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Recent findings from NCHS: Methadone deaths, 1999-2004

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Recent findings from NCHS: Methadone deaths, 1999-2004

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    1. Recent findings from NCHS: Methadone deaths, 1999-2004 Lois A. Fingerhut, MA Office of Analysis and Epidemiology National Center for Health Statistics SAMHSA, CSAT, July 2007

    2. Presentation Overview Poisoning mortality in perspective Review of NCHS published findings on methadone deaths Other insights from national mortality data for methadone Role of collaborative efforts

    3. Trends in leading mechanisms of injury death: 1968-2004 In 2004, the number of deaths due to poisoning (30,308) exceeded the number of firearm deaths by 739. Firearms and motor vehicle traffic deaths have been the 2 leading causes of injury death. The age-adjusted poisoning death rate increased 45% from 1999 to 2004 reaching 10.3 per 100,000 as compared with the 3% decline in the age adjusted firearm death rate to 10.0 per 100,000 in 2004. There was no change in the rate for motor vehicle traffic deaths (14.7 per 100,000) In 2004, the number of deaths due to poisoning (30,308) exceeded the number of firearm deaths by 739. Firearms and motor vehicle traffic deaths have been the 2 leading causes of injury death. The age-adjusted poisoning death rate increased 45% from 1999 to 2004 reaching 10.3 per 100,000 as compared with the 3% decline in the age adjusted firearm death rate to 10.0 per 100,000 in 2004. There was no change in the rate for motor vehicle traffic deaths (14.7 per 100,000)

    4. Published findings to date

    5. Age-specific methadone death rates: 1999-2004 Published in Health E-Stat; available on NCHS website www.cdc.gov/nchs/injury.htm Rates highest for 35-54 ; it should not go unnoticed however that the 2004 rate for those 55-64 (despite it being low)_ was 7 times the rate in 1999 and rate for 15-24 year olds was 11 times what it was in 1999 while rates in other age groups increased less than that Published in Health E-Stat; available on NCHS website www.cdc.gov/nchs/injury.htm Rates highest for 35-54 ; it should not go unnoticed however that the 2004 rate for those 55-64 (despite it being low)_ was 7 times the rate in 1999 and rate for 15-24 year olds was 11 times what it was in 1999 while rates in other age groups increased less than that

    6. Methadone deaths by underlying mechanism and intent: 1999-2004 Overall, the number of poisoning deaths mentioning methadone increased nearly 400% growing from 4% of all poisoning deaths to 13% of all in 2004. Unintentional poisoning mentioning meth increased 414%Overall, the number of poisoning deaths mentioning methadone increased nearly 400% growing from 4% of all poisoning deaths to 13% of all in 2004. Unintentional poisoning mentioning meth increased 414%

    7. Percent distribution of methadone deaths by cause and intent: 1999-2004 1999-2004 ¾ to nearly 80% coded to unintentional poisoning Undetermined—11-13% Suicide by poisoning 7 down to 5 % Noninjury deaths-6 down to 4%1999-2004 ¾ to nearly 80% coded to unintentional poisoning Undetermined—11-13% Suicide by poisoning 7 down to 5 % Noninjury deaths-6 down to 4%

    8. Other insights from national mortality data for methadone

    9. Methadone deaths by age and sex: 2004 Female injury - 34% of deaths Male injury 63%-- 4% of meth deaths were not injuries Female meth deaths peak in their 40’s while among makes there is a less obvious pattern to the number of deathsFemale injury - 34% of deaths Male injury 63%-- 4% of meth deaths were not injuries Female meth deaths peak in their 40’s while among makes there is a less obvious pattern to the number of deaths

    10. Methadone death rates by age and sex: 2003-04 Meth death rates among males tend to be twice the rates for females across this part of the age span where the rates are highestMeth death rates among males tend to be twice the rates for females across this part of the age span where the rates are highest

    11. Methadone-related unintentional poisoning death rates in 2003 and 2004, for states with highest rates in 2004 By State- these are crude death rates ranked by rates in 2004. W VA’s rate in 04 was “nearly” higher than that in Maine- z=1.94; In both states the rates increased nearly 50% from 2003 to 2004.By State- these are crude death rates ranked by rates in 2004. W VA’s rate in 04 was “nearly” higher than that in Maine- z=1.94; In both states the rates increased nearly 50% from 2003 to 2004.

    12. Most common ICD-10 code combinations with T40.3 (methadone): 2004 Here are some new data from a file only recently created at NCHS. We looked at all causes of death (not just poisoning or other injury) and found that in 1304 instances T40.3 was the only substance mentioned (all pois and txeff codes). That is a conservative number because the next leading combination of codes includes T50.9 and in some portion of those 576 deaths, meth was the only drug mentioned. So at least a third and as many as 40 some odd % of meth deaths only mention methadone. Here are some new data from a file only recently created at NCHS. We looked at all causes of death (not just poisoning or other injury) and found that in 1304 instances T40.3 was the only substance mentioned (all pois and txeff codes). That is a conservative number because the next leading combination of codes includes T50.9 and in some portion of those 576 deaths, meth was the only drug mentioned. So at least a third and as many as 40 some odd % of meth deaths only mention methadone.

    13. Other drugs mentioned with methadone T50.9 Other and unspecified drugs, medicaments and biological substances T40.5 Cocaine T42.4 Benzodiazepines T40.2 Other opioids

    14. Age-specific death rates for methadone-only deaths: 1999-2004 Increases since 1999 472% 25-34 256% 35-44 495% 45-54 About a third of all meth deathsIncreases since 1999 472% 25-34 256% 35-44 495% 45-54 About a third of all meth deaths

    15. Death certificate literals tell us… What is written on each line sequencing the cause of death; and If death is from an injury, what is written in the “describe how injury occurred” box. ---- This is the first file of literals Probably to be housed in the Research Data Center at NCHS. Need to examine closely for confidential information and coding quality

    16. What we gain from the literals Lines 1-4 from Part 1 of the death certificate Contain what the physician wrote about the sequencing patterns of causes. Line 5 from Part 2 of the death certificate Includes other important diseases or conditions existing at the time of death that may have contributed to death but were not part of the sequence in Part I. How injury occurred If present, generally determines underlying external cause of death.

    17. Example: Male 14 years Underlying cause- Y12 Undetermined drug poisoning Other codes T40.3, T50.9 (?) Line 1- Methadone poisoning How injury occurred: “Consumed a prescription medication that was not prescribed to him.” Place of death: unspecified

    18. Example: Female under 1 year Underlying cause: X85 Homicide by poisoning Other codes: T40.3 Line 1: Methadone intoxication How injury occurred: “Fed methadone” Place of injury: home

    19. Example: Male 25 years Underlying cause: K85 Other codes: T40.3, T50.9, X42 Line 1: Acute hemorrhagic pancreatitis Line 5: Acute methadone intoxication How injury occurred: Drug overdose Place: Home

    20. Female 14 years Underlying cause: X42 Unintentional drug poisoning Other codes: J18.9, T40.3 Line 1: Toxic effects of methadone Line 5-part 2: Acute pneumonia How injury occurred: Found unresponsive at home Place: home

    21. Example: Male 25 years Underlying cause: X62 Suicide by poisoning Other codes R29.8, T40.3, T50.9 Line 1: Central nervous system depression Line 2: Acute methadone intoxication How injury occurred: Apparent intentional drug overdose Place: home

    22. Role of Collaborations

    23. Key organizations and people DEA SAMSHA Medical examiners

    24. Issues to address Need for continued surveillance of narcotic drug use Lack of current information from death certificates Linking data across sources through systems like NVDRS

    25. Thank you Lois A. Fingerhut Special Assistant for Injury Epidemiology, Office of Analysis and Epidemiology National Center for Health Statistics LFingerhut@cdc.gov Special thanks to my colleagues Li-Hui Chen and Margaret Warner for programming assistance with the new file of death certificate “literals.”

    26. A new drug to be tracking

    27. Death rates for methadone and fentanyl (T40.4) by age and sex: 2004

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