Download - Henry Spiller edited

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

[email protected]

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

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

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