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CME / ABIM MOC / CE

Key Findings From Report on US Drug Overdose Deaths

  • Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 2/26/2018
  • Valid for credit through: 2/26/2019
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    You Are Eligible For

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Target Audience and Goal Statement

This article is intended for primary care physicians, pain management specialists, addiction medicine specialists, nurses, pharmacists, and other clinicians who care for individuals at risk for drug overdose.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Assess prescription patterns for opioid medications in the United States
  2. Evaluate trends in death from drug overdose in the United States


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Author(s)

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Disclosure: Megan Brooks has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD, FAAFP

    Health Sciences Clinical Professor, University of California, Irvine, Department of Family Medicine; Associate Dean for Diversity and Inclusion, University of California, Irvine, School of Medicine; Executive Director, University of California, Irvine, Program in Medical Education for the Latino Community, Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, FAAFP, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson and Johnson Healthcare
    Served as a speaker or a member of a speakers bureau for: Shire Pharmaceuticals

Editor/CME Reviewer/Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC

    Lead Nurse Planner, Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Key Findings From Report on US Drug Overdose Deaths

Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 2/26/2018

Valid for credit through: 2/26/2019

processing....

Clinical Context

The opioid epidemic in the United States is impossible to escape in our clinical practices, the popular media, and among friends and family. But are clinicians still prescribing high numbers of opioid medications? Guy and colleagues assessed the epidemiology of opioid prescribing in the July 17, 2017, issue of Morbidity and Mortality Weekly Report.[1]

Researchers focused on national prescribing data from 2006 to 2015. The rate of opioid prescriptions increased between 2006 and 2010, then remained stable through 2012. Opioid prescription rates declined by 13.1% from 2012 to 2015. The overall strength of opioids prescribed also declined in comparing data from 2010 and 2015.

There was significant variability in opioid prescription rates based on county. On multivariate analysis, factors significantly associated with higher rates of opioid prescriptions were higher proportions of non-Hispanic whites in the local population; higher rates of uninsured and Medicaid-enrolled individuals; higher rates of unemployment; higher prevalence rates of diabetes, arthritis, and disability; and nonurban status.

Opioid prescription rates have correlated positively with the prevalence of death from drug overdose. The current study by Hedegaard and colleagues assesses what has happened in recent years to the rates of mortality related to drug overdose.

Study Synopsis and Perspective

In 2016, a total of 63,632 people in the United States died of drug overdoses, an increase of 21% during 2015, according to the latest data from the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS).

The age-adjusted rate of drug overdose deaths was 19.8 per 100,000 in 2016, up from 16.3 per 100,000 in 2015 and 6.1 in 1999, Holly Hedegaard, MD, and colleagues from the NCHS report in a data brief released December 21, 2017.[2]

In 2016, death rates from drug overdose were highest for individuals ages 25 to 34 years (34.6 deaths per 100,000), 35 to 44 years (35.0 deaths per 100,000), and 45 to 54 years (34.5 deaths per 100,000). The greatest percentage increase in drug overdose death rates from 2015 to 2016 occurred in adults ages 15 to 24 years (28%), 25 to 34 years (29%), and 35 to 44 years (24%).

West Virginia had the highest drug overdose death rates in 2016 (52.0 per 100,000), followed by Ohio (39.1), New Hampshire (39.0), the District of Columbia (38.8), and Pennsylvania (37.9).

Increases in drug overdose deaths have largely been driven by the continued rise in deaths from synthetic opioids other than methadone (eg, fentanyl, fentanyl analogues, and tramadol), with rates doubling in a single year from 3.1 per 100,000 in 2015 to 6.2 in 2016, the authors note.

Drug overdose deaths involving heroin increased from 4.1 in 2015 to 4.9 in 2016. Rates of overdose deaths involving natural and semisynthetic opioids (eg, morphine, codeine, hydrocodone, and oxycodone) increased from 3.9 in 2015 to 4.4 in 2016.

Frightening Data Call for Immediate Action

"The escalating growth of opioid deaths is downright frightening -- and it's getting worse," commented John Auerbach, president and CEO of Trust for America's Health (TFAH), in a news release.[3] "Every community has been impacted by this crisis, and it's getting lots of headlines, yet we're not making the investments or taking the actions at anywhere near the level needed to turn the tide."

Last month, as reported by Medscape Medical News,[4] TFAH and Well Being Trust (WBT) released a report that projected that from 2016 to 2025, more than 1.6 million deaths would occur because of drugs, alcohol, and suicide. This would represent a 60% increase compared with that of the previous decade (2006-2015).

The report[5] -- Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy -- estimates that drug-related deaths could reach 163,000 per year by 2025 if the growth continues at current rates.

"These are not simply numbers -- these are actual lives. Seeing the loss of life at this dramatic rate calls for more immediate action," said WBT chief policy officer Benjamin F. Miller, PsyD. "Our fractured approach to a multisystemic issue isn't enough, and it isn't working. We collectively need to take a more comprehensive and systemic approach, beginning with prevention through recovery and treatment, to double down on investing in systems change for real results." The Pain in the Nation report outlines such a strategy.

NCHS Data Brief 294. Published December 21, 2017.

Study Highlights

  • Study data were drawn from mortality files in the National Vital Statistics System. Drug overdose was defined with use of diagnosis codes.
  • Researchers focused on national data from 2016. An estimated 86% of drug overdose deaths were unintentional.
  • The total number of drug overdose deaths in 2016 exceeded 63,600. The rate of drug overdose deaths per 100,000 population was 6.1 in 1999. In 2016, this figure had increased to 19.8 drug overdose deaths per 100,000 population.
  • Drug overdose deaths increased by approximately 10% per year between 1999 and 2006, and this rate slowed to an increase of 3% per year between 2006 and 2014. However, drug overdose deaths increased by 18% per year from 2014 to 2016.
  • Rates of drug overdose deaths were approximately double in comparing men vs women.
  • The age group among adolescents and adults with the highest risk for drug overdose death was individuals between 25 and 54 years old. The increases in the rate of drug overdose deaths from 2015 to 2016 among adults aged 15 to 24 years, 25 to 34 years, and 35 to 44 years were 28%, 29%, and 24%, respectively.
  • States with the highest rates of age-adjusted drug overdose deaths were West Virginia, Ohio, New Hampshire, and Pennsylvania. The lowest rates were found in Iowa, North Dakota, Texas, and South Dakota.
  • The annual rate of mortality from heroin overdose continued to increase but at a slower rate (19% from 33%) between 2014 and 2016.
  • Drug overdose deaths from use of synthetic opioids such as fentanyl increased from a rate of 0.3 cases per 100,000 population in 1999 to 6.2 cases per 100,000 population in 2016. Mortality rates related to these drugs increased by 88% per year between 2013 and 2016.
  • Drug overdose deaths from use of natural or semisynthetic opioids such as oxycodone and hydrocodone increased by an average of 3% per year between 2009 and 2016.
  • Methadone-related deaths declined from a peak of 1.8 cases per 100,000 population in 2006 to 1.0 cases per 100,000 population in 2016.

Clinical Implications

  • In a previous study, Guy and colleagues revealed that prescription opioids were not as frequently prescribed from 2012 to 2015 as in recent years, and the total opioid dosage declined during this period. Higher rates of opioid prescriptions by region were associated with higher proportions of non-Hispanic whites in the local population, higher rates of uninsured and Medicaid-enrolled individuals, and nonurban status.
  • The current study by Hedegaard and colleagues demonstrates that mortality rates from drug overdose continue to increase in the United States. Adults between 25 and 54 years old have the highest rates of drug overdose deaths, and states with the highest rates of age-adjusted drug overdose deaths were West Virginia, Ohio, New Hampshire, and Pennsylvania. The rate of overdose deaths from use of synthetic opioids such as fentanyl has particularly spiked from 2013 to 2016.
  • Implications for the Healthcare Team: The healthcare team should follow guidelines from the CDC as much as possible to prevent overuse and abuse of opioid medications and limit the risk for drug overdose.

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