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Margaret Warner, PhD

Trends in Drug Poisoning Mortality United States, 1980-2010. Margaret Warner, PhD. National Center for Health Statistics NAPHSIS Conference Seattle, Washington June 10, 2014. National Center for Health Statistics. Division of Vital Statistics, Mortality Statistic Branch.

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Margaret Warner, PhD

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  1. Trends in Drug Poisoning Mortality United States, 1980-2010 Margaret Warner, PhD National Center for Health Statistics NAPHSIS Conference Seattle, Washington June 10, 2014 National Center for Health Statistics Division of Vital Statistics, Mortality Statistic Branch

  2. How big is the problem?What drugs are involved?What are some of the challenges?What are we doing about it? Overview

  3. Motor vehicle traffic, poisoning, and drug poisoning death rates, 1999-2010 § NOTES: § In 1999, International Classification of Diseases, 10th Revision (ICD-10) replaced the previous revision of the ICD (ICD-9). SOURCE: CDC/NCHS, National Vital Statistics System

  4. Drug poisoning rates by country 1999-2010 Put movie here SOURCE: Rossen LM, Khan D, Warner M. Trends and Geographic Patterns in Drug-Poisoning Death Rates in the U.S., 1999–2009. Am J Prev Med. 45(6) e19-25. 2013

  5. Drug poisoning death rates SOURCE: CDC/NCHS, National Vital Statistics System

  6. Drug poisoning deaths involving opioid analgesics, by drug type NOTES: Opioid analgesic categories are not mutually exclusive. Deaths involving more than one opioid analgesic category shown in this figure are counted multiple times. SOURCE: CDC/NCHS, National Vital Statistics System

  7. Drug poisoning deaths involving other types of drugs NOTES: Deaths involving more than one drug shown in this figure are counted multiple times. SOURCE: CDC/NCHS, National Vital Statistics System

  8. Drug poisoning deaths involving opioid analgesics, by drug type What are the “Other opioids” involved in these deaths? NOTES: Opioid analgesic categories are not mutually exclusive. Deaths involving more than one opioid analgesic category shown in this figure are counted multiple times. Natural and semi-synthetic opioid analgesics include morphine, oxycodone and hydrocodone; and synthetic opioid analgesics include fentanyl. SOURCE: CDC/NCHS, National Vital Statistics System

  9. Drug poisoning deaths involving opioid analgesics, by drug type What are the “Other opioids” involved in these deaths? NOTES: Opioid analgesic categories are not mutually exclusive. Deaths involving more than one opioid analgesic category shown in this figure are counted multiple times. Natural and semi-synthetic opioid analgesics include morphine, oxycodone and hydrocodone; and synthetic opioid analgesics include fentanyl. SOURCE: CDC/NCHS, National Vital Statistics System

  10. From medical death investigation to multiple cause of death data Literal text Literal text Literal text Multiple cause of death files Literal text Mortality Medical Data System

  11. Specific drugs identified using keyword search of literal text file, 2010 Fentanyl Morphine Hydrocodone Propoxyphene Oxycodone T40.4 Other synthetic narcotics T40.2 Other Opioids NOTES: Deaths involving more than one drug shown in this figure are counted multiple times. SOURCE: CDC/NCHS, National Vital Statistics System and SuperMICAR literal text

  12. Percent of drug poisoning deaths with drug specified on death certificate, 2008-2010

  13. Percent of drug poisonings with drugs specified by State Death Investigation System, 2008-2010

  14. Percent drug poisoning deaths by manner and state

  15. Variability in cause of death for drug poisoning deaths • Detail of information recorded varies • Example: “multiple drug intoxication” • Example: “methadone ingestion” • Manner of death varies • Toxicological testing for drugs varies by type of decedent, type of jurisdiction or over time • Testing for specific drugs depends on perceived need for test and the cost of the test

  16. WA ME MT ND MN VT OR NH MA ID WI NY SD WY MI RI PA IA NJ NE NV OH DE IL IN UT MD CO WV VA KS MO CA KY NC TN OK AZ AR SC NM GA AL MS TX LA FL AK Centralized State ME Office County/District-based ME (physician) Offices HI County-based mixture of ME and Coroner Offices County-based coroner Offices Death investigation systems * * * * * * * * * * CT * * * * * * * * * * * * * * * * * State ME Sources: National Institute of Justice, Scientific Working Group on Medical Death Investigation, Death Investigation Systems, 2011 Bureau of Justice Statistics, Census of Medical Examiner and Coroner Offices, 2004

  17. Number of board certified forensic pathologists by county Source: National Institute of Justice, Scientific Working Group on Medical Death Investigation, Workplace Locations of Board Certified Forensic Pathologists in the United States who Perform Medicolegal Autopsies for Medical Examiner/Coroner Systems: 2012

  18. NCHS/CDC outreach to ME/C Working to improve national mortality surveillance by: • Promoting quality and consistency in death investigations • Enhancing the efficiency of data collection • Facilitating information sharing among medical death investigators. • Coordinating public health surveillance efforts

  19. What you can do Continue to monitor drugs… • Review your data… • Querying … See next talk • Coordinate with medicolegal officer in your state • Disseminate your state vital statistics data • “Special Emphasis Report” template from CDC National Center of Injury Prevention and Control

  20. Questions? Margaret Warner, PhD Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics 3311 Toledo Rd. Hyattsville, MD 20782 Phone: 301-458-4556 mwarner@cdc.gov

  21. Medical Death Investigation Systems Death investigation systems are governed by state and county laws and regulations Over 2,000 medical death investigation offices System variation includes: • Medical examiner, coroner, mixed, hybrid • State- or county-based system, State ME • Elected, appointed • Some offices in health departments, some law enforcement, some university affiliations

  22. Recommendations from Expert Panels National Academies of Sciences report, 2009

  23. Media

  24. National Efforts National Commission on Forensic Science • Convened by the Department of Justice and the National Institute of Standards and Technology • Initiative to strengthen the practice of forensic science • Subcommittee on Medicolegal Death Investigation Health agency involvement • White House Office of Science and Technology Policy • Medical aspects of medicolegal death investigation

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