What Every Clinician   Needs to Know  About Overdoses–    poison center    surveillance       April 10-12, 2012Walt Disney...
Accepted Learning Objectives:1. Describe the correlation betweenprescription drug abuse and the rate ofopioid-related over...
Disclosure Statement•  Henry Spiller has disclosed no relevant,   real or apparent personal or   professional financial re...
US Poison centers – brief            overview•  Cover the entire US population – all 50   states and US territories (prese...
Examples of what is tracked in             database.•  Demographic (age, gender, date,   geographic location)•  Specific s...
1999 to 2011 opioid exposures - US•  Prescription Opioid   exposures have   increased more   than 150%•  During same 13 ye...
Comparison of PC data with    other national data sourcesSOURCES: National Vital Statistics System, 1999-2008; Automation ...
1999 to 2011 opioid exposures - Kentucky•  Prescription Opioid   exposures have   increased 164%•  During same 14   year p...
GeographicSource - NPDS
GeographicSource - NPDS
GeographicSource - NPDS
Drug overdose death rates by state             (2008) Source – www.cdc.gov – national vital statistics system
Drug overdose deathrates by state (2008)Of the top 6 states identified in2008 fatalities• 4 of 6 - New Mexico, WestVirgini...
GeographicSource – Kentucky Regional Poison Control center
GeographicSource – Kentucky Regional Poison Control center
GeographicSource – Kentucky Regional Poison Control center
Rx Opioid exposures in US 2001 – 2011•  Methadone   increase – 181%•  Tramadol increase -   240%•  Morphine increase –   1...
Rx Opioid exposures in KY 2001 – 2011•  Tramadol increase -   346%•  Oxycodone   increase 72%•  Hydrocodone   increase - 3...
Poison center as Sentinels                   Effect of Scheduling on Tramadol casesRef: Spiller HA, et al. Effect of sched...
Age of Opioid overdoses reported        to poison center
Impact on Healthcare facility      utilization for Rx OpioidsSource – KY Regional Poison Control Center
Percentage of hospital utilization  for poisonings involving Rx             opioids Source – Kentucky Regional Poison Cont...
Rx drug misuse/abuse – not just              opioidsKentucky           National data
Medical outcome from opioids by year•  Major effects   increased by   743%•  Moderate   effects   increased by   397%•  Fa...
Public health roles of a Poison               Center•  Assess, triage and manage poison Patients  –  Act as primary care f...
Use of Poison Centers in     formulating strategies•  Real Time monitor of changes  –  Changes in specific drugs  –  Chang...
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What Every Clinician Needs to Know About Overdoses
National Rx Drug Abuse Summit 4-10-12

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Henry Spiller edited

  1. 1. What Every Clinician Needs to Know About Overdoses– poison center surveillance April 10-12, 2012Walt Disney World Swan Resort
  2. 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. 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. 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. 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. 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. 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. 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. 9. GeographicSource - NPDS
  10. 10. GeographicSource - NPDS
  11. 11. GeographicSource - NPDS
  12. 12. Drug overdose death rates by state (2008) Source – www.cdc.gov – national vital statistics system
  13. 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. 14. GeographicSource – Kentucky Regional Poison Control center
  15. 15. GeographicSource – Kentucky Regional Poison Control center
  16. 16. GeographicSource – Kentucky Regional Poison Control center
  17. 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. 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. 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. 20. Age of Opioid overdoses reported to poison center
  21. 21. Impact on Healthcare facility utilization for Rx OpioidsSource – KY Regional Poison Control Center
  22. 22. Percentage of hospital utilization for poisonings involving Rx opioids Source – Kentucky Regional Poison Control Center
  23. 23. Rx drug misuse/abuse – not just opioidsKentucky National data
  24. 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. 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. 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

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