Admissions to Substance Abuse Treatment for the Admissions to Substance Abuse Treatment for the Abuse of Opioid Analgesics:Abuse of Opioid Analgesics:

Findings from theFindings from the Treatment Episode Data SetTreatment Episode Data Set

Deborah TrunzoOffice of Applied Studies

Substance Abuse and Mental Health Services Administration

November 13, 2008

Treatment Episode Data Set (TEDS)

• Client-level information on treatment admissions

• Collected by States and reported to SAMHSA

• Primarily from facilities receiving public funds

• Estimated coverage – 80%

• 1.8 million admissions annually

2

TEDS Data Elements

• Demographic variables

• Drug use history – top 3 substances of abuse at admission– route of administration– frequency of use– age at first use

• Treatment variables

3

Limitations of TEDS

• Drugs of abuse reported in “generic” categories, not specific brand names or formulations

• All States report on “opiates other than heroin” as a group

• Only 16 States report on specific opioid analgesics

–

4

Treatment Admissions by Primary Substance: 2006

Alcohol39%

Marijuana16%

Cocaine14%

Heroin14%

Stimulants9%

Opioid analgesics*

4%

Other4%

* Includes admissions where primary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

N = 1.8 million

5

Treatment Admissions Involving Opioid Analgesics1

1992-2006

0

20

40

60

80

100

120

140

1992 1994 1996 1998 2000 2002 2004 2006

No

. o

f ad

mis

sio

ns (

000s)

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

OxyContin introduced

6

Percent Increase in Admissions for Heroin and Opioid Analgesics1: 1997-2006

12% 4%

367%

295%

0

50

100

150

200

250

300

350

400

Totaladmissions

Heroin (primary) Opioidanalgesics

(primary)

Opioidanalgesics

(any)

% i

ncre

ase

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

7

Admissions Involving Specific Opioid Analgesics1: 2006

Oxycodone 15,300

Codeine 1,200

Hydrocodone 900

Hydromorphone 800

Propoxyphene 162

Meperidine 80

Pentazocine 30

Tramadol 50

Other opiates or synthetics 33,100

1Data submitted by 16 States: AL, HI, ID, KY, MD, ME, MO, MS, ND, NH, NJ, NM, NV, NY, OH, SD

8

States Reporting Specific Opioid Analgesics: 2006

9

Percent Increase in Admissions for Specific Opioid Analgesics1:2000-2006

137% 121%19%

1,513%

67%

-60%

168%

-200

0

200

400

600

800

1,000

1,200

1,400

1,600

All op

ioid

anal

gesic

s

Codeine

Hydro

morp

hone

Mep

erid

ine

Oxyco

done

Penta

zoci

ne

Propoxy

phene

% i

nc

rea

se

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone. Analysis restricted to 13 States that reported detailed drug codes for 2000 and 2006.

10

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

Proportion of Opioid Analgesic1 Admissions by State: 2006

8-9%

< 5%

5% No data

6-7% > 16%

11

Opioid Analgesic1 Treatment Admission Rates by Urbanization: 2000 and 2006

23

1623

30 28 26

55

31

58

68

7671

0

10

20

30

40

50

60

70

80

90

Total US LargeMSA, inCentral

City

LargeMSA, Notin Central

City

Small MSA Non-MSA,Small City

Non-MSA,No City

Pe

r 1

00

,00

0 a

ge

12

& o

ve

r

2000 2006

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

MSA = Metropolitan Statistical Area12

Percent of Primary and Secondary Opioid Analgesic Admissions Using Other Substances: 2006

37

2220

17

107

59

29

13 15

3

29

6 5

0

0

40

NoneAlcohol

Marijuana

Cocaine

Tranquillizers

Heroin

Stimulants

Other/unknown

Perc

ent

Opiate Analgesics Primary Opiate Analgesics Secondary

13

Treatment Admissions Involving Opioid Analgesics1 by Age and Route of Administration: 2006

0

1000

2000

3000

4000

10 15 20 25 30 35 40 45 50 55 60

No

. o

f a

dm

iss

ion

s

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

Age

Oral

Inhaled

InjectedOther

14

Treatment Admissions Involving Oxycodone1 by Age and Route of Administration: 2006

0

50

100

150

200

250

300

350

400

450

10 15 20 25 30 35 40 45 50 55 60

No

. o

f ad

mis

sio

ns

1 Includes admissions where primary, secondary, or tertiary substance was reported as Oxycodone.

Age

Oral

Injected

Inhaled

Other

15

Characteristics of Opioid Analgesic1 Admissions1997 and 2006

1997 2006

Male 56% 57%

White (non-Hispanic) 83% 88%

Less than 20 years of age

20 to 29 years

30 years or more

5%

16%

79%

11%

37%

52%

New users (3 yrs use or less) 20% 28%

Oral

Injected

Inhaled

78%

14%

3%

74%

10%

13%

1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone.

16

Admissions for Primary Opioid Analgesics1 by Age of First Use: 1997-2006

0%

25%

50%

75%

100%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

% o

f adm

issi

ons

17 and under

18 - 24

25 - 34

35 - 44

55+

45 - 54

* Includes admissions where primary substance was reported as Other

opiates/synthetics. Excludes admissions for non-prescription use of methadone. 17