William A. Lanier, DVM, MPH Kristina Russell, MPH Utah Department of Health Risk Factors for Prescription Opioid Death – Utah, 2008–2009 Office of Surveillance, Epidemiology, and Laboratory Services Scientific Education and Professional Development Program Office
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Risk Factors for Prescription Opioid Death – Utah, 2008–2009
Risk Factors for Prescription Opioid Death – Utah, 2008–2009. William A. Lanier, DVM, MPH Kristina Russell, MPH. Utah Department of Health. Office of Surveillance, Epidemiology, and Laboratory Services. Scientific Education and Professional Development Program Office. - PowerPoint PPT Presentation
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William A. Lanier, DVM, MPHKristina Russell, MPH
Utah Department of Health
Risk Factors for Prescription Opioid Death –
Utah, 2008–2009
Office of Surveillance, Epidemiology, and Laboratory ServicesScientific Education and Professional Development Program Office
Prescription Opioid Use and Safety Bind to opioid receptors in the central
nervous system Therapeutic Use
Analgesia
Side Effects Respiratory depression Dependence
Causes of Prescription Opioid Death Nonmedical use?
Obtaining from nonprescription sources Using more than prescribed
Increase in opioids prescribed? Inherent risks of drugs Unsafe prescribing practices
Risk factors inadequately understood Lack of knowledge about decedents Lack of control group who used opioids
Study Objective and Design Identify risk factors for death People who died from prescription opioids People who used prescription opioids Compared populations
Data Sources: Decedents Medical examiner records Death certificates Next-of-kin interviews
Decedents (N = 254) October 26, 2008–October 25, 2009 Prescription opioid cause of death Accidental or intent-undetermined manner
of death Utah residents ≥18 years of age Interview completed by next-of-kin
Data Source: Comparison Group Behavioral Risk Factor Surveillance System
(BRFSS) Self-reported Landline only Non-institutionalized Weighted to reflect state population Prescription pain medication questions
added 2008
Comparison Group (N = 1,308) Utah 2008 BRFSS Used prescription opioid in prior 12 months Utah residents ≥18 years of age
Statistical Methods Exposure prevalence (prevalence of
characteristics)
Exposure prevalence ratios (EPR) as measure of association
95% Confidence intervals (CI)
Decedent prevalence
Comparison prevalence
EPR =
Characteristics Compared and Denominators
CharacteristicDecedents
(N)Comparison
(N)Medication source 222 1,300
Medication use 155 1,245Chronic pain
(obtained via prescription)
191 1,253
Education level 254 1,307
Smoking status 244 1,307
Marital status 254 1,276
Health insurance 243 1,307
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
n
Obtained via
prescription91.9 96.2
0.96 (0.94–0.97)
Obtained via other
source39.6 8.3 4.8
(3.6–6.0)
Used more than
prescribed52.9 3.2 16.5
(9.3–23.7)
Pain Medication Source and Use
Pain Type among Decedents Acute pain
8%
Chronic pain83%
No pain9%
Chronic Pain Comparison (Obtained via Prescription)
Chronic pain32%
Comparison (N = 1253)
Chronic pain94%
Decedents (N = 191)
EPR = 3.0 (95% CI = 2.7–
3.3)
Acute pain only
6% Acute pain only
78%
Prescription Opioid Use and Chronic Pain
Use outside prescription increases risk Not all decedents used outside prescription Majority of decedents obtained by
prescription
Chronic pain in majority of decedents Prevalence higher if obtained via prescription
Risk by Specific Opioid
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
n
Methadone 28.1 1.815.5
(6.3–24.6)
Morphine 13.4 2.45.7
(3.5–7.9)
Oxycodone 37.9 28.41.3
(1.2–1.5)
Hydrocodone 25.3 69.60.4
(0.3–0.4)
18–24 25–34 35–44 45–54 55–64 ≥650
5
10
15
20
25
30
35
Decedents
Comparison
Age category (years)
Popu
latio
n pe
rcen
tAge Category of
Decedents and Comparison Group
Age Category, Stratified by Sex
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
nMale, 25–34 30.4 24.0 1.3 (1.0–
1.6)Male, 35–44 24.4 20.4 1.2 (0.9–
1.5)Male, 45–54 23.0 22.1 1.0 (0.8–
1.2)Female, 25–34 21.8 24.8 0.9 (0.7–
1.0)Female, 35–44 21.8 17.1 1.3 (1.0–
1.5)Female, 45–54 37.0 16.1 2.3 (1.9–
2.7)
Education and Smoking
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
n
Did not graduate from
high school18.5 6.2 3.0
(2.0–3.9)
Smoked daily 54.5 9.7 5.6 (4.4–6.9)
Smoked daily (education-
adjusted)49.1 9.7 5.0
(4.0–6.1)
Education and Smoking Low education level
Predispose to lack of insurance and other factors Smoking rates higher among low educated
Association mildly confounded by education Smoking rates higher among substance
abusers Could confound association Population susceptible to addiction
Marital Status and Health Insurance
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
n
Divorced/Separated 34.6 9.4 3.7
(3.0–4.4)
Uninsured 29.2 12.5 2.3 (1.8–2.8)
Marital Status and Health Insurance Divorced/separated
Indicates lack of social support Increase risky drug use Decrease chance of timely care
Lack of health insurance Limits access to care Consequence of chronic pain or substance abuse
Illicit Substance Use History (Lifetime)among Decedents (N = 251)
Number of Drugs
Number of
Decedents
Percentage of Decedents
(%)
Heroin 52 20.7
Cocaine 77 30.7
Any illicit substance 154 61.4
Illicit substance use treatment 129 51.4
Mental Illness
Characteristic
Prevalence (%)EPR
(95% CI)DecedentsCompariso
nDepressed/
FMD 30.3 13.5 2.2(1.8–2.6)
Limitations Interview response influences
Social desirability Recall Lack of knowledge about decedents
Incomplete comparability of data sources Potential risk factors not analyzed
Illicit substance use Mental illness
Confounding variables
Conclusion Risk of death complicated Use outside prescription bounds risky Decedents needed chronic pain therapy Other factors important Providers can recognize risk and control
exposure
Recommendations Prescribers should screen chronic pain
patients Update screening tools to include risk
factors Continue research on risk factors
Smoking Illicit substance use Mental illness
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Office of Surveillance, Epidemiology, and Laboratory ServicesScientific Education and Professional Development Program Office
Utah Department of Health
CDC
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