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Henry Spiller edited

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What Every Clinician Needs to Know About Overdoses …

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

Published in Health & Medicine
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  • 1. What Every Clinician Needs to Know About Overdoses– poison center surveillance April 10-12, 2012Walt Disney World Swan Resort
  • 2. Accepted Learning Objectives:1. Describe the correlation betweenprescription drug abuse and the rate ofopioid-related overdose deaths (accidentaland deliberate) and hospital admissions.2. State the value of Poison Control Centerdata in formulating strategies to reduceprescription drug diversion health careassociated 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 sourcesSOURCES: National Vital Statistics System, 1999-2008; Automation of Reports andConsolidated 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. GeographicSource - NPDS
  • 10. GeographicSource - NPDS
  • 11. GeographicSource - NPDS
  • 12. Drug overdose death rates by state (2008) Source – www.cdc.gov – national vital statistics system
  • 13. Drug overdose deathrates by state (2008)Of the top 6 states identified in2008 fatalities• 4 of 6 - New Mexico, WestVirginia, Utah and Kentucky -were hot spots in Poison centerdata in 2001 and onward Source – MMWR 2011;60:1487-1492
  • 14. GeographicSource – Kentucky Regional Poison Control center
  • 15. GeographicSource – Kentucky Regional Poison Control center
  • 16. GeographicSource – 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 casesRef: 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 OpioidsSource – 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 opioidsKentucky 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