Opioids : trends and current status in Massachusetts : fatal overdoses, hospital discharges, emergency department visits, & trends in treatment services

2004·0.33 MB·English

by  Massachusetts. Department of Public Health. Injury Surveillance Program

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AND GUBBENT STATUS MftSSABHUSinS
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Ovefdoses, Hospital Disdiaiges, EmepcyDepaMVisis, &TrendsinTfealmentSen/ices
MassachusettsDepartmentofPublicHealth
CenterforHealthInformation,Statistics,Research&Evaluation,andtheBureauofSubstanceAbuseServices February2004
• Poisonings, which include drug overdoses, are the leading cause of injury death
in Massachusetts, surpassing motor vehicle injury deaths.
• 68% of poisoning fatalities in 2001 were associated with opioids.
• From 1999 to 2001 opioid-related fatal overdose rates increased 48%;
,
hospitalization rates increased 38%.
• Total charges for opioid-related hospitalizations exceeded $120 million in 2001.
WHAT ARE OPIOIDS?
The tenri "opioid" designates a class ofdrugs derived from opium or manufactured synthetically with a
chemical structure similarto opium. Heroin is a naturally derived opioid. Otheropioids such as oxycodone
(Oxycontin®), morphine, meperdine, methadone, codeine and others, are used therapeuticallyforthe
management of pain and otherconditions. These products may be diverted from pharmaceutical purposes
and used
illicitly.
OPIOID-RELATED FATAL OVERDOSES
IVIAGNITUDE AND TRENDS
Figure 1. Poisoning and Opioid-Related
MA
Poisonings are the leading cause of injury Fatal Overdoses, Residents,
death among Massachusetts residents; 68% of 1990-2001
these deaths in 2001 were opioid-related.
Opioid-related poisoning deaths as a
proportion ofall poisoning deaths increased
from 28% in 1990 to 68% in 2001
In 2001 deaths due to opioid-related
,
overdoses (n=487) were more than 5 times the
number of deaths in 1990 (n=94).
Opioid-related death rates^ increased an
average of 15% peryear between 1990 and
1998, and an average of 23% between 1999 %
and 2001; the opioid-related death rate was
1.6 per 100,000 residents in 1990 and 7.7
Year
deaths per 100,000 in 2001.
Duetoachange incodingproceduresfrom 1998to 1999, Source:RegistryofVital Recordsand Statistics, MDPH.
thedatawasexamined intwodistinctperiods;from 1990-1998,
and 1999to2001.
Opioids: Trendsand CurrentStatusin Massachusetts Page 1
InjurySun/eiilance Program, MDPH
OPIOID-RELATED FATAL OVERDOSES
fconf/nued;)
AGE GROUPS
Figure 2. Opioid-Related Fatal Overdose
Between 1990 and 2001, rates increased Rates by Age Group and Sex,
MA
for both males and females and among Residents, 2001
age groups between ages 15 and 54.
In 2001, individuals between the ages of 30.0
Male
35 and 44 experienced the highest opioid-
oa> 25.0 Female
related fatal overdose rates (36 deaths per '« il
a> 20.0
100,000). U.
o
o
oo_ 15.0 -
SEX o
10.0
For all age groups, opioid-related fatal Q. 5.0
overdoses were higher among males than (0 0.0
ce.
females. In 2001, death rates due to an
opioid-related overdose among males
were 3 times higher than for females (1 1.9
Age Group (years)
deaths per 100,000 and 3.9 per 100,000,
respectively).
Opioid-related overdose rates among Source:RegistryofVital Recordsand Statistics, MDPH.
females increased an average of 17% per
year between 1991^ and 1998, and 26% per
year between 1999 and 2001.
Rates among males increased an average
of 13% per year between 1990 and 1998,
and an average of 23% between 1999 and
2001. Figure 3. Opioid-Related Fatal
Overdose Rates by Race/Ethnicity,
RACE/ETHNICITY MA Residents, 2001
In 2001, opioid-related fatal overdose rates «
c 10.0 n
were highest among Hispanic residents
TO
(9.6 deaths per 100,000), followed by w 8.0
a>
blacks (8.8 per 100,000) and whites (7.9 QooC 6.0 -
per 100,000). o
o
Asian residents had lower opioid-related o 4.0 -
fatal overdose rates (2.1 deaths per 2.0 -
Q.
100,000) compared with other racial and ©
"(3 0.0 -
ethnic groups.
Hispanic Black, White, Asian Other
non- non-
Hispanic Hispanic
Race/Bhnicity
Source:RegistryofVital Recordsand Statistics, MDPH.
^Duetolowcasenumbersin 1990, percentageincrease
wasreportedforratesbeginning in 1991.
Opioids: TrendsandCurrentStatusin Massachusetts Page2
Injury Surveillance Program, MDPH
5
OPIOID-RELATED HOSPITALIZATIONS^
MAGNITUDE AND TRENDS
Figure 4. Opioid-Related Hospital Discharge
MA
• Opioid-related hospitalization rates have Rates by Sex, Residents,
risen gradually since 1996, increasing 38% 1994-2001
from 1999 to 2001.
• In 2001, there were 14,530 opioid-related -a—Male
acute care hospitalizations among
Massachusetts residents (228.9 per
100,000 residents).
• Total charges for opioid-related
hospitalizations exceeded $120 million in
2001.
SEX
• The rate of opioid-related hospitalizations
increased 36% among males from 1999 to
Year
2001 and 41% among females.
Source:MAHospital Discharge Database, CenterforHealth
Information, Statistics, Researchand Evaluation, MDPH.
AGE GROUPS
Figure 5. Opioid-Related Hospital Discharge
• The most dramatic increases in opioid- Rates by Age Group and Sex,
related hospitalization rates between 1999 MA Residents, 2001
and 2001 were observed among
individuals aged 15 to 24 years and 45 to 600.0 n
54 years, a 78% and 47% increase,
respectively.
• In 2001, males of every age group age 1
and over, had higher hospital discharge
rates than females. The largest variation of
opioid-related hospitalization rates
between males and females were among
persons aged 45 to 54, with males having
rates 2.3 times that offemales.
Age Group(years)
^Representsallacute-care hospitalizationswhereopioid abuse
orpoisoningwasconsidered asoneofthediagnosesatdischarge. Source:MAHospital Discharge Database,CenterforHealth
DataexcludeshospitalizationsatVeteransAffairs, psychiatric, Infonnation, Statistics, Researchand Evaluation, MDPH.
rehabilitativeorlong-termcarefacilitiesanddeathsthatoccunred
duringhospitalization.Trendswereonlyevaluatedfrom 1994
onwardfordataqualityreasons.
Opioids: Trendsand CurrentStatusin Massachusetts Page3
Injury Surveillance Program, MDPH
BOSTON AREA EMERGENCY DEPARTMENT
VISITS'^
MAGNITUDE AND TRENDS
Figure 6. ED Mentions for Heroin and Other
• The estimated emergency department Narcotics, Estimates for
(ED) visits due to heroin use for the greater Greater Boston, 1994-2001
Boston area increased 52% from 1999 to
2001. — —
Heroin
• For the greater Boston area, the estimated 5,000 -1
ED visits due to the use of narcotic
§ 4,000 -
analgesics and narcotic combinations,
excluding heroin, increased 95% from i 3,000
1999 to 2001. Q
2,000 -
o
1 1,000
E
z 0 -\
'^o
^7 '^e <>o
Year
Source:DrugAbuseWarning Networl< (DAWN), Substance
Abuseand Mental Health ServicesAdministration. USDHHS.
* Source: DrugAbuseWarning Network (DAWN), SubstanceAbuseand
Mental HealthServicesAdministration, US Dept.ofHealthand
HumanServices, http://dawninfo.samhsa.gov. DAWNisanational public
health surveillancesystemthatmonitorstrendsindrugabuserelated
emergencydepartmentvisits. Localestimatesarederivedfromasample
ofhospitalsin5countiesinthegreaterBoston area. Eachdrugfora
reported caseiscalled a"mention."Onedrug-related EDvisitcan have
uptofourspecificsubstanceslisted. DAWNdataarenotcollectedin
otherareasofMassachusetts.
Opioids: TrendsandCurrentStatusin Massachusetts Page4
Injury Surveillance Program, MDPH
TREATMENT AND PREVENTION^
TREATMENT FORADULT HEROIN USERS
Figure 7. Admissions to Substance Abuse
Treatment Services in MA:
• In 2002, there were 51,715 admissions Adult Heroin Users, 1992-2002
among Massachusetts adults (ages 18 and
over) for substance abuse treatment
60,000 n
services who reported having used heroin. 51,715
w
This represents a 17% increase between co 50,000 -
1999 and 2001, and an overall increase of '55
216% from 1992 through 2002. 1a(A 40,000 -
<
30,000 -
o
PATIENT CHARACTERISTICS FOR 2002
n 20,000 -
E3 16,337
• 73% (n=37,721) of patients were male and z 10,000 -
27% (n=13,988) were female.
0 -
• Over one third oftreatment admissions in
2002 were among persons between the ?o <9o ^^o '^(h
ages of 30 and 39 (n=19,041); the mean
Year
age was 33.6 years.
• 65% of patients were white, 9% were
black, and 22% were Latino. Source:BureauofSubstanceAbuseServices, Management
Infomnation System, MDPH.
• 66.7% of patients reported injection drug
use during the past year.
• 87.9% were unemployed, 24.7% were
homeless, and 24.3% had received prior
mental health treatment.
RESOURCES
SubstanceAbuseand Mental Health
Massachusetts DepartmentofPublic Health ServicesAdministration
vwvw.samhsa.qov
Bureau ofSubstanceAbuseServices
250 Washington Street, 3rd Floor Centerfor Substance Abuse Prevention
Boston MA, 02108 Tel. [phone]
www.samhsa.gov/centers/csap/csap.html
Tel. [phone]
Fax [phone] Centerfor Substance Abuse Treatment
TTY(617) 536-5186 Tel. [phone]
www.state.nna.us/dph/bsas/BSAS.htm
National ClearinghouseforAlcohol and Drug
Massachusetts DepartmentofPublic Health Information (NCADI)
CenterforHealth Information, Statistics, Research & Tel. [phone]
Evaluation
Injury Surveillance Program MassachusettsCommunity Health Information
2 Boylston Street, 6th Floor Profile (MassCHIP)
vwvw.masschip.state.ma.us/
Boston MA, 02116
Tel. [phone] Tel. 1-888-MAS-CHIP
Fax [phone] (in Massachusetts)
www.state.ma.us/dph/bhsre/isp/isp.htm
*Source: Bureau ofSubstanceAbuseServicesManagementInformation System(SAIVIIS), IVIDPH. SAMISincludesdata provided byall
BSASlicensedsubstanceabusetreatmentprograms. Datareflectadmissions, notpatients. Patientscan havemultipleadmissions.
Opioids: Trendsand CurrentStatusin Massachusetts Page5
InjurySurveillance Program, MDPH
Massachusetts Department of Public Health
Center for Health Information, Statistics, Research and Evaluation
Injury Surveillance Program (ISP)
2 Boylston Street, 6*^ Floor
Boston, MA 02116
ISP Director
Holly Hackman
ProjectStaff:
MariaCaterinaCiampi,Intern
KateChamberlin
,
DakshaGopal
BethC. Hume
LaurieJannelli
Cheng Mao
LoretaMcKeown
PatriceMelvin
BridgetNestor
LaVonneOrtega
VictoriaOzonoff
VeronicaVieira
This publication was supported bygrants #U17/CCU119390 and #U17/CCU119400fromthe CentersforDisease
Control and Prevention. Its contents are solelythe responsibilityofthe authorsand do notrepresenttheofficial views
ofthe Centersfor Disease Control and Prevention.
For Information on Substance Treatment and Services:
Contact the Department's
Bureau of Substance Abuse Services on-line at
www.state.ma.us/dph/bsas/BSAS.htm
OR
Call the
MASubstance Abuse Information and Education
HELPLINE®
1-800-327-5050
1