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The Death Toll of Prescription Drug Abuse: Statistics and Analysis, Past and Present Al Mock, MD, MS, DABP, FCAP, FNAME WV Chief Medical Examiner October.

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Presentation on theme: "The Death Toll of Prescription Drug Abuse: Statistics and Analysis, Past and Present Al Mock, MD, MS, DABP, FCAP, FNAME WV Chief Medical Examiner October."— Presentation transcript:

1 The Death Toll of Prescription Drug Abuse: Statistics and Analysis, Past and Present Al Mock, MD, MS, DABP, FCAP, FNAME WV Chief Medical Examiner October 25, 2014 Charleston, WV

2 Polypharmacy 1 Most Drug Overdose Deaths Involve Multiple Substances

3 Trend in Deaths 2 Data Source: WV Health Statistics Center, Vital Statistics System

4 Drug Overdose Rates by State 3

5 Prevalence of Illicit Drug Dependence 4 Illicit Drug Dependence in the Past Year Among Persons Aged 12 or Older by State Percentages, Annual Averages Based on 2010 and 2011 NSDUH’s 2.02-2.54 1.89-2.01 1.78-1.88 1.63-1.77 1.39-1.62 Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2010 (Revised March 2012) and 2011 Percentage of Persons

6 WV versus US 5 Centers for Disease Control and Prevention. Prevention Status Reports 2013: Prescription Drug Overdose-West Virginia. Atlanta, GA: US Department of Health and Human Services; 2014

7 Trend Analysis 6 Data Source: WV Health Statistics Center, Vital Statistics System Note - 2012 and 2013 Preliminary

8 Trend Analysis 7 Data Source: WV Health Statistics Center, Vital Statistics System Note - 2012 and 2013 Preliminary

9 Demographic Analysis 8 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

10 Drug Overdose Deaths by Month 9 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

11 Geographic 10

12 Trend Analysis – Major Selected Drugs 11 Data Source: WV Health Statistics Center, Vital Statistics System

13 Trend Analysis – 8 Commonly Involved 12 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

14 Trend Analysis – Five Prescription Opiates 13 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

15 Trend Analysis – 6 Prescription Non-opiates 14 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

16 Trend Analysis – Some drugs trend together 15 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

17 Trend Analysis – Other Major Players 16 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

18 Trend Analysis 17 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

19 Trend Analysis 18 Data Source: WV Health Statistics Center, Vital Statistics System * - 2012 and 2013 Preliminary

20 OPIOIDS 19 Data Source: WV Health Statistics Center, Vital Statistics System

21 OPIOIDS 20 Data Source: WV Health Statistics Center, Vital Statistics System

22 OPIOIDS 21 Data Source: WV Health Statistics Center, Vital Statistics System

23 OPIOIDS 22 Data Source: WV Health Statistics Center, Vital Statistics System

24 OPIOIDS 23 Data Source: WV Health Statistics Center, Vital Statistics System

25 OPIOIDS 24 Data Source: WV Health Statistics Center, Vital Statistics System

26 OPIOIDS 25 Data Source: WV Health Statistics Center, Vital Statistics System

27 ANTI-ANXIETY 26 Data Source: WV Health Statistics Center, Vital Statistics System

28 ANTI-ANXIETY 27 Data Source: WV Health Statistics Center, Vital Statistics System

29 ANTI-DEPRESSANTS 28 Data Source: WV Health Statistics Center, Vital Statistics System

30 ANTI-DEPRESSANTS 29 Data Source: WV Health Statistics Center, Vital Statistics System

31 STIMULANTS 30 Data Source: WV Health Statistics Center, Vital Statistics System

32 STIMULANTS 31 Data Source: WV Health Statistics Center, Vital Statistics System

33 OTHER DRUGS 32 Data Source: WV Health Statistics Center, Vital Statistics System

34 FATAL SECONDARY EFFECTS TRANSPORTATION: 458 FATAL CRASHES (2004-5) WITH DRUG IMPAIRED OPERATORS (28.4%)* WORK-PLACE FATAL INJURY ASSOCIATED WITH DRUG IMPAIRMENT (1999-2008: 3.5%)** PEDIATRIC DEATHS AND PHARMACEUTICAL ABUSE? (SUID, CANNOT EXCLUDE EXTERNAL) * MMWR: VOL. 55/NO. 48; DECEMBER 8, 2006 ** DATA SOURCE: WV HEALTH STATISTICS CENTER, VITAL STATISTICS SYSTEM 33

35 GENERAL OBSERVATIONS* RATE OF FATAL OVERDOSES ROSE DRAMATICALLY FROM 1999 THROUGH 2007. REMAINED STEADY IN 2007 - 2009. WHY? BEGAN INCREASING AGAIN IN 2009 – 2011, MOSTLY DUE TO OXYMORPHONE ABUSE (OPANA®). 2012-- OXYMORPHONE DEATHS HAVE DECLINED, BUT NOW A HUGE INCREASE IN HEROIN OVERDOSE FATALITIES. * INFORMATION PROVIDED BY DR. JIM KRANER, WV CHIEF TOXICOLOGIST 34

36 ROUTINE ENCOUNTERS 2012* ETOH/DRUGS AS CONTRIBUTORY FACTOR MVAs, ATVs, Tractors, Suicide, Homicide COMMONLY SEE BZD + OPIOID +/- ETOH Very rarely a single agent outside of suicides Route of administration/bioavailability UNUSUALLY COMMON GABAPENTIN, CITALOPRAM, QUETIAPINE, AND PHENERGAN BATH SALTS, SYNTHETIC THC, AIR DUSTER HUGE DISPENSE # PER BOP VA, border counties, fail to report, Rx after death DOCTOR SHOPPING (>5/Y); NEEDS DEFINITION * PERSONAL OBSERVATIONS, AL MOCK MD 35

37 Polypharmacy - Co-use Heroin and Fentanyl 36 2012 – 1 death - Monongalia 2013 – 4 deaths – Berkeley and Jefferson 2014 – 5 deaths through July – Wayne, Raleigh, Wood, Calhoun, Berkeley

38 Sudden Unexplained Infant Deaths Rate / 100K live births; 1999 to 2007 West Virginia and U.S. US: *58.4/ 100K LIVE BIRTHS WV: **125.7/100K LIVE BIRTHS * CDC, Center for Health Statistics; R=95 ** WV Center for Health Statistics; R=95

39 Number of infants with NAS prevalence of maternal drug use/abuse ( NAS) diagnoses in a single hospital Used by permission: David Chaffin, MD; Marshall U. School of Medicine; 2009.

40 Bed-sharing in WV SUID 2004-2005; N=64 N=45 (70%) N=19 Source: CFRT, OCME-West Virginia

41 Infant Death and Drug (Ab)use Maternal/caretaker impairment – Impaired judgment – Neglect issues CO-SLEEPING WITH DECREASED AROUSAL Opioid associated NAS: risk of SUID* *Journal of Pediatrics, 117, 876–887; 1990.

42 41

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