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What Every Clinician Needs to Know About Overdosespoison center surveillance April 10-12, 2012 Walt Disney World Swan Resort

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What Every Clinician Needs to Know About OverdosesNational Rx Drug Abuse Summit 4-10-12

Transcript of Henry Spiller edited

  • 1. What Every Clinician Needs to Know About Overdoses poison center surveillance April 10-12, 2012Walt Disney World Swan Resort
  • 2. Accepted Learning Objectives:1. Describe the correlation betweenprescription drug abuse and the rate ofopioid-related overdose deaths (accidentaland deliberate) and hospital admissions.2. State the value of Poison Control Centerdata in formulating strategies to reduceprescription drug diversion health careassociated problems.
  • 3. 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 [email protected]
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. Comparison of PC data with other national data sourcesSOURCES: National Vital Statistics System, 1999-2008; Automation of Reports andConsolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA),1999-2010; Treatment Episode Data Set, 1999-2009
  • 8. 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%
  • 9. GeographicSource - NPDS
  • 10. GeographicSource - NPDS
  • 11. GeographicSource - NPDS
  • 12. Drug overdose death rates by state (2008) Source www.cdc.gov national vital statistics system
  • 13. Drug overdose deathrates by state (2008)Of the top 6 states identified in2008 fatalities4 of 6 - New Mexico, WestVirginia, Utah and Kentucky -were hot spots in Poison centerdata in 2001 and onward Source MMWR 2011;60:1487-1492
  • 14. GeographicSource Kentucky Regional Poison Control center
  • 15. GeographicSource Kentucky Regional Poison Control center
  • 16. GeographicSource Kentucky Regional Poison Control center
  • 17. 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%
  • 18. 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%
  • 19. Poison center as Sentinels Effect of Scheduling on Tramadol casesRef: Spiller HA, et al. Effect of scheduling tramadol as a controlled substance on poison center exposures to tramadol. Ann Pharmacotherapy 2010:44:1016-1021
  • 20. Age of Opioid overdoses reported to poison center
  • 21. Impact on Healthcare facility utilization for Rx OpioidsSource KY Regional Poison Control Center
  • 22. Percentage of hospital utilization for poisonings involving Rx opioids Source Kentucky Regional Poison Control Center
  • 23. Rx drug misuse/abuse not just opioidsKentucky National data
  • 24. 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
  • 25. 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
  • 26. 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