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Risk Factors for Prescription Opioid Death – Utah, 2008–2009

Risk Factors for Prescription Opioid Death – Utah, 2008–2009. William A. Lanier, DVM, MPH Kristina Russell, MPH. Utah Department of Health. Office of Surveillance, Epidemiology, and Laboratory Services. Scientific Education and Professional Development Program Office.

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Risk Factors for Prescription Opioid Death – Utah, 2008–2009

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  1. Risk Factors for Prescription Opioid Death – Utah, 2008–2009 William A. Lanier, DVM, MPH Kristina Russell, MPH Utah Department of Health Office of Surveillance, Epidemiology, and Laboratory Services Scientific Education and Professional Development Program Office

  2. Utah News Clippings about Prescription Drug Death

  3. Deaths from Prescription Opioids Utah, 2000–2009 265 56

  4. Prescription Opioid Use and Safety • Bind to opioid receptors in the central nervous system • Therapeutic Use • Analgesia • Side Effects • Respiratory depression • Dependence

  5. Causes of Prescription Opioid Death • Nonmedical use? • Obtaining from nonprescription sources • Using more than prescribed • Increase in opioids prescribed? • Inherent risks of drugs • Unsafe prescribing practices • Risk factors inadequately understood • Lack of knowledge about decedents • Lack of control group who used opioids

  6. Study Objective and Design • Identify risk factors for death • People who died from prescription opioids • People who used prescription opioids • Compared populations

  7. Data Sources: Decedents • Medical examiner records • Death certificates • Next-of-kin interviews

  8. Decedents (N = 254) • October 26, 2008–October 25, 2009 • Prescription opioid cause of death • Accidental or intent-undetermined manner of death • Utah residents • ≥18 years of age • Interview completed by next-of-kin

  9. Data Source: Comparison Group • Behavioral Risk Factor Surveillance System (BRFSS) • Self-reported • Landline only • Non-institutionalized • Weighted to reflect state population • Prescription pain medication questions added 2008

  10. Comparison Group (N = 1,308) • Utah 2008 BRFSS • Used prescription opioid in prior 12 months • Utah residents • ≥18 years of age

  11. Statistical Methods • Exposure prevalence (prevalence of characteristics) • Exposure prevalence ratios (EPR) as measure of association • 95% Confidence intervals (CI) EPR = Decedent prevalence Comparison prevalence

  12. Characteristics Compared and Denominators

  13. Pain Medication Source and Use

  14. Pain Type among Decedents

  15. Chronic Pain Comparison (Obtained via Prescription) Acute pain only 6% Acute pain only 78% EPR = 3.0 (95% CI = 2.7–3.3)

  16. Prescription Opioid Use and Chronic Pain • Use outside prescription increases risk • Not all decedents used outside prescription • Majority of decedents obtained by prescription • Chronic pain in majority of decedents • Prevalence higher if obtained via prescription

  17. Risk by Specific Opioid

  18. Age Category of Decedents and Comparison Group

  19. Age Category, Stratified by Sex

  20. Education and Smoking

  21. Education and Smoking • Low education level • Predispose to lack of insurance and other factors • Smoking rates higher among low educated • Association mildly confounded by education • Smoking rates higher among substance abusers • Could confound association • Population susceptible to addiction

  22. Marital Status and Health Insurance

  23. Marital Status and Health Insurance • Divorced/separated • Indicates lack of social support • Increase risky drug use • Decrease chance of timely care • Lack of health insurance • Limits access to care • Consequence of chronic pain or substance abuse

  24. Illicit Substance Use History (Lifetime)among Decedents (N = 251)

  25. Mental Illness

  26. Limitations • Interview response influences • Social desirability • Recall • Lack of knowledge about decedents • Incomplete comparability of data sources • Potential risk factors not analyzed • Illicit substance use • Mental illness • Confounding variables

  27. Conclusion • Risk of death complicated • Use outside prescription bounds risky • Decedents needed chronic pain therapy • Other factors important • Providers can recognize risk and control exposure

  28. Recommendations • Prescribers should screen chronic pain patients • Update screening tools to include risk factors • Continue research on risk factors • Smoking • Illicit substance use • Mental illness

  29. Acknowledgments Scientific Education and Professional Development Program Office Office of Surveillance, Epidemiology, and Laboratory Services

  30. Utah Department of Health Contact Information • William Lanier • wlanier@utah.gov • 801-538-6527 • Erin Johnson • erjohnso@utah.gov • 801-538-6542 • Kristina Russell • krisrussell@utah.gov • 801-538-9297

  31. Extra Slides

  32. Other Potential Risk Factors • Urban • Military • White • Hispanic

  33. Sex

  34. Unemployed and Lived Alone

  35. Body Mass Index (BMI)

  36. Numbers of Drugs as Decedent CODs (N = 254)

  37. Morphine or Heroin? • Heroin metabolizes to morphine • Prescription morphine • Heroin • Unknown

  38. Alcohol Use and Cause of Death • 88% of decedents ever drank • 14% of decedents drank daily in last 2 months • 2% of comparison group drank daily in last month • COD among decedents: 10%

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