Increase in Unintentional Medication Overdose Deaths

Piercefield, Emily; Archer, Pam; Kemp, Philip; Mallonee, Sue

doi:10.1016/j.amepre.2010.05.016

Cited by 48 publications

(37 citation statements)

References 8 publications

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“…21 The significant increase in opioid-related deaths has raised the concern of many. 5,6,8 This problem has also been observed in the pediatric population. [22][23][24] Action at the national level includes the recent proposal from the Food and Drug Administration for the establishment of physician education programs for the prescribing of long-acting and extended-release opioids as part of their national opioid risk evaluation and mitigation strategy (the REMS program).…”

Section: Introductionmentioning

confidence: 88%

“…4 As part of this issue, there has been a startling increase in unintentional drug overdoses and related deaths since the late 1990s. 5,6 Reported overdose deaths involving opioid analgesics increased from 4,030 in 1999 to 14,800 in 2008. 7,8 Data from 2008 reveal that drug overdoses were the second leading cause of injury death in the United States, after motor vehicle crashes.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Cantrill

Brown

Carlisle

et al. 2012

Annals of Emergency Medicine

215

172

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This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED). This guideline is the result of the efforts of the American College of Emergency Physicians, in consultation with the Centers for Disease Control and Prevention, and the Food and Drug Administration. The critical questions addressed in this clinical policy are: (1) In the adult ED patient with noncancer pain for whom opioid prescriptions are considered, what is the utility of state prescription drug monitoring programs in identifying patients who are at high risk for opioid abuse? (2) In the adult ED patient with acute low back pain, are prescriptions for opioids more effective during the acute phase than other medications? (3) In the adult ED patient for whom opioid prescription is considered appropriate for treatment of new-onset acute pain, are short-acting schedule II opioids more effective than short-acting schedule III opioids? (4) In the adult ED patient with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing opioids on discharge from the ED outweigh the potential harms?

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Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Cantrill

Brown

Carlisle

et al. 2012

Annals of Emergency Medicine

215

172

View full text Add to dashboard Cite

show abstract

“…5,6 Although there is a rich historical literature on the demographics and event-level characteristics of heroin overdose, 7,8 our understanding of recent trends of opioid overdose is limited and largely based on health system and non-urban regional analyses. [9][10][11][12][13][14] Prescription opioid overdose has been documented among rural and suburban non-Hispanic white men, [9][10][11][12][13][14][15] middle-aged females, 16,17 and those using psychotherapeutic drugs. 2,18 Patients in safety net healthcare systems, including the Veterans Administration 19 and Medicaid, 20 are more likely to die of prescription opioid overdose compared to the general population.…”

Section: Introductionmentioning

confidence: 99%

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

et al. 2015

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Drug overdose is now the leading cause of unintentional death nationwide, driven by increased prescription opioid overdoses. To better understand urban opioid overdose deaths, this paper examines geographic, demographic, and clinical differences between heroin-related decedents and prescription opioid decedents in San Francisco from 2010 to 2012. During this time period, 331 individuals died from accidental overdose caused by opioids (310 involving prescription opioids and 31 involving heroin). Deaths most commonly involved methadone (45.9 %), morphine (26.9 %), and oxycodone (21.8 %). Most deaths also involved other substances (74.9 %), most commonly cocaine (35.3 %), benzodiazepines (27.5 %), antidepressants (22.7 %), and alcohol (19.6 %). Deaths were concentrated in a small, high-poverty, central area of San Francisco and disproportionately affected African-American individuals. Decedents in high-poverty areas were significantly more likely to die from methadone and cocaine, whereas individuals from more affluent areas were more likely die from oxycodone and benzodiazepines. Heroin decedents were more likely to be within a younger age demographic, die in public spaces, and have illicit substances rather than other prescription opioids. Overall, heroin overdose death, previously common in San Francisco, is now rare. Prescription opioid overdose has emerged as a significant concern, particularly among individuals in high-poverty areas. Deaths in poor and affluent regions involve different causative opioids and co-occurring substances.

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“…In several countries diversion has been linked to an increase in methadone-related fatalities and in extensive illicit use of buprenorphine. [7][8][9][10] Measures have been taken to reduce these risks, such as developing safer versions of the medications. 11 The first one to reach the market was Subuxone, a sublingual tablet where buprenorphine was combined with the opioid antagonist naloxone, which reduces the potential for abuse.…”

Section: Introductionmentioning

confidence: 99%

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Johnson

Richert

2014

Journal of Psychoactive Drugs

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BackgroundDiversion-patients who sell or share their medication-is a hotly debated but relatively unresearched phenomenon. We have investigated the prevalence of self-reported diversion of methadone and buprenorphine at OST programs in Sweden. We have also examined if demographic, treatment, and social factors can be associated with an increased risk of diversion. MethodsStructured interviews were conducted with 411 patients from eleven OST programs. A standardized questionnaire with 106 close-and five open-ended questions were used. 280 interviews were done on site, by the researchers, while 131 interviews were conducted by specially trained patients through privileged access interviewing. The data were analyzed through frequency-and averages-calculations, cross-tabulations, and logistic regression analysis. ResultsIn total, 24.1% (n=99) of the patients reported diversion in the past month. 67.6% (n=277) stated that they had diverted at some point. The peer interviews showed significantly higher levels of diversion (37.4% past month) compared with the researcher interviews (17.2%).Neither demographic factors, dosages, nor collection routines were associated with diversion.The likelihood of diversion was higher for patients on mono-buprenorphine (OR=5.64) and buprenorphine-naloxone (OR=2.10), than among methadone patients. Other factors which increased the likelihood of diversion were current illicit drug use (OR=5.60), having had 3 patients as a primary source of illicit methadone or buprenorphine prior to treatment (OR=3.39), and mainly socializing with active drug users (OR=2.12). ConclusionSelf-reported diversion was considerably higher than in previous studies. This is most likely due to the new methodological strategy we used, but may also partly be explained by low availability of OST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Efforts to decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, and expanded access to treatment, rather than on control measures.

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Increase in Unintentional Medication Overdose Deaths

Cited by 48 publications

References 8 publications

Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

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