1. Unintentional Drug Poisoning Deaths, Michigan Residents, 1999-2009 Su Min Oh, PhD Michigan Department of Community Health Bureau of Substance Abuse and Addiction Services

2. Background – United States In 2009, drug poisonings became the leading cause of injury death in the United States, surpassing motor vehicle crashes Majority of drug poisonings are unintentional Increase in poisonings largely due to opioid analgesics

3. Background - United States (cont.) From 1999 to 2002, the number of unintentional drug poisoning deaths involving Opioid analgesics - increased 91% Cocaine - increased 23% Heroin – increased 12 % In 2007, number of overdose deaths involving opioid analgesic exceeded overdose deaths with heroin and cocaine combined

4. Background - Michigan Unintentional poisonings became the leading cause of injury death in 2009 Increase in prescriptions for opioid analgesics

5. Purpose of Study Examine unintentional drug poisoning deaths involving opioid analgesics, heroin, and cocaine between 1999 and 2009 in Michigan

6. Methods Data used from 1999-2009 Michigan death certificate files Limited to Michigan residents Analysis limited to deaths with an underlying cause of death as unintentional drug poisoning ICD-10 code of X40-X44

7. Methods (cont.) Types of drugs involved were identified using the following ICD-10 codes Opioid analgesics (T40.2-T40.4) Heroin (T40.1) Cocaine (T40.5) Other specified (T36-T50.8) Unspecified (T50.9)

8. Methods (cont.) Rates age-adjusted according to the 2000 U.S. Census population and calculated per 100,000 population Differences in unintentional drug poisoning death rates were examined by descriptive factors

9. Number of Unintentional Drug Poisoning Deaths, Michigan, 1999-2009 Year Number of deaths

10. Age-Adjusted Unintentional Drug Poisoning Death Rates by Gender, Michigan, 1999–2009 Rate per 100,000 population Year Male Female Total

11. Age-Adjusted Unintentional Drug Poisoning Death Rates by Race, Michigan, 1999–2009 Rate per 100,000 population Year Black White

12. Unintentional Drug Poisoning Death Rates by Age Groups, Michigan, 1999–2009 Rate per 100,000 population Year 15-24 years 65+ years 55-64 years 45 – 54 years 35– 44 years 25– 34 years

13. Unintentional Drug Poisoning Death Rates by Major Drug Type, Michigan, 1999–2009 Unspecified Opioid analgesic involvement Other specified Heroin only Cocaine and heroin Cocaine only Crude Rate per 100,000 population Year

14. Unintentional Drug Poisoning Death Rates involving Opioid Analgesics, Michigan, 1999–2009 Crude rate per 100,000 population Year Only opioid analgesic With cocaine With heroin Heroin & cocaine Total

15. Michigan’s 2005 Population by Preparedness Regions Detroit

16. Unintentional Drug Poisoning Death Rates by Region, Michigan, 1999

17. Unintentional Drug Poisoning Death Rates by Region, Michigan, 2004

18. Unintentional Drug Poisoning Death Rates by Region, Michigan, 2009

19. Discussion Unintentional drug poisoning death rates increased over the past decade in Michigan Death rates due to opioid analgesics increased more than heroin and cocaine Increase in deaths closely paralleled the increased number of Rx opioid analgesics statewide

20. Limitations Utilization of vital statistics data Validity and completeness of data Toxicology testing varies by region/county Limited access to Michigan’s Prescription Monitoring System

21. Michigan Initiatives Increased surveillance by Task Force formed during fentanyl outbreak RxOTC Drug Abuse Workgroup established in Feb. 2011 Broaden statewide media message Broaden education and use of Screening, Brief Intervention, Referral, and Treatment (SBIRT) Increase access and use of PMP

22. Recommendations Increased awareness Health care providers Patients and parents Multifaceted strategies Safe storage & disposal of drugs At-risk populations

23. Acknowledgements Michigan Department of Community Health Bureau of Disease Control, Prevention and Epidemiology Kim Hekman, MPH Lorraine Cameron, MPH, PhD

24. References Warner, M. Updates to Drug Poisoning Data Brief 2009 mortality data. Emerging Opioid Overdose Conference Call. March 2012. Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. Hyattsville, MD: National Center for Health Statistics; 2011. Centers for Disease Control and Prevention. Unintentional drug poisoning in the United States. CDC Issue Brief. July 2010. Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. Sep 2006; 15(9):618-627. Michigan 2009 Death Certificate Registry, Michigan Department of Community Health. Michigan Epidemiological Profile, Michigan Department of Community Health. March 2012.

25. Contact Information Su Min Oh: ohs@michigan.govohs@michigan.gov Bureau of Substance Abuse and Addiction Services: www.michigan.gov/mdch-bsaas Substance Abuse Epidemiology: www.michigan.gov/substanceabuseepi