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Centers for Disease Control and Prevention National Center for Injury Prevention and Control

Centers for Disease Control and Prevention National Center for Injury Prevention and Control

The Epidemiology of Unintentional Drug Poisoning in the United StatesThe Epidemiology of Unintentional

Drug Poisoning in the United States

Len Paulozzi, MD, MPH

SEOW Audio ConferenceDecember 12, 2007

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Unintentional drug poisoning mortality rates, US, 1970-2004

Unintentional drug poisoning mortality rates, US, 1970-2004

0

1

2

3

4

5

6

7

8

'70

'72

'74

'76

'78

'80

'82

'84

'86

'88

'90

'92

'94

'96

'98

'00

'02

'04

Year

Cru

de

rate

per

100

,000

Heroin

Crack cocaine

Prescription drugs

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MethodologyMethodology

Mortality counts are based on death certificate information only.

Coroners and medical examiners determine person’s intent and drug(s) responsible.

“Unintentional” poisoning deaths include “accidental” ingestion, overmedication, and overdoses of drugs used nonmedically (“drug overdoses”).

Unless otherwise indicated, suicides and deaths of undetermined intent are not included.

Most mortality statistics can be generated for single states using WISQARS or WONDER

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Unintentional drug poisoning mortality rates by major drug type, US, 1990-1998

Unintentional drug poisoning mortality rates by major drug type, US, 1990-1998

0

0.2

0.4

0.6

0.8

1

1.2

'90 '91 '92 '93 '94 '95 '96 '97 '98

Rate

per

100,0

00 p

ers

on

s

opiates

other

unspecified

cocaine

psychotropic

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Unintentional drug poisoning mortality rates by major drug type, US, 1999-2004

Unintentional drug poisoning mortality rates by major drug type, US, 1999-2004

0

0.5

1

1.5

2

2.5

3

3.5

'99 '00 '01 '02 '03 '04

Rate

per

100,0

00 p

ers

on

s

narcotics (opiates &cocaine)

other & unspec

psychotropics

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Unintentional deaths from “narcotics” and “other/unspecified drug” by major type of drug,

US, 1999-2004

Unintentional deaths from “narcotics” and “other/unspecified drug” by major type of drug,

US, 1999-2004

0

1000

2000

3000

4000

5000

6000

7000

8000

'99 '00 '01 '02 '03 '04

Nu

mb

er

of

death

s

narcotic analgesic

cocaine

heroin

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Unintentional deaths from “narcotics” and “other/unspecified drugs” by type of opioid analgesic,

US, 1999-2004

Unintentional deaths from “narcotics” and “other/unspecified drugs” by type of opioid analgesic,

US, 1999-2004

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

'99 '00 '01 '02 '03 '04

Nu

mb

er

of

death

s

opium derived

methadone

other syntheticnarcotic

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Unintentional drug poisoning mortality rates by sex and age group, US, 2003-2004

Unintentional drug poisoning mortality rates by sex and age group, US, 2003-2004

02

46

81012

1416

1820

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Group

Rate

per

100,0

00

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Unintentional poisoning mortality rates by race, US, 2004

Unintentional poisoning mortality rates by race, US, 2004

7.546.94

8.6

1.07

0

1

2

3

4

5

6

7

8

9

10

White Black AIAN API

Ag

e-a

dju

ste

d r

ate

per

100,0

00

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Unintentional and undetermined drug poisoning Unintentional and undetermined drug poisoning mortality rates by state, US, 2004mortality rates by state, US, 2004

2.3-6.8 6.9-8.6 8.7-16.7

Rate per 100,000 population

7.2

6.8

3.8

2.7

7.2

4.2

2.3

2.3

3.7

7.1

6.1

7.1

6.6

7.4

11.1

6.2

14.6

5.4

5.9

8.3

11.9

6.6

6.08.2

11.6

HI7.2

8.2

13.5

7.5

8.3

7.4

11.0

11.2

16.7

10.4

11.4

9.4

11.1

7.9

13.5

10.5

NH 7.9VT 6.7MA 9.3RI 8.5CT 8.5NJ 5.9DE 5.9MD 10.7DC 14.7

6.9

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Age-adjusted rates of unintentional and undetermined drug poisoning mortality by urban-rural category and

year, US, 1999--2004

Age-adjusted rates of unintentional and undetermined drug poisoning mortality by urban-rural category and

year, US, 1999--2004

0

2

4

6

8

10

`99 `00 `01 `02 `03 `04

Ra

te p

er

10

0,0

00

Large CentralMetro

Large FringeMetro

Medium Metro

Small Metro

Micropolitan(non-metro)

NonCore (non-metro)

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Unintentional drug poisoning mortality rates and total sales of opioid analgesics in morphine

equivalents by year in the U.S.

Unintentional drug poisoning mortality rates and total sales of opioid analgesics in morphine

equivalents by year in the U.S.

0

1

2

3

4

5

6

7

8

'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06

Ra

te p

er

10

0,0

00

0

100

200

300

400

500

600

700

800

Mg

pe

r p

ers

on

Deaths/100,000 Opioid sales (mg/person)

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Sales of opioids by type, US, 1997 thru 3rd quarter, 2006

(DEA ARCOS data)

Sales of opioids by type, US, 1997 thru 3rd quarter, 2006

(DEA ARCOS data)

0

20

40

60

80

100

120

140

'97 '98 '99 '00 '01 '02 '03 '04 '05 '06

Year

Mg

/pers

on

oxycodone

hydrocodone

codeine

morphine

methadone

meperidine

fentanyl

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Estimated numbers of new nonmedical users in past year by type of drug, US, 1990-2003

(NSDUH 2002-2004)

Estimated numbers of new nonmedical users in past year by type of drug, US, 1990-2003

(NSDUH 2002-2004)

0

500

1000

1500

2000

2500

3000

90 91 92 93 94 95 96 97 98 99 00 01 02 03

Nu

mb

ers

in

1000's

Pain relievers

Tranquilizers

Cocaine

Stimulants

Heroin

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Prevalence of nonmedical use of prescription pain relievers in past year among persons aged 18 or older

by education level, US, 2002-2004

Prevalence of nonmedical use of prescription pain relievers in past year among persons aged 18 or older

by education level, US, 2002-2004

5.3

4.5

5.3

2.9

0

1

2

3

4

5

6

< HS HS Some college College grad

Perc

en

t w

ith

use

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Prevalence of nonmedical use and dependence/abuse of prescription pain relievers among persons aged 12

or older by period of use (NSDUH, 2005)

Prevalence of nonmedical use and dependence/abuse of prescription pain relievers among persons aged 12

or older by period of use (NSDUH, 2005)

13.4

4.9

1.90.6

0

2

4

6

8

10

12

14

16

Lifetime Past Year Past Month

Perc

en

t

Nonmedical use

Dependence/abuse

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Epidemiology of opioid use versus opioid abuseEpidemiology of opioid use versus opioid abuse

Although females are more likely to use opioids, males are more likely to abuse and overdose with them.

Although people over 65 are most likely to use opioids, people in 20s and 40s are most likely to abuse them.

Many people dying of prescription overdoses have a history of substance abuse.

Therefore, overdoses are more likely to represent abuse than overmedication.

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Lessons learnedLessons learned

Regulated prescription drugs taken mostly by mouth can produce a larger overdose epidemic than illicit drugs of uncertain strength taken intravenously, such as heroin.

Just as a drug that is efficacious in clinical trials may not be effective in the community, drugs “safe” in terms of abuse in controlled settings may be abused in the community.

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Some examples of how federal agencies are addressing the problem

Some examples of how federal agencies are addressing the problem

CDC started surveillance using existing data and is supporting some etiologic and evaluation work.

FDA placed “black boxes” on OxyContin (2001) and methadone (2006).

DEA stepped up efforts against drug diversion. DOJ provided funding for state prescription drug monitoring

programs through the Hal Rogers Program since FY2002. Congress passed the National All Schedules Prescription

Electronic Reporting Act (NASPER) in 2005 to fund additional prescription monitoring programs.

White House Office of National Drug Control Policy issued a Synthetic Drug Control Strategy in May, 2006.

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Thank youThank you

Contact information:– Len Paulozzi, MD, MPH– Division of Unintentional Injury Prevention,

National Center for Injury Prevention and Control, CDC

– 770-488-1394– lbp4@cdc.gov

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Paulozzi LJ, Ballesteros MF, Stevens JA. Recent trends in mortality from unintentional injury in the United States. Journal of Safety Research 2006; 37:277-283.

Paulozzi LJ. Sharp rise in opioid analgesic involvement in drug abuse deaths in the American metropolitan areas. American Journal of Public Health 2006; 96:1755-1757.

Paulozzi LJ. Opioid analgesics and rates of fatal drug poisoning in the United States. American Journal of Preventive Medicine 2006; 31:506-511.

Kaplan J, Kraner J, Paulozzi LJ. Alcohol and other drug use among victims of motor-vehicle crashes -– West Virginia, 2004—2005. MMWR 2006;55:1293-1296.

Paulozzi LJ, Annest J. Unintentional poisoning deaths – United States, 1999-2004. MMWR 2007;56:93-96.

Paulozzi LJ. QuickStats: Percentage change in death rates for the leading causes of unintentional injury, by mechanism of injury --- United States, 1999—2004. MMWR 2007;56:309.

Paulozzi LJ, Annest J. US data show sharply rising drug-induced death rates. Injury Prevention 2007;13:130-132.

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National Survey on Drug Use and Health: National Findings (OAS, NSDUH Series H-30, DHHS Pub. No. SMA 06-4194). Rockville, MD.