What Every Clinician Needs to Know About Overdoses National Rx Drug Abuse Summit 4-10-12

1. What Every Clinician
Needs to Know
About Overdoses–
poison center
surveillance
April 10-12, 2012
Walt Disney World Swan Resort

2. Accepted Learning Objectives:
1. Describe the correlation between
prescription drug abuse and the rate of
opioid-related overdose deaths (accidental
and deliberate) and hospital admissions.
2. State the value of Poison Control Center
data in formulating strategies to reduce
prescription drug diversion health care
associated problems.

3. Disclosure Statement
• Henry Spiller has disclosed no relevant,
real or apparent personal or
professional financial relationships.
Henry A. Spiller, MS, D.ABAT,
FAACT
Director, Kentucky Regional
Poison Control Center
Henry.spiller@nortonhealthcare.org

4. US Poison centers – brief
overview
• Cover the entire US population – all 50
states and US territories (presently 57
Centers)
• Access from general public and
healthcare professionals
• 24/7/365, staffed by physicians, nurses
and pharmacist
• Real time database
• Assess, triage and manage poison Patients
– Act as primary care for non-HCF patient
– Act as toxicology consults for ED and inpatients

5. Examples of what is tracked in
database.
• Demographic (age, gender, date,
geographic location)
• Specific substances
• Clinical effects
– Cardiovascular, Dermal, Gastrointestinal,
Hemetological and Hepatic, Neurological,
Respiratory, Ocular, Other (e.g. acidosis,
hypoglycemia, fever, etc)
• Therapies - 68 specific therapies
• Outcomes

6. 1999 to 2011 opioid exposures - US
• Prescription Opioid
exposures have
increased more
than 150%
• During same 13 year
period all poisoning
exposure increased
8.3%
• Opioids increased
from 2% to 4% of
poisoning exposures
in US

7. Comparison of PC data with
other national data sources
SOURCES: National Vital Statistics System, 1999-2008; Automation of Reports and
Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA),
1999-2010; Treatment Episode Data Set, 1999-2009

8. 1999 to 2011 opioid exposures - Kentucky
• Prescription Opioid
exposures have
increased 164%
• During same 14
year period all
poisoning exposure
increased 2%
• Opioids increased
from 2% of
exposures to 5%

9. Geographic
Source - NPDS

10. Geographic
Source - NPDS

11. Geographic
Source - NPDS

12. Drug overdose death rates by state
(2008)
Source – www.cdc.gov – national vital statistics system

13. Drug overdose death
rates by state (2008)
Of the top 6 states identified in
2008 fatalities
• 4 of 6 - New Mexico, West
Virginia, Utah and Kentucky -
were hot spots in Poison center
data in 2001 and onward
Source – MMWR 2011;60:1487-1492

14. Geographic
Source – Kentucky Regional Poison Control center

15. Geographic
Source – Kentucky Regional Poison Control center

16. Geographic
Source – Kentucky Regional Poison Control center

17. Rx Opioid exposures in US 2001 – 2011
• Methadone
increase – 181%
• Tramadol increase -
240%
• Morphine increase –
117%
• Hydrocodone
increase - 101%
• Oxycodone
increase 103%
• Codeine decrease
13%

18. Rx Opioid exposures in KY 2001 – 2011
• Tramadol increase -
346%
• Oxycodone
increase 72%
• Hydrocodone
increase - 34%
• Morphine increase –
51%
• Methadone
decrease – 5%
• Codeine decrease
52%

19. Poison center as Sentinels
Effect of Scheduling on Tramadol cases
Ref: Spiller HA, et al. Effect of scheduling tramadol as a controlled substance on poison center exposures to tramadol. Ann
Pharmacotherapy 2010:44:1016-1021

20. Age of Opioid overdoses reported
to poison center

21. Impact on Healthcare facility
utilization for Rx Opioids
Source – KY Regional Poison Control Center

22. Percentage of hospital utilization
for poisonings involving Rx
opioids
Source – Kentucky Regional Poison Control Center

23. Rx drug misuse/abuse – not just
opioids
Kentucky National data

24. Medical outcome from opioids by year
• Major effects
increased by
743%
• Moderate
effects
increased by
397%
• Fatalities
increased by
172%
Source – Kentucky Regional Poison Control Center

25. Public health roles of a Poison
Center
• Assess, triage and manage poison Patients
– Act as primary care for non-HCF patient
– Act as toxicology consults for ED and inpatients
• Toxico- and Public heath surveillance (real-
time)
• Public and professional Education
• Research data on product safety and
toxicity

26. Use of Poison Centers in
formulating strategies
• Real Time monitor of changes
– Changes in specific drugs
– Changes in demographics
– Geographic changes
• Education
– Poison centers have trained and board
certified toxicologists and Specialists
– Existing outreach education efforts to
healthcare professionals and public