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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
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

prescription opioid use and safety
Prescription Opioid Use and Safety
  • Bind to opioid receptors in the central nervous system
  • Therapeutic Use
    • Analgesia
  • Side Effects
    • Respiratory depression
    • Dependence
causes of prescription opioid death
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
study objective and design
Study Objective and Design
  • Identify risk factors for death
  • People who died from prescription opioids
  • People who used prescription opioids
  • Compared populations
data sources decedents
Data Sources: Decedents
  • Medical examiner records
  • Death certificates
  • Next-of-kin interviews
decedents n 254
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
data source comparison group
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
comparison group n 1 308
Comparison Group (N = 1,308)
  • Utah 2008 BRFSS
  • Used prescription opioid in prior 12 months
  • Utah residents
  • ≥18 years of age
statistical methods
Statistical Methods
  • Exposure prevalence (prevalence of characteristics)
  • Exposure prevalence ratios (EPR) as measure of association
  • 95% Confidence intervals (CI)

EPR =

Decedent prevalence

Comparison prevalence

chronic pain comparison obtained via prescription
Chronic Pain Comparison (Obtained via Prescription)

Acute pain only 6%

Acute pain only 78%

EPR = 3.0 (95% CI = 2.7–3.3)

prescription opioid use and chronic pain
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
education and smoking
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
marital status and health insurance
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
limitations
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
conclusion
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
recommendations
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
slide29

Acknowledgments

Scientific Education and Professional Development Program Office

Office of Surveillance, Epidemiology, and Laboratory Services

utah department of health contact information
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
other potential risk factors
Other Potential Risk Factors
  • Urban
  • Military
  • White
  • Hispanic
morphine or heroin
Morphine or Heroin?
  • Heroin metabolizes to morphine
  • Prescription morphine
  • Heroin
  • Unknown
alcohol use and cause of death
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%