Hospitalizations for Poisoning by Prescription Opioids, Sedatives, and Tranquilizers
ABSTRACT Unintentional poisoning deaths have been increasing dramatically over the past decade, and the majority of this increase has resulted from overdoses of specific prescription drugs. Despite this trend, there are limited existing data examining hospitalizations for poisonings, both unintentional and intentional, associated with prescription drugs. A better understanding of these hospitalizations may help identify high-risk populations in need of intervention to prevent subsequent mortality.
This article aims to describe the incidence and characteristics of hospitalizations resulting from poisoning by prescription opioids, sedatives, and tranquilizers in the U.S. from 1999 to 2006 and make comparisons to hospitalizations for all other poisonings during this time period.
Hospitalizations for poisonings were selected from the Nationwide Inpatient Sample (NIS), a stratified, representative sample of approximately 8 million hospitalizations each year, according to the principal discharge diagnosis. Intentionality of the poisoning was determined by external cause of injury codes. SAS callable SUDAAN software was used to calculate weighted estimates of poisoning hospitalizations by type and intentionality. Demographic and clinical characteristics of poisoning cohorts were compared. Data were analyzed in 2009.
From 1999 to 2006, U.S. hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers increased a total of 65%. This increase was double the increase observed in hospitalizations for poisoning by other drugs and substances. The largest increase in the number of hospitalized cases over the 7-year period was seen for poisonings by benzodiazepines, whereas the largest percentage increase was observed for methadone (400%). In comparison to patients hospitalized for poisoning from other substances, those hospitalized for prescription opioids, sedatives, and tranquilizers were more likely to be women, aged >34 years, and to present to a rural or urban nonteaching hospital.
Prescription opioids, sedatives, and tranquilizers are an increasing cause of hospitalization. The hospital admission provides an opportunity to better understand the contextual factors contributing to these cases, which may aid in the development of targeted prevention strategies.
- SourceAvailable from: Jeanne M Manubay
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- "Women being prescribed opioids in chronic pain clinics are more prone to taking a greater number of medications (opioid and nonopioid) than men (Darnell and Stacey, 2012), a practice that exposes them to a higher risk for drug-drug interactions, additive side effects, and possible overdose. In the past 15 years, opioid-related overdoses leading to hospitalization have increased for women but not for men (Coben et al., 2010). This trend was also recently reported in an analysis by the Centers for Disease Control and Prevention, which noted an increase in the percentage in deaths from opioid pain reliever overdose among women compared with men since 1999 (Mack and Paulozzi, 2013). "
ABSTRACT: Background: The characteristics of patients with co-occurring chronic pain and prescription opioid abuse have not been well described, and even less is known about differences between men and women in this population. Objectives: This study evaluated sex differences in the demographic, diagnostic, and behavioral attributes of patients with chronic pain and opioid abuse. Methods: Data were collected via self-report and semistructured clinical interviews from 162 patients (120 men and 42 women) who screened for a study investigating the abuse liability of prescription opioids. Results: There were no differences between men and women in age, race, education, marital status, or employment status. Participants had used prescription opioids for 5.4 ± 6.7 years. The majority of participants (60%) had low back pain in addition to opioid dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. More women reported more arthritic pain than men, but otherwise there were no differences in types of pain. Pain exerted a greater effect in women on mood, walking ability, and social relations. Men reported more of certain aberrant behaviors, including abuse of alcohol or illicit drugs, unauthorized dose increases, contact with street culture, and being arrested by police. Women were more depressed than men. Conclusions: The demographic profile of opioid-abusing patients with chronic pain presenting for treatment in a clinical trial was similar between sexes; however, some important differences were observed. Women reported more psychiatric comorbidity and endorsed greater pain-related physical and social impairment. Men reported more aberrant behaviors. These differences suggest that men with chronic pain and opioid abuse/dependence may benefit by closer monitoring of aberrant behaviors whereas women may benefit from closer attention paid to physical and psychological effects of pain.Journal of Addiction Medicine 10/2014; 9(1). DOI:10.1097/ADM.0000000000000086 · 1.76 Impact Factor
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- "Adolescent populations are particularly vulnerable to opioid misuse and abuse, with early initiation increasing the likelihood of future addiction (Compton and Volkow, 2006; McCabe, 2012, 2011, 2009; Meier, 2012). In turn, these nonmedical user are estimated to cost society over $53 billion each year through their greater burden on health and service systems as well as increased rates of disability (Birnbaum et al., 2011; Coben et al., 2010; Hansen et al., 2011a; Johnston et al., 2010; SAMHSA, 2009). "
ABSTRACT: Purpose Prescription drug abuse has reached epidemic proportions. Nonmedical prescription opioid use carries increasingly high costs. Despite the need to cultivate efforts that are both effective and fiscally responsible, the cost-effectiveness of universal evidence-based-preventive-interventions (EBPIs) is rarely evaluated. This study explores the performance of these programs to reduce nonmedical prescription opioid use. Methods Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions (2002–2010). Within the intervention communities, prevention teams selected a universal family and school program from a menu of EBPIs. All families were offered a family-based program in the 6th grade and received one of three school-based programs in 7th-grade. The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program was assessed using propensity and marginal structural models. Results This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use. Further, findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs. Conclusions Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use should be further considered when developing comprehensive responses to this growing national crisis.Preventive Medicine 05/2014; 62. DOI:10.1016/j.ypmed.2014.01.029 · 3.09 Impact Factor
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- "Between 1997 and 2007, the number of milligrams of methadone distributed in the United States increased more than 10-fold, primarily for the treatment of chronic pain (Manchikanti & Singh, 2008). At the same time, hospitalization rates for methadone-related overdoses increased by 400%, (Coben et al., 2010) and methadonerelated overdose fatalities increased in several states (Ballesteros et al., 2003; Graham, Merlo, Goldberger, & Gold, 2008; Sorg & Greenwald, 2002). State and federal efforts have responded to these increases by supporting physician education on safe opioid prescribing and prescription monitoring programs (Office of National Drug Control Policy, 2010; U.S. Food & Drug Administration FDA, 2011). "
ABSTRACT: Overdose education and naloxone distribution (OEND) is an intervention that addresses overdose, but has not been studied among people who take methadone, a drug involved in increasing numbers of overdoses. This study describes the implementation of OEND among people taking methadone in the previous 30days in various settings in Massachusetts. From 2008 to 2010, 1553 participants received OEND who had taken methadone in the past 30days. Settings included inpatient detoxification (47%), HIV prevention programs (25%), methadone maintenance treatment programs (MMTP) (17%), and other settings (11%). Previous overdose, recent inpatient detoxification and incarceration, and polysubstance use were overdose risks factors common among all groups. Participants reported 92 overdose rescues. OEND programs are public health interventions that address overdose risk among people who take methadone and their social networks. OEND programs can be implemented in MMTPs, detoxification programs, and HIV prevention programs.Journal of substance abuse treatment 09/2012; 44(2). DOI:10.1016/j.jsat.2012.07.004 · 2.90 Impact Factor