Rates Of Opioid Overdose Research Articles

Police Officers Can Safely and Effectively Administer Intranasal Naloxone

Introduction: Opioid overdose rates continue to rise at an alarming rate. One method used to combat this epidemic is the administration of naloxone by law enforcement. Many cities have implemented police naloxone administration programs, but there is a minimal amount of research examining this policy. The following study examines data over 18 months, after implementation of a police naloxone program in an urban setting. We describe the most common indications and outcomes of naloxone administration as well as examine the incidence of arrest, immediate detention, or voluntary transport to the hospital. In doing so, this study seeks to describe the clinical factors surrounding police use of naloxone, and the effects of police administration. Methods: All police officer administrations were queried from April 2014 through September 2015 (n = 126). For each incident we collected the indication, response, and disposition of the patient that was recorded on a “sick-injured civilian” report that officers were required to complete after administration of naloxone. All of the relevant information was abstracted from this report into an electronic data collection form that was then input into SPSS for analysis. Results: The most common indication for administration was unconscious/unresponsive (n = 117; 92.9%) followed by slowed breathing (n = 72; 57.1%), appeared blue (n = 63; 50.0%) and not breathing (n = 41; 32.5%). After administration of naloxone the majority of patients regained consciousness (n = 82; 65.1%) followed by began to breath (n = 71; 56.3%). However, in 17.5% (n = 22) of the cases “Nothing” happened when naloxone was administered. The majority of patients were transported voluntarily to the hospital (n = 122; 96.8%). Lastly, there was only one report where the patient became combative. Conclusion: Our study shows that police officers trained in naloxone administration can correctly recognize symptoms of opioid overdose, and can appropriately administer naloxone without significant adverse effects or outcomes. Furthermore, the administration of police naloxone does not result in a significant incidence of combativeness or need for scene escalations such as immediate detention. Further research is needed to investigate the impact of police naloxone; specifically, comparing outcomes of police delivery to EMS alone, as well as the impact on rural opioid overdoses.

Protocol: changes in rates of opioid overdose and poisoning events in an integrated health system following the introduction of a formulation of OxyContin® with abuse-deterrent properties.

BackgroundAddiction, overdoses and deaths resulting from prescription opioids have increased dramatically over the last decade. In response, several manufacturers have developed formulations of opioids with abuse-deterrent properties. For many of these products, the Food and Drug Administration (FDA) recognized the formulation with labeling claims and mandated post-marketing studies to assess the abuse-deterrent effects. In response, we assess differences in rates of opioid-related overdoses and poisonings prior to and following the introduction of a formulation of OxyContin® with abuse-deterrent properties.Methods/DesignTo assess effects of this formulation, electronic medical record (EMR) data from Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Northern California (KPNC) are linked to state death data and compared to chart audits. Overdose and poisoning events will be categorized by intentionality and number of agents involved, including illicit drugs and alcohol. Using 6-month intervals over a 10-year period, trends will be compared in rates of opioid-related overdoses and poisoning events associated with OxyContin® to rates of events associated with other oxycodone and opioid formulations. Qualitative interviews with patients and relatives of deceased patients will be conducted to capture circumstances surrounding events.DiscussionThis study assesses and tracks changes in opioid-related overdoses and poisoning events prior to and following the introduction of OxyContin® with abuse-deterrent properties. Public health significance is high because these medications are designed to reduce abuse-related behaviors that lead to important adverse outcomes, including overdoses and deaths.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-016-0064-y) contains supplementary material, which is available to authorized users.

Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses

Objective: Growing rates of opioid abuse and overdose throughout the nation have lead some community organizations to develop naloxone administration programs. Methods: In Pitt County North Carolina, two of our law enforcement agencies were trained in the identification of opioid overdose and use of naloxone therapy. Results: Attributed partially to introduction of fentanyl into the illicit drug market, our community experienced a 48-hour period in which officers successfully deployed five doses of antagonist medication to four individuals. Conclusion: This article presents case descriptions demonstrating the feasibility and safety of law enforcement naloxone programs. Key words: opioid; heroin; EMS; naloxone; overdose; substance abuse

A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction.

Rates of Opioid Dispensing and Overdose after Introduction of Abuse-deterrent Extended-release Oxycodone and Withdrawal of Propoxyphene: Larochelle MR, Zhang F, Ross-Degnan D, et al. JAMA Internal Med 2015;175:978–87.

Rates of Opioid Dispensing and Overdose after Introduction of Abuse-deterrent Extended-release Oxycodone and Withdrawal of Propoxyphene: Larochelle MR, Zhang F, Ross-Degnan D, et al. JAMA Internal Med 2015;175:978–87.

Rates of opioid dispensing and overdose after introduction of abuse-deterrent extended-release oxycodone and withdrawal of propoxyphene.

In the second half of 2010, abuse-deterrent extended-release oxycodone hydrochloride (OxyContin; Purdue Pharma) was introduced and propoxyphene was withdrawn from the US market. The effect of these pharmaceutical market changes on opioid dispensing and overdose rates is unknown. To evaluate the association between 2 temporally proximate changes in the opioid market and opioid dispensing and overdose rates. Claims from a large national US health insurer were analyzed, using an interrupted time series study design. Participants included an open cohort of 31.3 million commercially insured members aged 18 to 64 years between January 1, 2003, and December 31, 2012, with median follow-up of 20 months (last follow-up, December 31, 2012). Introduction of abuse-deterrent OxyContin (resistant to crushing or dissolving) on August 9, 2010, and market withdrawal of propoxyphene on November 19, 2010. Standardized opioid dispensing rates and prescription opioid and heroin overdose rates were the primary outcomes. We used segmented regression to analyze changes in outcomes from 30 quarters before to 8 quarters after the 2 interventions. Two years after the opioid market changes, total opioid dispensing decreased by 19% from the expected rate (absolute change, -32.2 mg morphine-equivalent dose per member per quarter [95% CI, -38.1 to -26.3]). By opioid subtype, the absolute change in dispensing by milligrams of morphine-equivalent dose per member per quarter at 2 years was -11.3 (95% CI, -12.4 to -10.1) for extended-release oxycodone, 3.26 (95% CI, 1.40 to 5.12) for other long-acting opioids, -8.19 (95% CI, -9.30 to -7.08) for propoxyphene, and -16.2 (95% CI, -18.8 to -13.5) for other immediate-release opioids. Two years after the market changes, the estimated overdose rate attributed to prescription opioids decreased by 20% (absolute change, -1.10 per 100,000 members per quarter [95% CI, -1.47 to -0.74]), but heroin overdose increased by 23% (absolute change, 0.26 per 100,000 members per quarter [95% CI, -0.01 to 0.53]). Opioid dispensing and prescription opioid overdoses decreased substantially after 2 major changes in the pharmaceutical market in late 2010. Pharmaceutical market interventions may have value in combatting the prescription opioid overdose epidemic, but heroin overdose rates continue to increase. Complementary strategies to identify and treat opioid abuse and addiction are urgently needed.

Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users

Background: The aim of the study was to estimate the lethality of opioid overdose among young heroin users. Methods: A prospective community cohort study was conducted in Barcelona and Madrid, Spain. Participants included 791 heroin users aged 18-30 years who were followed up between 2001 and 2006. Fatal overdoses were identified by record linkage of the cohort with the general mortality register, while non-fatal overdoses were self-reported at baseline and follow-up interviews. The person-years (py) at risk were computed for each participant. Fatal and non-fatal overdose rates were estimated by city. Transition towards injection shortly before the overdose could not be measured. Overdose lethality (rate of fatal overdose in proportion to total overdose) and its 95% CI was estimated using Bayesian models. Results: The adjusted rates of fatal and non-fatal opioid overdose were 0.7/100 py (95% CI: 0.4-1.1) and 15.8/100 py (95% CI: 14.3-17.6), respectively. The adjusted lethality was 4.2% (95% CI: 2.5-6.5). Conclusions: Four out of 100 opioid overdoses are fatal. These are preventable deaths that could be avoided before or after the overdose takes place. Resources are urgently needed to prevent fatal opioid overdose.

Prehospital Naloxone for Drug Overdose

With increasing rates of opioid overdose in the U.S., increased availability of intranasal naloxone — including distribution to addicted individuals,

Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in US Rural Communities

We determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs). In 2012, 42 states contributed all or a portion of their ambulatory data to the National Emergency Medical Services Information System. We used a logistic regression model to measure the association between naloxone administration and emergency medical services certification level, age, gender, geographic location, and patient primary symptom. The odds of naloxone administration were much higher among EMT-intermediates than among EMT-basics (adjusted odds ratio [AOR] = 5.4; 95% confidence interval [CI] = 4.5, 6.5). Naloxone use was higher in suburban areas than in urban areas (AOR = 1.41; 95% CI = 1.3, 1.5), followed by rural areas (AOR = 1.23; 95% CI = 1.1, 1.3). Although the odds of naloxone administration were 23% higher in rural areas than in urban areas, the opioid drug overdose rate is 45% higher in rural communities. Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death.

Trends and characteristics of heroin overdoses in Wisconsin, 2003–2012

BackgroundHeroin abuse has increased substantially during the past decade in the United States. This study describes trends and demographic shifts of heroin overdoses and heroin-related fatalities in Wisconsin and contrasts these with prescription opioid overdoses. MethodsThis study was cross-sectional using databases of emergency department (ED) visits, hospital admissions, and death certificates in Wisconsin, United States, during 2003–2012. Cases were Wisconsin residents treated for heroin or prescription opioid overdose, and residents who died of heroin-related drug poisoning. Primary measurements were rates over time and by geographic region, and rates and rate ratios for selected demographic characteristics. ResultsDuring 2003–2012, age-adjusted rates of heroin overdoses treated in EDs increased from 1.0 to 7.9/100,000 persons; hospitalized heroin overdoses increased from 0.7 to 3.5/100,000. Whites accounted for 68% of hospitalized heroin overdoses during 2003–2007 but 80% during 2008–2012. Heroin-related deaths were predominantly among urban residents; however, rural fatalities accounted for zero deaths in 2003 but 31 (17%) deaths in 2012. Among patients aged 18–34 years, those hospitalized with heroin overdose were more often men (73.0% versus 54.9%), uninsured (44.2% versus 29.9%), and urban (84.3% versus 73.2%) than those with prescription opioid overdose. Rates of ED visits for heroin overdose in this age group exceeded rates for prescription opioid overdose in 2012 (26.1/100,000 versus 12.6/100,000 persons, respectively). ConclusionsAn epidemic of heroin abuse is characterized by demographic shifts toward whites and rural residents. Rates of heroin overdose in younger persons now exceed rates of prescription opioid overdose.

An Evaluation of Naloxone Use for Opioid Overdoses in West Virginia: A Literature Review.

Naloxone is a common treatment option for the reversal of an opioid overdose. The law regulating naloxone varies from state to state and therefore so does the drug’s availability. The state of Rhode Island has legalized naloxone for over-the-counter use while a number of states allow prescriptions to opioid abusers and family members. The medical community as a whole appears to be divided on the issue of availability to lay persons. This is largely due to a lack of information on this relatively new subject, as well as discrepancies within the existing naloxone research in regard to the use of naloxone among the general public. This literature review provides an objective examination of the pros and cons of increasing the availability of naloxone to the public, with an emphasis on the state of West Virginia (WV). Due to WV’s high rates of opioid abuse and overdose, the implications of increasing public accessibility to naloxone could be invaluable in the effort to reduce opioid related deaths. To this end, a WV law that has recently gone into effect allows emergency personnel and family members of opioid addicts to carry naloxone. Ongoing research investigations will determine the impact of this law in regard to the overall wellbeing of the residents of WV and the implications on future laws regulating naloxone use.

Aberrant drug-related behaviors: a qualitative analysis of medical record documentation in patients referred to an HIV/chronic pain clinic.

Due to rising rates of opioid addiction and overdose among individuals on chronic opioid therapy, aberrant drug-related behaviors (ADRBs) are an important and challenging issue. Our objective was to qualitatively investigate the documentation of ADRBs in the medical record. Manually abstracted provider notes from an HIV primary care clinic were analyzed using content analysis methods. Categories of ADRBs identified included patients requesting opioids, obtaining nonprescribed opioids, and becoming emotional about opioids. We also identified several types of provider language used when documenting ADRBs, including purely descriptive language and emotional language such as labeling, frustration, and concern, and responses such as setting conditions for opioid prescription and action-oriented language. The impact of including emotional language in the medical record is unknown. Development of instruments that can be used to facilitate ADRB documentation, as well as evidence-based approaches to addressing ADRBs, is needed.

Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons

In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded among countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. The comparison between these two countries in opioid prescribing and opioid overdose mortality underscores important features of prescribing, culture, and health systems that may be permissive or protective in the development of a public health crisis. As access to opioid medications increases around the world, it becomes vitally important to understand the forces impacting opioid use and misuse. Trends in benzodiazepine and methadone use in the UK as well as structural elements of the National Health Service may serve to buffer opioid-related harms in the face of increasing prescriptions. In addition, the availability and price of heroin, as well as the ease of access to opioid agonist treatment in the UK may limit the growth of the illicit market for prescription opioids. The comparison between the US and the UK in opioid consumption and overdose rates should serve as a call to action for UK physicians and policymakers. Basic, proactive steps in the form of surveillance – of overdoses, marketing practices, prescribers, and patients – and education programs may help avert a public health crisis as opioid prescriptions increase.

Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009

Opioid-related mortality has increased in the United States in the past decade. The purpose of this study was to examine trends and regional variation in opioid prescribing and overdose rates in a national health system, the Veterans Health Administration. Annual cohorts of Veterans Health Administration patients were identified on the basis of medical records, and overdose mortality was determined from National Death Index records. State-level prescribing and overdose rates were mapped to provide information on regional variability. There were significant increases between 2001 and 2009 in the rate of overdoses associated with nonsynthetic opioids (β=0.53, 95% confidence interval, 0.35, 0.70) and methadone (β=0.63, 95% confidence interval, 0.37, 0.90) but not synthetic/semisynthetic opioids. State-level overdose rates had a moderate correlation with the average proportion of patients in that state receiving opioids (r=0.29). The present study demonstrates that the increases in prescription opioid overdoses observed in the general population are also found in the patient population of a national health system and provides further evidence of the population-level association between trends in opioid prescribing and opioid overdose deaths. There is substantial regional variation in both opioid prescribing and opioid-related overdose rates, and these data can inform region-specific overdose prevention strategies and opioid policy.

Would legalizing illicit opioids reduce overdose fatalities? Implications from a natural experiment

Overdose is the leading cause of premature mortality among heroin users. We examine whether the provision of regulated and quality-controlled heroin to users in specified doses would reduce heroin overdose rates. We also address this in the context of the epidemic of prescription opioid use and deaths seen in recent years in the United States and internationally. We explore the extent to which any change in legal access to heroin would affect overdose rates, and note that this depends upon the validity of the two main assumptions that variations in illicit drug purity and/or the presence of drug contaminants are major causes of overdose. Toxicological and demographic data from studies of heroin overdose deaths do not support these assumptions. The surge in the use of pharmaceutical opioids provides an example of the legal delivery of opioids of known dosage and free of contaminants, where overdose deaths can be examined to test these assumptions. Rates of fatal opioid overdose have escalated, with increased rates of prescribing of pharmaceutical opioids. On the basis of the experience with prescription opioids, unregulated legal heroin access would not reduce overdose rates.

EMS Runs for Suspected Opioid Overdose: Implications for Surveillance and Prevention

Background. Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008–2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Results. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00–5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45–54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008–2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions. While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.

Preventing Prescription Opioid Overdose Deaths

Preventing Prescription Opioid Overdose Deaths

Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis

Objective To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts.Design...

States Should Take More Responsibility for Reining In Painkiller Abuse

Back to table of contents Previous article Next article Professional NewsFull AccessStates Should Take More Responsibility for Reining In Painkiller AbuseLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:20 Jan 2012https://doi.org/10.1176/pn.47.2.psychnews_47_2_5-bAbstractThe epidemic of prescription painkiller overdose deaths in the United States grew more severe over the last decade, and—as of 2008—was fast approaching the number of deaths from motor-vehicle crashes, the nation’s leading cause of injury death. That’s according to a recent analysis by the Centers for Disease Control and Prevention (CDC), published in the November 4, 2011, Morbidity and Mortality Weekly.The CDC analyzed rates of fatal opioid painkiller overdoses, nonmedical use of the medications, sales, and treatment admissions for the period 1999 to 2008. Rates of nonmedical opioid pain reliever use in the past year by state were obtained from the 2008 to 2009 National Survey on Drug Use and Health (NSDUH). The CDC found that those opioid-related deaths had increased to the point of exceeding deaths involving heroin and cocaine combined. And, they said, the wide variation among states in the nonmedical use of opioid pain relievers and overdose rates they found cannot be explained by underlying demographic differences in state populations. Rather, wide variations in prescribing patterns are more likely to blame.“The proliferation of high-volume prescribers can have a large impact on state use of opioid pain relievers and overdose death rates,” said CDC researchers, who pointed to a spate of illegitimate pain clinics that provide medication to large volumes of patients without adequate evaluation of follow-up (so called “pill mills”) as one contributor to disparities in numbers between states. “Large increases in overdoses involving the types of drugs sold by illegitimate pain clinics have been reported in Florida and Texas,” they said.“Public-health interventions to reduce prescription drug overdose must strike a balance between reducing misuse and abuse and safeguarding legitimate access to treatment, the CDC emphasized, noting that health care providers should only use opioid pain relievers in carefully screened and monitored patients when nonopioid pain treatments have not been sufficient to treat pain, as recommended in published evidence-based guidelines.The CDC tasked states with achieving some level of control over opioid pain prescriptions, saying that state agencies, as regulators of health-care practice, have the responsibility and authority to monitor and correct inappropriate and illegal prescribing.“All interventions need to be evaluated further, and new interventions developed,” said the CDC. “Concerted attempts to address this problem, especially in states with high rates of opioid pain reliever sales, nonmedical use, or overdose mortality, might help control the epidemic.”“Vital Signs: Overdoses of Prescription Opioid Pain Relievers, United States, 1999-2008” is posted at www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w. ISSUES NewArchived

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Background: Buprenorphine is a partial opioid agonist with a reported “ceiling effect” for respiratory depression. Despite implied safety, it has been associated with significant overdoses. Conflicting data exist regarding the response to naloxone. Research Question: How do the clinical characteristics and response to naloxone following buprenorphine overdose compare with those of heroin and methadone overdose? Methods: Consecutive patients admitted to two teaching hospitals with Glasgow Coma Score (GCS) <12 and at least two of the following three criteria were included in this 4year prospective. Observational Study: History suggestive of opioid overdose, pinpoint pupils, or initial respiratory rate <12/min. Demographics, intent, initial GCS, respiratory rate, oxygen saturation (SpO2), and vital signs were collected. Urine toxicological screening was performed and only overdoses involving the exclusive presence of 6-monoacetylmorphine, buprenorphine, or methadone were included. Cases involving multiple opioids were excluded, but cases with benzodiazepine coingestion were allowed. Patients were treated with naloxone and/or flumazenil. Antidote dose and order were at the discretion of the attending physician. Response to naloxone was considered “positive” if full awakening occurred or intubation avoided. Results: During the study, 160 patients were admitted for opioid overdose and 84 met inclusion criteria. These 84 were divided into three groups: heroin (n=26), buprenorphine (n=39), and methadone (n=19). Initial GCS, respiratory rate, SpO2, and blood gas analysis were similar between groups. Benzodiazepine coingestion was more common in the buprenorphine vs heroin group and suicide more common in the methadone vs buprenorphine group. Naloxone was administered in 65% of 84 patients. Buprenorphine-poisoned patients did not respond to 0.4– 0.8 mg intravenous naloxone (0/19). Conclusion: Buprenorphine overdose induced a typical opioid syndrome that was not reversed with naloxone. Critique: The strength of the study was a large number of patients and confirmation of toxins. Weaknesses include lack of data on pinpoint pupils (an inclusion criteria), subjective endpoints, preponderance of benzodiazepine co-ingestions, and lack of detailed naloxone dosing information. Implication for Toxicologists: This study gives further evidence that buprenorphine overdose produces a typical opioid toxidrome. If naloxone is used to treat suspected buprenorphine overdose, doses of 0.4 to 0.8 mg may be insufficient to reverse the clinical effects. Benzodiazepines are common coingestants.