1 National Estimates from the Drug Abuse Warning Network CAPT Kathy Poneleit United States Public Health Service Office of Applied Studies Substance Abuse.

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Presentation transcript:

1 National Estimates from the Drug Abuse Warning Network CAPT Kathy Poneleit United States Public Health Service Office of Applied Studies Substance Abuse & Mental Health Services Administration November 13,

SAMHSA/OAS 2 Today's Agenda  No conflicts of interest  Overview of DAWN  Key findings from 2007 –Nonmedical use of opiates/opioids – comparisons –Extended- vs. immediate-release oxycodone –Extended- vs. immediate-release morphine

SAMHSA/OAS 3 DAWN Survey Design  Stratified probability sample of hospitals –Short-term, general, non-Federal hospitals with 24-hour emergency departments (EDs)  National estimates account for: –Sample design –Unit nonresponse –Partial nonresponse in responding hospital

SAMHSA/OAS 4 National Estimates Oversample areas (urban) + Remainder area (urban & rural)

SAMHSA/OAS 5 Source of DAWN Estimates, Eligible hospitals4,5054,5494,5684,575 Sample of hospitals Responding hospitals Response rate Drug-related ED visits2,537,7223,009,0253,441,8553,998,228 Drugs reports4,047,1354,624,4555,384,8176,247,718

SAMHSA/OAS 6 DAWN Data Collection: Retrospective Review of Medical Records Source: DAWN, 2007 data, 11/11/2008 National estimates Charts reviewed 10,038,897 Cases found 375,031 Drug-related ED visits reviewed ED visits not reviewed

SAMHSA/OAS 7 Analysis Domains Drug-related ED visits Medical use Pharmaceuticals Nonmedical use Pharmaceuticals Illicit drugs Alcohol

SAMHSA/OAS 8 Definition: Nonmedical Use of Pharmaceuticals  Based on retrospective chart review –Exceeded prescribed or recommended dose –Used drugs prescribed for another –Malicious poisoning –Substance abuse –Excludes drug-related suicide attempts –Includes suicide ideation, plan, gesture

SAMHSA/OAS 9 Drug-Related ED Visit Rates, Source: National estimates from DAWN, No significant change*Significant change, 2004 vs vs vs. 2007

SAMHSA/OAS 10 Oxycodone Controlled and Immediate Release

SAMHSA/OAS 11 Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 Source: National estimates from DAWN, 2007 * Single- & multi-ingredient formulations CI lower bound Estimate CI upper bound

SAMHSA/OAS 12 Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 Source: National estimates from DAWN, 2007 * Single- & multi-ingredient formulations CI lower bound Estimate CI upper bound

SAMHSA/OAS 13 Classification of Oxycodone Reports  Controlled release (CR) –OxyContin (99%) Alternate terms: –Generic OxyContin –Teva OxyContin –Impax OxyContin –Oxycodone CR –Oxycodone ER –Oxycodone SR  Immediate release (IR) –acetaminophen-oxy e.g., Percocet (92%) –aspirin-oxy e.g., Percodan –ibuprofen-oxy e.g., Combunox –oxycodone e.g., Roxicodone

SAMHSA/OAS 14 Classification of Oxycodone Reports (cont'd)  Unknown release type (UK) –Oxycodone (95%) alternate terms: –Free oxycodone –M-Oxy –Oxycodone hydrochloride –Oxycodone metabolites

SAMHSA/OAS 15 Nonmedical Use of Pharmaceuticals, Oxycodone, by Release Type, Source: National estimates from DAWN, CI lower bound Estimate CI upper bound ControlledImmediate Unknown

SAMHSA/OAS 16 Oxycodone, CR vs. IR – All Visits Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs vs No significant change

SAMHSA/OAS 17 Oxycodone, CR vs. IR – Medical Use Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs vs No Significant change

SAMHSA/OAS 18 Oxycodone, CR vs. IR – Nonmedical Use Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs No significant change 2006 vs

SAMHSA/OAS 19 Oxycodone, CR vs. IR Source: DAWN estimates for the U.S., % of visits Nonmedical useMedical use

SAMHSA/OAS 20 Nonmedical Use: Hydrocodone and Oxycodone by Release Type, Source: DAWN estimates for the U.S., Hydrocodone UK ER IR Oxycodone:

SAMHSA/OAS 21 Nonmedical Use: All Opiates/Opioids, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 22 Nonmedical Use: All Hydrocodone, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 23 Nonmedical Use: All Oxycodone, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 24 Nonmedical Use: Oxycodone CR, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 25 Nonmedical Use: Oxycodone IR, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 26 Nonmedical Use: Oxycodone UK, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 27 Nonmedical Use: Disposition from ED, Oxycodone by Release Type, 2007 Source: DAWN estimates for the U.S., 2007 % of ED visits ControlledUnknownImmediate Some follow-up No evidence of follow-up care

SAMHSA/OAS 28 Nonmedical Use: Number of Drugs, Oxycodone by Release Type, 2007 Source: DAWN estimates for the U.S., 2007 % of ED visits ControlledUnknownImmediate 1 drug Multiple drugs

SAMHSA/OAS 29 Nonmedical Use ED Visits: Conclusions  Opioid analgesics nearing 287,000 visits –¼ Oxycodone ¼ Hydrocodone –  in immediate and unknown release types  Highest visit rates in patients aged  Majority of patients treated and released  Polydrug use was higher for immediate versus controlled release

SAMHSA/OAS 30 Morphine Controlled and Immediate Release

SAMHSA/OAS 31 Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 Source: National estimates from DAWN, 2007 * Single- & multi-ingredient formulations CI lower bound Estimate CI upper bound

SAMHSA/OAS 32 Classification of Morphine Reports  Controlled release (CR) –MS Contin (71%) Alternate terms: –Avinza –Kadian –Morphine Sulfate SR –Oramorph SR –Morphine Extended Release –Morphine Patches  Immediate release (IR) –Morphine Sulfate –Morphine Pill –Morphine IR –Morphine Rapi-Ject –Roxanol –Morphelan

SAMHSA/OAS 33 Nonmedical Use of Pharmaceuticals, Morphine, by Release Type, Source: National estimates from DAWN, CI lower bound Estimate CI upper bound Controlled Immediate

SAMHSA/OAS 34 Morphine, CR vs. IR – All Visits Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs vs No significant change

SAMHSA/OAS 35 Morphine, CR vs. IR – Medical Use Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs vs No Significant change

SAMHSA/OAS 36 Morphine, CR vs. IR – Nonmedical Use Source: DAWN estimates for the U.S., *Significant change, 2004 vs vs No significant change 2006 vs. 2007

SAMHSA/OAS 37 Morphine, CR vs. IR Source: DAWN estimates for the U.S., % of visits Nonmedical useMedical use

SAMHSA/OAS 38 Nonmedical Use: Hydrocodone and Morphine by Release Type, Source: DAWN estimates for the U.S., Hydrocodone UK CR IR Morphine:

SAMHSA/OAS 39 Nonmedical Use: All Morphine, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 40 Nonmedical Use: Morphine CR, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 41 Nonmedical Use: Morphine IR, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007

SAMHSA/OAS 42 Nonmedical Use: Disposition from ED, Morphine by Release Type, 2007 Source: DAWN estimates for the U.S., 2007 % of ED visits ControlledUnknownImmediate Some follow-up No evidence of follow-up care

SAMHSA/OAS 43 Nonmedical Use: Number of Drugs, Morphine by Release Type, 2007 Source: DAWN estimates for the U.S., 2007 % of ED visits ControlledUnknownImmediate 1 drug Multiple drugs

SAMHSA/OAS 44 Nonmedical Use ED Visits: Conclusions  Morphine related ED visits nearing 30,000 –Immediate release  –Controlled release is similar  Highest visit rates in patients aged  Majority of patients treated and released  Polydrug use is typical

SAMHSA/OAS 45 Important Considerations: DAWN Depends on ED Medical Records  Link between ED visit and use of drug  Dose levels and source of drug unavailable  Nonspecific drug reports –Opiates/opioids, unspecified (unnamed) –Unknown release-type  Unique names for immediate versus extended release enable better surveillance

SAMHSA/OAS 46 Acknowledgements  Rong Cai, Statistician