Dramatic Shifts Seen in Opiate Overdose Demographics

Nancy A. Melville

November 08, 2011

November 8, 2011 (Washington, DC) — Rates of hospital admissions for prescription opiate overdoses from 1993 to 2007 far exceeded heroin overdoses, rising by as much as 291%. The shift included a sharp increase in admissions of whites and middle-aged women, according to research presented here at the American Public Health Association 139th Annual Meeting.

Researchers from the University of Maryland, in Baltimore, evaluated data from the Nationwide Inpatient Survey on hospital admissions for opiate overdose. They found that the rate of overdoses related to prescription opiates, primarily oxycodone and methadone, started to exceed those of heroin overdoses at the end of the 1990s.

In the United States, hospital admissions for heroin overdose increased from about 1.2 per 100,000 in 1993 to about 1.4 in 2007; admissions for prescription opiate overdoses increased from about 2.0 per 100,000 to about 12.0 in the same period.

Overall, the rate of opiate overdose admissions increased from 8889 (34.5 per million) in 1993 to 40,655 (135 per million) in 2007 — a 291% increase.

Although the death rate from heroin overdoses declined slightly — from nearly 0.1 per 100,000 people in 1993 to about 0.05 in 2007 — the death rate from prescription drug overdoses increased significantly — from about 0.1 per 100,000 people in 1993 to about 0.3 in 2007.

The data also showed significant changes in the profile of the typical overdose patient. Overdoses among white patients rose most dramatically, from 23.5 million to 119.4 million — a 408% increase.

The rate far exceeded that for black patients, which increased 105% to 80.7 per million in 2007. Overdose rates among Hispanic patients increased 48% to 44.9 per million.

"In the early 1990s, the opiate overdose epidemic was typically characterized as being primarily an African American problem occurring in the urban core. It's clear that something really dramatic is happening here, with the problem shifting to an overwhelmingly white population," said Jay Unick, PhD, assistant professor at the School of Social Work, University of Maryland.

"Even with heroin overdoses, the only group showing increases are whites."

The gender profile also showed a dramatic shift — the increase in prescription opiate overdose admissions for males was 214% and for females was 414%.

Admission rates in all age categories from 16 and 64 years increased; however, the 40- to 49-year age group showed the highest rate of increase in overdose risk.

Opiate overdose rates continue to increase at urban hospitals, rising about 2.3% each year. Increases are also emerging in rural hospitals, Dr. Unick said.

"Urban hospitals are still where the majority of overdoses are happening, but the rural problem is increasing dramatically," he said. "We haven't moved away from an urban core problem, we've just developed a problem in addition to it."

Changes in the quality, purity, and price of heroin appear to be influencing overdose rates, but less is known about the factors that are driving the prescription opiate overdose rates.

"The findings leave us with a lot of questions about what changes prompted these shifts in prescription opiate overdoses," Dr. Unick said: "Is it an increase in supply? Is it more socially acceptable? Is it easier for someone to swallow a pill than stick a needle in their arm?"

"We need to know more about the underlying factors that explain the increases."

The study comes on the heels of a report released this week by the Centers for Disease Control and Prevention in Atlanta, Georgia, declaring that deaths from prescription painkillers reached epidemic levels in the past decade, and indicating that in 2010, as many as 12 million Americans 12 years or older reported the nonmedical use of prescription painkillers in the previous year.

According to Nicholas Reuter, PhD, from the Substance Abuse and Mental Health Services Administration (SAMHSA), in Rockville, Maryland, prescription drugs are second only to marijuana as the most common form of drug abused by the nation's 22 million current illicit drug users.

"In terms of nonmedical uses of prescription drugs, pain medication abuse is well ahead of tranquilizers, stimulants, and sedatives, and represents as much as 2% of the population, or about 5.5 million people," he said.

Rates are particularly high in certain populations. In the military, for instance, rates of nonmedical prescription drug use run as high as 10%, Dr. Reuter said.

He added that a SAMHSA survey indicated that most users obtain their prescription drugs from friends or relatives who have legal prescriptions.

SAMHSA and a variety of other organizations are using a host of strategies to try to address the problem of pain medication abuse.

"The government is working to educate prescribers, dispensers, and consumers alike about prescription problems in the United States," he said.

Dr. Reuter added that prescription drug monitoring programs are in place in 48 states, and some states are also beginning to crack down on pain clinics with records of overprescribing medications.

Dr. Unick and Dr. Reuter have disclosed no relevant financial relationships.

American Public Health Association (APHA) 139th Annual Meeting: Abstract 245942. Presented November 1, 2011.

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