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What Every Clinician Needs to Know
About Overdoses– poison center surveillance
April 10-12, 2012 Walt Disney World Swan Resort
Accepted Learning Objectives: 1. Describe the correlation between prescription drug abuse and the rate of opioid-related overdose deaths (accidental and deliberate) and hospital admissions. 2. State the value of Poison Control Center data in formulating strategies to reduce prescription drug diversion health care associated problems.
Disclosure Statement
• Henry Spiller has disclosed no relevant, real or apparent personal or professional financial relationships.
Henry A. Spiller, MS, D.ABAT, FAACT
Director, Kentucky Regional Poison Control Center
US Poison centers – brief overview
• Cover the entire US population – all 50 states and US territories (presently 57 Centers)
• Access from general public and healthcare professionals
• 24/7/365, staffed by physicians, nurses and pharmacist
• Real time database • Assess, triage and manage poison Patients
– Act as primary care for non-HCF patient – Act as toxicology consults for ED and inpatients
Examples of what is tracked in database.
• Demographic (age, gender, date, geographic location)
• Specific substances • Clinical effects – Cardiovascular, Dermal, Gastrointestinal,
Hemetological and Hepatic, Neurological, Respiratory, Ocular, Other (e.g. acidosis, hypoglycemia, fever, etc)
• Therapies - 68 specific therapies • Outcomes
1999 to 2011 opioid exposures - US
• Prescription Opioid exposures have increased more than 150%
• During same 13 year period all poisoning exposure increased 8.3%
• Opioids increased from 2% to 4% of poisoning exposures in US
Comparison of PC data with other national data sources
SOURCES: National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 1999-2010; Treatment Episode Data Set, 1999-2009
1999 to 2011 opioid exposures - Kentucky
• Prescription Opioid exposures have increased 164%
• During same 14 year period all poisoning exposure increased 2%
• Opioids increased from 2% of exposures to 5%
Geographic
Source - NPDS
Geographic
Source - NPDS
Geographic
Source - NPDS
Drug overdose death rates by state (2008)
Source – www.cdc.gov – national vital statistics system
Drug overdose death rates by state (2008)
Of the top 6 states identified in 2008 fatalities • 4 of 6 - New Mexico, West Virginia, Utah and Kentucky - were hot spots in Poison center data in 2001 and onward
Source – MMWR 2011;60:1487-1492
Geographic
Source – Kentucky Regional Poison Control center
Geographic
Source – Kentucky Regional Poison Control center
Geographic
Source – Kentucky Regional Poison Control center
Rx Opioid exposures in US 2001 – 2011
• Methadone increase – 181%
• Tramadol increase - 240%
• Morphine increase – 117%
• Hydrocodone increase - 101%
• Oxycodone increase 103%
• Codeine decrease 13%
Rx Opioid exposures in KY 2001 – 2011
• Tramadol increase - 346%
• Oxycodone increase 72%
• Hydrocodone increase - 34%
• Morphine increase – 51%
• Methadone decrease – 5%
• Codeine decrease 52%
Poison center as Sentinels Effect of Scheduling on Tramadol cases
Ref: Spiller HA, et al. Effect of scheduling tramadol as a controlled substance on poison center exposures to tramadol. Ann
Pharmacotherapy 2010:44:1016-1021
Age of Opioid overdoses reported to poison center
Impact on Healthcare facility utilization for Rx Opioids
Source – KY Regional Poison Control Center
Percentage of hospital utilization for poisonings involving Rx
opioids
Source – Kentucky Regional Poison Control Center
Rx drug misuse/abuse – not just opioids
Kentucky National data
Medical outcome from opioids by year
• Major effects increased by 743%
• Moderate effects increased by 397%
• Fatalities increased by 172% Source – Kentucky Regional Poison Control Center
Public health roles of a Poison Center
• Assess, triage and manage poison Patients – Act as primary care for non-HCF patient – Act as toxicology consults for ED and inpatients
• Toxico- and Public heath surveillance (real-time)
• Public and professional Education • Research data on product safety and
toxicity
Use of Poison Centers in formulating strategies
• Real Time monitor of changes – Changes in specific drugs – Changes in demographics – Geographic changes
• Education – Poison centers have trained and board
certified toxicologists and Specialists – Existing outreach education efforts to
healthcare professionals and public