Office of Vital Statistics
ODH Violence and Injury Prevention Program
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2 Drugs, 420
OHIO’S OPIOID EPIDEMIC
ODH Violence and Injury Prevention Program
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WHO IS IMPACTED?
Average, age-adjusted unintentional drug overdose death rate per 100,000, by county, Ohio residents, 2007-20121,2
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Ohio Average Age‐Adjusted Rate ‘07‐12: 13.9 per 100,000 ODH Violence and Injury Prevention Program
AVERAGE UNINTENTIONAL DRUG OVERDOSE DEATH RATE BY AGE GROUP, OVER TIME, OHIO RESIDENTS 2012 RESIDENTS, 2002 2002-2012 35
2002-05 2005-07 2007-08 2009-12
Rate e per 100,,000
30 25 20 15 10 5 0 15-24
25-34
35-44 45-54 Age group
55-64
Source: Ohio Department of Health, Office of Vital Statistics ODH Violence and Injury Prevention Program
65-74
75+
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0-14
Average Annual Unintentional Fatal Overdose Rate1 by Sex, Age Group, Ohio, 2009-12 40.0 Females 40%
35.0 Males 60%
Rate p per 100,000 0
30.0 25.0 20.0
Male Female
15 0 15.0 10.0 5.0 0.0
