Transcript Document

Avy Redus, MS
Project Coordinator
[email protected]
Claire Nguyen, MS
Injury Epidemiologist
[email protected]
Oklahoma State Department of Health
Injury Prevention Service
405-271-3430
http://poison.health.ok.gov
BACKGROUND
Poisoning
 Ingestion, inhalation, absorption, or contact with a
substance resulting in a toxic effect or bodily harm.
Unintentional
 Individual did not intend harm to themselves or
someone else
 May intentionally take a drug, but did not intend to
harm themselves
METHODS
Office of the Chief Medical Examiner
Centralized system
IPS receives ME reports for all non-natural
deaths
Narrative
Autopsy
Toxicology
Manner of death
12
Rate per 100,000 Population
10
Unintentional drug overdose death rates in the U.S.
have more than tripled since 1990.
8
6
4
2
0
1990
1992
1994
1996
1998
2000
2002
2004
2006
*Deaths are those for which poisoning by drugs (illicit, prescription, and over-the-counter) was the underlying cause.
Source: Centers for Disease Control and Prevention, 2013
2008
2010
MAGNITUDE OF THE PROBLEM, U.S.
•15,000 deaths annually
•In 2010, 1 in 20 used pain killers for
nonmedical purposes
•Enough prescription painkillers were
prescribed in 2010 to medicate every
American adult around-the-clock for
a month.
Source: Centers for Disease Control and Prevention, 2012
UNINTENTIONAL POISONING DEATH RATES,
OKLAHOMA AND THE UNITED STATES, 1999-2010
Rate per 100,000 Population
25
20
15
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Oklahoma
US
Source: WISQARS, Centers for Disease Control and Prevention
UNINTENTIONAL POISONING AND MOTOR VEHICLE CRASH
DEATH RATES, OKLAHOMA, 1999-2010
Rate per 100,000 Population
25
20
15
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Unintentional Poisoning
Source: WISQARS, Centers for Disease Control and Prevention
MVC
MORTALITY RATES BY AGE GROUP* AND GENDER,
UNINTENTIONAL POISONING, OKLAHOMA, 2007-2012
45
Rate per 100,000 Population
40
35
30
25
Males
Females
20
15
10
5
0
15-24
25-34
35-44
45-54
Age Group
55-64
65-74
*Decedents under age 15 and over age 74 were excluded due to small number of cases (<1% of all UP deaths)
Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database (Abstracted from Medical Examiner
reports)
DEATHS INVOLVING PRESCRIPTION DRUGS, ILLICIT DRUGS, OR
ALCOHOL BY YEAR OF DEATH, UNINTENTIONAL POISONING,
OKLAHOMA, 2007-2012
800
Number of Deaths
700
600
500
All poisonings
400
Prescription
Alcohol
300
Methamphetamine
Cocaine
200
100
0
2007
2008
2009
2010
Year of Death
2011
Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database
(Abstracted from Medical Examiner reports)
2012
SUBSTANCES INVOLVED IN UNINTENTIONAL
POISONING DEATHS, OKLAHOMA, 2007-2012
Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database
(Abstracted from Medical Examiner reports)
MEDICATIONS
 Most common
medications (number of
deaths);
 Oxycodone (791)
 Hydrocodone (787)
 Alprazolam (733)
 Methadone (628)
 Morphine (463)
Medication Type
Prescription medication
Narcotic analgesic
Anti-anxiety
Muscle relaxant
Antidepressant
Tri-cyclic antidepressant
Non-narcotic analgesic
Antipsychotic
Respiratory
Hypnotic/sedative
Antiemetic
CNS stimulant
Other**
Over the counter
Number
3075
2677
1007
305
252
186
186
47
52
39
31
25
60
143
Rate
13.7
12.0
4.5
1.4
1.1
0.8
0.8
0.2
0.2
0.2
0.1
0.1
0.3
0.6
Unintentional Poisoning Death Rates by County of Residence1, Oklahoma, 2007-2012
Cimarron
Texas
Beaver
Woods
Harper
Alfalfa
Nowata
Kay
Grant
Washington
Osage
Woodward
Rogers
Noble
Garfield
Ottawa
Craig
Mayes
Pawnee
Major
Delaware
Ellis
Rates per 100,000
population
Blaine
Roger Mills
Canadian
Beckham
Washita
State
rate2:
17.5
Cherokee
Sequoyah
Okfuskee
Greer
Harmon
Grady
Kiowa
McClain
Pittsburg
Latimer
Le Flore
Pontotoc
Coal
Murray
Stephens
Tillman
Haskell
Hughes
Garvin
Comanche
Jackson
PottaSeminole
watomie
Pushmataha
Cotton
Carter
Johnston
Atoka
Jefferson
Love
1County
Adair
Muskogee
Okmulgee
Oklahoma
Cleveland
Caddo
12.6 – 17.8
<5 deaths
Wagoner
Logan
McIntosh
17.9 – 21.0
7.6 – 12.5
Kingfisher
Creek
Lincoln
Custer
Top 5 counties
21.1 – 34.2
Tulsa
Payne
Dewey
of residence was unknown for 31 persons.
Source: OSDH, Injury Prevention Service, Unintentional Poisonings Database
(Abstracted from Medical Examiner reports)
Marshall
Bryan
Choctaw
McCurtain
LEGAL CONSEQUENCES
HEALTH CONSEQUENCES
SOCIAL CONSEQUENCES
FINANCIAL CONSEQUENCES
WHY HAS PRESCRIPTION
DRUG ABUSE/MISUSE
BECOME SO PREVALENT?
WHAT CAN YOU DO?
SAFE USE
• Never take prescription
medication that is not
prescribed to you
• Never take your prescription
medication more often or in
higher doses than
prescribed
• Never drink alcoholic
beverages while taking
prescription medications
• Never share your
prescription medications
with anyone
• Taking prescription pain
medications with other
depressants such as sleep
aids, anti-anxiety
medications, or cold medicine
can be dangerous
• Tell your healthcare provider
about ALL medicines and
supplements you take
SAFE STORAGE
•Keep your prescription
drugs in a secure location
to make sure kids, family,
and guests don’t have
access to your medications
•Know where your
prescription medications
are at all times
•Keep prescription pills in
the original bottle with the
label attached, and the
child resistant cap secured
•Keep track of how many
prescription pills are in
your bottle so you are
immediately aware if any
are missing
SAFE DISPOSAL
• Please take your medications
to a permanent collection site
(drop box) or a special
community take-back event
• Call your city or county law
enforcement professionals
• Do not flush prescription
drugs down the toilet unless
information on your
prescription label or FDA
specifically instructs you to do
so.
• Follow FDA guidelines when
throwing the drugs in
household trash
WHAT CAN COMMUNITIES DO?
•Engage in community take-back events
•Get involved
• Town hall meetings
• Community coalitions
•Community-based prevention education
•Support groups
•Promote safe use, storage, and disposal
•Promote the use of the PMP
•Naloxone
WHAT CAN BUSINESSES DO?
•Active promotion of a referral to treatment hotline (211)
•Provide educational information of prescription drug
abuse/misuse
•Explanation of substance abuse services in new employee
orientation
•Onsite support services
(employee benefits,
employee assistance program,
counselor, clinician, etc.)
WHAT CAN BUSINESSES DO?
Adopt workplace prescription drug policies
•
•
•
•
Prohibited behavior
Major medical insurance
Pharmacy benefit program
EAP
• Crisis intervention
• Assessment, referral
• Short-term and follow-up counseling
• Treatment monitoring
WHAT SHOULD PARENTS DO?
Educate yourself
•
•
•
•
Defining
Risks
Signs and Symptoms
Prevention
Communicate the risks of
prescription drug
abuse/misuse to your kids
• Children who know the risks of
drugs at home are up to 50% less
likely to use drugs than those who
do not get the education
Safeguard your medicine
cabinet
• Keep prescription medicine in a
secure location; lock them up
• Count and monitor the number
of pills you have
• Ask your friends and family
members to do the same
Get help
• 211
• 1-855-DRUGFREE
(1-855-378-4373)
SIGNS AND SYMPTOMS OF A DRUG OVERDOSE EMERGENCY
• Won’t awaken when aroused
• Bluish purple skin tones for lighter skinned people and grayish or ashen
tones for darker skinned people
• Slow, shallow, erratic, or absent breathing
• Snore-like gurgling or choking sounds
• Elevated body temperature
• Vomiting
• Irrational behavior or confusion
Signs and symptoms of drug overdose may differ depending upon the type of drug consumed.
Emergency: If you suspect someone is experiencing a drug overdose, you
must react to this true medical emergency by calling “911” without delay.
CONTACT INFORMATION
•Call 211 for treatment referrals
•Call OBNDD directly to report diversion
• 1-800-522-8031
• http://www.ok.gov/obndd/
People
CASE STUDIES
A male in his 40s with a history of knee pain due to years of working
laying carpet. He had recently been released from rehab for his
prescription pain medication addiction, but was prescribed more
pain medications for his knee and back pain. He was home with his
wife and not feeling well. His wife was doing laundry and could hear
him snoring loudly. She noticed he was no longer snoring, went to
check on him, and found him unresponsive. His death was
pronounced by EMS. His toxicology report included five different
prescriptions medications, two of which were opioids.
CASE STUDIES
An older adult female had recently been to the doctor and
prescribed two new medications, fentanyl patches and oxycodone
for pain. She was also previously prescribed hydrocodone. She fell
asleep on the couch and her husband carried her to the bedroom
and put her to bed. She slept most of the day, and her husband
woke late that evening and noticed she would not move when he
asked her. He called 911 and she was pronounced by EMS.
CASE STUDIES
A female in her 30s suffered from arthritis and bipolar disorder. She
went to rehab approximately a year before her death after
overmedicating several times. Her husband worked out of town, but
said she was in great spirits when he came home for the weekend.
She complained of some pain from her arthritis, and told her
husband she knows her body and doses herself. He woke in the
middle of the night to her snoring, and several hours later became
concerned when she did not get up to check on their crying baby.
She was unresponsive with blue face, lips, and tongue. Her
toxicology report included an antidepressant, opioid, and muscle
relaxant.
CASE STUDIES
A male in his 30s with a history of a work-related back injury 5-10
years previous. He had multiple surgeries on his back and neck
since the injury. He was home alone and found unresponsive by
family on their arrival to the home. He did not have a known history
of substance abuse or mental health problems. He had a
prescription for both of the drugs involved in his death.
CASE STUDIES
A young adult male veteran had recurring pain from an injury
sustained during a tour in Iraq. He suffered from depression and
had a history of overmedicating. He was found unresponsive in the
middle of the night and pronounced on arrival by a first responder.
His death involved multiple prescription drugs, including prescription
painkillers and antidepressants. He had a known prescription for
almost all of the drugs.
STATE PLAN
• Community/Public Education
• Provider/Prescriber Education
• Disposal/Storage for the Public
• Disposal/Storage for Providers
• Tracking and Monitoring
• Regulatory/Enforcement
• Treatment/Interventions
LEGISLATION
• HB 1781
Share PMP data
• HB 1782
Expand use of naloxone
• HB 1783
Limit hydrocodone refills
• HB 1491
Notify providers of possible
doctor shoppers
PROJECT LAZARUS
COMMUNITY ORGANIZATION
• Town hall meetings
• Task forces/coalitions
• Tool kit for primary care prescribers
•
•
•
•
Pain management guidelines
Sample patient-prescriber agreement
Patient education materials
Screening, brief intervention, and referral
to treatment information
• Support group for pain patients
COMMUNITY-BASED PREVENTION EDUCATION
• Schools
• Colleges
• Civic organizations
• Churches
• Red Ribbon campaign
• Media
• Billboards
PRESCRIBER EDUCATION
• One-on-one prescriber education
on pain management
• Continuing medical education
• Promotion of prescription
monitoring program
REDUCE EXCESS SUPPLY AND INCREASE TREATMENT
Enhanced hospital policy
• Limit on amount dispensed
• Required check of PMP
Take-back events by law enforcement
• Fixed disposal sites
Drug detox and treatment programs
NALOXONE PROGRAM
More than half of deaths occurred at home
• Emergency medical care not called or not able to reach victim in time
to reverse the overdose
• Bystanders did not recognize as lethal overdose
• Concern for liability
Free naloxone for high risk patients
Results: Opioid Prescribing
The overdose death rate dropped 71% in two years after the start of
Project Lazarus and the Chronic Pain Initiative.
Source: Wilkes Co. Health Department; NC SCHS; CDC Wonder
KEY COMPONENTS
• High prescription opioid unintentional
poisoning rates
• Some degree of community awareness
• Coalition building capacity
• Motivated community organizer
• Support from the medical establishment
• Strong data utilization practices
OSDH SUPPORT
State plan action items
Assist with local plans
• Link with DMH contacts
Presentations
• Train-the-trainer
• Regional provider training
Educational materials
Provide local data
• Death, hospital discharge, PMP
Technical assistance
Avy Redus, MS
Oklahoma State Department of Health
Project Coordinator
405-271-3430
[email protected]
Claire Nguyen, MS
Oklahoma State Department of Health
Injury Epidemiologist
(405) 271-3430
[email protected]
http://poison.health.ok.gov