Accidental Overdose Deaths in Oklahoma, 2002–2017: Opioid and Methamphetamine Trends

2020 ◽  
Vol 44 (7) ◽  
pp. 672-678
Author(s):  
Rachel Bonk ◽  
Ross J Miller ◽  
Joshua Lanter ◽  
Cheryl Niblo ◽  
Jesse Kemp ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Sharp Increase ◽  
The State ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Death Rates ◽  
Synthetic Opioids ◽  
Accidental Overdose ◽  
Overdose Deaths

Abstract To evaluate trends related to accidental overdose deaths in Oklahoma, with a focus on opioids and methamphetamine. All accidental drug overdose deaths in the state of Oklahoma from 2002 to 2017 were reviewed. Opioids were grouped into the following categories: all opioids, prescription opioids, synthetic opioids and heroin. Age-adjusted death rates for methamphetamine and each opioid category were calculated and analyzed. Accidental overdoses accounted for 9,936 deaths during the study period. Of these, opioids were seen in 62.9%, with prescription opioids comprising 53.8%, synthetic opioids 10.3% and heroin 2.8%. Synthetic opioids, despite a recent upward nationwide trend, showed a slight overall decrease (−6.8%) from 2009 to 2017. In contrast, methamphetamine showed a 402.2% increase from 2009 to 2017 and an overall increase of 1,526.7%. Methamphetamine was involved in the most overdoses (1,963), followed by oxycodone (1,724). Opioid-related deaths were most common among white individuals (90.3%) and showed a slight male predilection (56.9%). With the intent of assessing the opioid epidemic as it relates to accidental overdoses in Oklahoma, this study suggests that opioid-related overdoses have slowed in recent years amidst a sharp increase in methamphetamine deaths.

scholarly journals Adolescent prescription opioid misuse, illicit opioid use and overdose

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Michele K. Bohm ◽  
Heather Clayton
Keyword(s):  
Dose Response ◽  
Drug Overdose ◽  
Prescription Opioids ◽  
Response Relationship ◽  
Opioid Use ◽  
Dose Response Relationship ◽  
Heroin Use ◽  
Synthetic Opioids ◽  
Overdose Deaths ◽  
Illicit Opioid Use

ObjectiveGiven the evolving opioid overdose epidemic, we examined the interrelationships between nonmedical use of prescription opioids and illicit opioid use in adolescents.IntroductionThe number of overdose deaths involving illicit opioids such as heroin and illicitly-manufactured fentanyl (IMF) is now higher than deaths involving prescription opioids. Adolescents misusing prescription opioids are more likely to use heroin. Although nonmedical use of prescription opioids (NUPO) among adolescents is decreasing,there is still relatively high prevalence of this behavior. Such high prevalence, along with the evolving epidemiology of the drug overdose epidemic as well as the association between NUPO and heroin use, signal that NUPO in adolescents is still an important issue. Understanding the interrelationships between NUPO and illicit opioid use in adolescents can inform prevention efforts. The purpose of this study is to: 1) present the magnitude of the drug overdose problem in adolescents, 2) compare the prevalence of heroin use and injection drug use (IDU) between students reporting NUPO and those not reporting NUPO, and 3) determine whether a dose-response relationship exists between these behaviors among adolescents. This information will be beneficial when focusing on adolescents at risk for heroin use by helping to determine whether any NUPO is associated with heroin use or if such risk is only noted at a higher frequency of NUPO behavior.MethodsWe analyzed data from two surveillance sources to capture adolescent overdose mortality and behavioral risk factors. Overdose death data for decedents aged 15 to 19 years were obtained for 2010 and 2016 from CDC WONDER, an online database with national mortality data based on death certificates for U.S. residents. We identified deaths involving prescription and illicit opioids using International Classification of Disease, 10th revision (ICD-10) codes for drug overdose deaths. Each death is assigned one underlying cause of death code and the following identified overdoses: X40-44 (unintentional), X60-64 (intentional), X85 (homicide), or Y10-14 (undetermined intent). Additionally, for overdose deaths attributed to specific drugs or drug categories, ICD-10 multiple cause of death codes were used to determine the number of deaths involving any opioid, either prescription or illicit (T40.1-T40.4 and T40.6), prescription opioids (T40.2 or T40.3), heroin (T40.1), and heroin and/or synthetic opioids (e.g., fentanyl) excluding methadone (T40.1 or T40.4). We compared the proportion of overdose deaths involving prescription opioids that also involved heroin or synthetic opioids in 2010 and 2016. The second data source, the 2017 national Youth Risk Behavior Survey (YRBS), a nationally representative cross-sectional survey of high school students, was analyzed to look at behavioral risk factors. We assessed lifetime NUPO (LNUPO) and calculated frequency of LNUPO by heroin use, injection drug use (IDU), and heroin/IDU using logistic regression models to generate adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals (CI). We used linear contrast analysis to determine dose-response relationships between frequency of LNUPO and heroin use, IDU and heroin/IDU.ResultsThe number of adolescents aged 15 to 19 years who died of drug overdose increased from 831 in 2010 (3.8 per 100,000) to 873 in 2016 (4.1 per 100,000). While the proportion of overdose deaths involving prescription opioids declined during this time period, the proportion involving heroin and/or synthetic opioids, such as fentanyl increased. In 2016, two-thirds of overdose deaths among decedents aged 15 to 19 years involved either a prescription or illicit opioid. The percent of deaths involving prescription opioids that also involved heroin and/or synthetic opioids, such as fentanyl increased from 5% in 2010 to 25% in 2016. Using the 2017 YRBS sample, we estimate that 14% of high school students nationwide have ever used prescription opioids nonmedically in their lifetime. Compared to students reporting no LNUPO, students reporting LNUPO were more likely to report heroin use (9.2% vs. 0.4%), IDU (7.8% vs. 0.4%), and heroin/ IDU (10.1% vs. 0.7%). We observed a positive dose-response relationship with frequency of LNUPO. Adjusted prevalence ratios for heroin, IDU and heroin/IDU increased with increasing frequency of LNUPO and were even significantly higher among those reporting just one or two occasions of LNUPO than among those reporting no LNUPO.ConclusionsOur findings on opioid-involved drug overdose mortality and opioid use patterns confirm NUPO is still a concern for adolescents. We report a five-fold increase, from 2010 to 2016, in the percent of adolescent overdose deaths involving prescription opioids that also involved illicit opioids such as heroin and/or IMF. This may reflect deliberate polysubstance use among adolescents using prescription opioids nonmedically, but should also be considered in the context of stable prevalence of reported heroin use in YRBS and the National Survey on Drug Use and Health. In addition to issues with self-report bias, adolescents may not self-identify as a person who uses heroin, for example, if they unknowingly use counterfeit prescription pills that contain heroin or IMF. Health risk behaviors established in adolescence often continue into young adulthood and understanding associations between opioid initiation, misuse, and overdose is critical for prevention efforts. Although we found a dose-response relationship between the frequency of LNUPO and the prevalence of heroin and IDU, we also report significantly higher heroin use and IDU among students reporting just one or two occasions of LNUPO compared to students reporting no LNUPO. This underscores the importance of prevention efforts aimed at all adolescents who use prescription opioids nonmedically, with particular emphasis on those frequently misusing them. Clinical, community, and school-based efforts can address NUPO, noting these associations. 

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Electronic Reporting ◽  
Number Of Patients ◽  
Overdose Deaths

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

scholarly journals Confronting Two Crises: The COVID-19 Pandemic, the Opioid Epidemic, and the Industrial Hygienist

2021 ◽  
pp. 104829112110295
Author(s):  
Jonathan Rosen ◽  
Peter Harnett
Keyword(s):  
Disease Control ◽  
Drug Overdose ◽  
Industrial Hygiene ◽  
Prevention Programs ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Crisis ◽  
The Impact ◽  
Overdose Deaths ◽  
Industrial Hygienist

This article was originally written for and published in the January 2021 issue of The Synergist, a monthly publication of the American Industrial Hygiene Association. The article addresses the convergence of the COVID-19 and opioid crises, the impact of the opioid crisis on the workplace and workers, and the role that industrial hygienists can play in developing workplace programs to prevent and respond to opioid misuse. While the article is specifically written for industrial hygienists, the review and recommendations will be useful to others who are developing workplace opioid prevention programs. Note that the data presented in this article were current as of January 2021. Centers for Disease Control and Prevention’s latest available data are for the twelve-month period ending October 2020 and include 88,990 total overdose deaths and 91,862 predicted, when reporting is completed. Source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm (accessed on 15 June 2021).

scholarly journals Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016

2019 ◽  
Vol 135 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Sumedha Gupta ◽  
Alex Cohen ◽  
Evan M. Lowder ◽  
Bradley R. Ray
Keyword(s):  
Drug Overdose ◽  
Geographic Area ◽  
Opioid Epidemic ◽  
Data Set ◽  
Marion County ◽  
True Number ◽  
Vital Records ◽  
Simple Imputation ◽  
Overdose Deaths ◽  
Imputation Approach

Objectives: Understanding the scope of the current opioid epidemic requires accurate counts of the number of opioid-involved drug overdose deaths. Given known errors and limitations in the reporting of these deaths, several studies have used statistical methods to develop estimates of the true number of opioid-involved overdose deaths. This study validates these procedures using a detailed county-level database of linked toxicology and vital records data. Methods: We extracted and linked toxicology and vital records data from Marion County, Indiana (Indianapolis), during a 6-year period (2011-2016). Using toxicology data as a criterion measure, we tested the validity of multiple imputation procedures, including the Ruhm regression-based imputation approach for correcting the number of opioid-involved overdose deaths. Results: Estimates deviated from true opioid-involved overdose deaths by 3% and increased in accuracy during the study period (2011-2016). For example, in 2016, 231 opioid-involved overdose deaths were noted in the toxicology data, whereas the corresponding imputed estimate was 233 opioid-involved overdose deaths. A simple imputation approach, based on the share of opioid-involved overdose deaths among all drug overdose deaths for which the death certificate specified ≥1 drug, deviated from true opioid-involved overdose deaths by ±5%. Conclusions: Commonly used imputation procedures produced estimates of the number of opioid-involved overdose deaths that are similar to the true number of opioid-involved overdose deaths obtained from toxicology data. Although future studies should examine whether these results extend beyond the geographic area covered in our data set, our findings support the continued use of these imputation procedures to quantify the extent of the opioid epidemic.

scholarly journals Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study (Preprint)

2019 ◽  
Author(s):  
Mohd Anwar ◽  
Dalia Khoury ◽  
Arnie P Aldridge ◽  
Stephanie J Parker ◽  
Kevin P Conway
Keyword(s):  
North Carolina ◽  
Language Processing ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Least Squares Regression ◽  
Online Data ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Twitter Data

BACKGROUND Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. OBJECTIVE This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. METHODS Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. RESULTS The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (<i>P</i>=.01 and <i>P</i>&lt;.001, respectively), as well as in the following year (<i>P</i>=.03 and <i>P</i>=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (<i>P</i>=.03). CONCLUSIONS Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

Improvements in Toxicology Testing to Identify Fentanyl Analogs and Other Novel Synthetic Opioids in Fatal Drug Overdoses, Connecticut, January 2016–June 2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 80S-86S
Author(s):  
Heather A. Clinton ◽  
Shobha Thangada ◽  
James R. Gill ◽  
Amy Mirizzi ◽  
Susan B. Logan
Keyword(s):  
Drug Overdose ◽  
Drug Market ◽  
Medical Examiner ◽  
Testing Methods ◽  
Synthetic Opioids ◽  
Postmortem Toxicology ◽  
Drug Overdoses ◽  
Fentanyl Analogs ◽  
Novel Synthetic Opioids ◽  
Overdose Deaths

Objectives Drug overdose deaths in Connecticut increasingly involve a growing number of fentanyl analogs and other novel nonfentanyl synthetic opioids (ie, novel synthetics). Current postmortem toxicology testing methods often lack the sophistication needed to detect these compounds. We examined how improved toxicology testing of fatal drug overdoses can determine the prevalence and rapidly evolving trends of novel synthetics. Methods From 2016 to June 2019, the Connecticut Office of the Chief Medical Examiner increased its scope of toxicology testing of suspected drug overdose deaths in Connecticut from basic to enhanced toxicology testing to detect novel synthetics. The toxicology laboratory also expanded its testing panels during this time. We analyzed toxicology results to identify and quantify the involvement of novel synthetics over time. Results From 2016 to June 2019, 3204 drug overdose deaths received enhanced toxicology testing; novel synthetics were detected in 174 (5.4%) instances. Ten different novel synthetics were detected with 205 total occurrences. Of 174 overdose deaths with a novel synthetic detected, most had 1 (n = 146, 83.9%) or 2 (n = 26, 14.9%) novel synthetics detected, with a maximum of 4 novel synthetics detected. Para-fluorobutyrylfentanyl/FIBF, furanylfentanyl, and U-47700 were most identified overall, but specific novel synthetics came in and out of prominence during the study period, and the variety of novel synthetics detected changed from year to year. Conclusions Enhanced toxicology testing for drug overdose deaths is effective in detecting novel synthetics that are not identified through basic toxicology testing. Identifying emerging novel synthetics allows for a timely and focused response to potential drug outbreaks and illustrates the changing drug market.

Promoting Sustainable Responses to the US Opioid Epidemic with Community-Academic Partnerships: Qualitative Outcomes from a Statewide Program.

2021 ◽  
Author(s):  
David L. Driscoll ◽  
Alison Evans Cuellar ◽  
Vinod Agarwal ◽  
Debra Jones ◽  
Kathy Hosig ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Academic Support ◽  
The State ◽  
National Institutes Of Health ◽  
Opioid Overdose ◽  
Evidence Based ◽  
Community Agencies ◽  
Health Services Administration ◽  
Nominal Categories ◽  
Overdose Deaths

Abstract Background: Drug overdose deaths in the United States have continued to increase at an alarming rateThe United States is facing two devastating public health crises– the opioid epidemic and the COVID-19 pandemic. Within this context, one of the most ambitious implementation studies in addiction research is moving forward. Launched in May 2019, the HEALing Communities Study (HCS) was developed by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of the Helping to End Addiction Long-termSM Initiative (National Institutes of Health, 2020). The goal for this research was to reduce opioid overdose deaths by 40 % in three years by enhancing and integrating the delivery of multiple evidence-based practices (EBPs) with proven effectiveness in reducing opioid overdose deaths across health care, justice, and community settings. This paper describes the initial vision, goals, and objectives of this initiative; the impact of COVID-19; and the potential for knowledge to be generated from HCS at the intersection of an unrelenting epidemic of opioid misuse and overdoses and the ravishing COVID-19 pandemic.. The Substance Abuse and Mental Health Services Administration distributed more than $7 billion between January 2016 and June 2020 to address the drug overdose crisis. The funds were intended to support evidence-based responses, including medications for opioid use disorder, and other prevention, treatment and recovery activities. Although the SOR grants support much-needed community level interventions, many of the services they support may not be sustainable. Methods: This paper describes a statewide effort to support local entities through SAMHSA’s State Opioid Response (SOR) grants in Virginia. Our investigators conducted detailed needs assessment exercises with community agencies across the state, and collaboratively developed requests for proposals (RFPs) to sustain their SOR programs. We distributed the RFPs to prospective partners at universities across the state, and provided all responsive proposals to local agencies who selected the proposal most likely to meet their needs. Our investigators also conducted an inductive, three-phase content analysis approach to examine the RFPs submitted to the VHEOC to identify nominal categories of support requested of the academic partners. Results: Our investigators received and coded 27 RFPs from ten community agencies representing four of five regions of the state. We identified six nominal categories of academic support with high inter-coder agreement. The six categories of support requested of the academic partners were program development and support, literature review and best practices, outreach and education, data analysis and interpretation, program evaluation, and grant writing assistance. Several RFPs requested up to three categories of support in a single project. Conclusions: Our analysis of the requests received by the consortium identified several categories of academic support for SOR-grantees addressing the drug overdose crisis. The most common requests related to development and maintenance of supportive collaborations, which existing research has demonstrated is necessary for the long-term sustainability of SOR-funded services. In this way, the academic partners served as a source of support for sustainable SOR-funded programs. As the state opioid response program is implemented nationally, we hope that other states will consider similar models in response to the opioid crisis.

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