. ^ AND GUBBENT STATUS MftSSABHUSinS i_l__N_f_l_S— _ _ lit — 064 ^ _ . _ ^ ^ J Ovefdoses, Hospital Disdiaiges, EmepcyDepaMVisis, &TrendsinTfealmentSen/ices MassachusettsDepartmentofPublicHealth CenterforHealthInformation,Statistics,Research&Evaluation,andtheBureauofSubstanceAbuseServices February2004 • Poisonings, which include drug overdoses, are the leading cause of injury death in Massachusetts, surpassing motor vehicle injury deaths. • 68% of poisoning fatalities in 2001 were associated with opioids. • From 1999 to 2001 opioid-related fatal overdose rates increased 48%; , hospitalization rates increased 38%. • Total charges for opioid-related hospitalizations exceeded $120 million in 2001. WHAT ARE OPIOIDS? The tenri "opioid" designates a class ofdrugs derived from opium or manufactured synthetically with a chemical structure similarto opium. Heroin is a naturally derived opioid. Otheropioids such as oxycodone (Oxycontin®), morphine, meperdine, methadone, codeine and others, are used therapeuticallyforthe management of pain and otherconditions. These products may be diverted from pharmaceutical purposes and used illicitly. OPIOID-RELATED FATAL OVERDOSES IVIAGNITUDE AND TRENDS Figure 1. Poisoning and Opioid-Related MA Poisonings are the leading cause of injury Fatal Overdoses, Residents, death among Massachusetts residents; 68% of 1990-2001 these deaths in 2001 were opioid-related. Opioid-related poisoning deaths as a proportion ofall poisoning deaths increased from 28% in 1990 to 68% in 2001 In 2001 deaths due to opioid-related , overdoses (n=487) were more than 5 times the number of deaths in 1990 (n=94). Opioid-related death rates^ increased an average of 15% peryear between 1990 and 1998, and an average of 23% between 1999 % and 2001; the opioid-related death rate was 1.6 per 100,000 residents in 1990 and 7.7 Year deaths per 100,000 in 2001. Duetoachange incodingproceduresfrom 1998to 1999, Source:RegistryofVital Recordsand Statistics, MDPH. thedatawasexamined intwodistinctperiods;from 1990-1998, and 1999to2001. Opioids: Trendsand CurrentStatusin Massachusetts Page 1 InjurySun/eiilance Program, MDPH OPIOID-RELATED FATAL OVERDOSES fconf/nued;) AGE GROUPS Figure 2. Opioid-Related Fatal Overdose Between 1990 and 2001, rates increased Rates by Age Group and Sex, MA for both males and females and among Residents, 2001 age groups between ages 15 and 54. In 2001, individuals between the ages of 30.0 Male 35 and 44 experienced the highest opioid- oa> 25.0 Female related fatal overdose rates (36 deaths per '« il a> 20.0 100,000). U. o o oo_ 15.0 - SEX o 10.0 For all age groups, opioid-related fatal Q. 5.0 overdoses were higher among males than (0 0.0 ce. females. In 2001, death rates due to an opioid-related overdose among males were 3 times higher than for females (1 1.9 Age Group (years) deaths per 100,000 and 3.9 per 100,000, respectively). Opioid-related overdose rates among Source:RegistryofVital Recordsand Statistics, MDPH. females increased an average of 17% per year between 1991^ and 1998, and 26% per year between 1999 and 2001. Rates among males increased an average of 13% per year between 1990 and 1998, and an average of 23% between 1999 and 2001. Figure 3. Opioid-Related Fatal Overdose Rates by Race/Ethnicity, RACE/ETHNICITY MA Residents, 2001 In 2001, opioid-related fatal overdose rates « c 10.0 n were highest among Hispanic residents TO (9.6 deaths per 100,000), followed by w 8.0 a> blacks (8.8 per 100,000) and whites (7.9 QooC 6.0 - per 100,000). o o Asian residents had lower opioid-related o 4.0 - fatal overdose rates (2.1 deaths per 2.0 - Q. 100,000) compared with other racial and © "(3 0.0 - ethnic groups. Hispanic Black, White, Asian Other non- non- Hispanic Hispanic Race/Bhnicity Source:RegistryofVital Recordsand Statistics, MDPH. ^Duetolowcasenumbersin 1990, percentageincrease wasreportedforratesbeginning in 1991. Opioids: TrendsandCurrentStatusin Massachusetts Page2 Injury Surveillance Program, MDPH 5 OPIOID-RELATED HOSPITALIZATIONS^ MAGNITUDE AND TRENDS Figure 4. Opioid-Related Hospital Discharge MA • Opioid-related hospitalization rates have Rates by Sex, Residents, risen gradually since 1996, increasing 38% 1994-2001 from 1999 to 2001. • In 2001, there were 14,530 opioid-related -a—Male acute care hospitalizations among Massachusetts residents (228.9 per 100,000 residents). • Total charges for opioid-related hospitalizations exceeded $120 million in 2001. SEX • The rate of opioid-related hospitalizations increased 36% among males from 1999 to Year 2001 and 41% among females. Source:MAHospital Discharge Database, CenterforHealth Information, Statistics, Researchand Evaluation, MDPH. AGE GROUPS Figure 5. Opioid-Related Hospital Discharge • The most dramatic increases in opioid- Rates by Age Group and Sex, related hospitalization rates between 1999 MA Residents, 2001 and 2001 were observed among individuals aged 15 to 24 years and 45 to 600.0 n 54 years, a 78% and 47% increase, respectively. • In 2001, males of every age group age 1 and over, had higher hospital discharge rates than females. The largest variation of opioid-related hospitalization rates between males and females were among persons aged 45 to 54, with males having rates 2.3 times that offemales. Age Group(years) ^Representsallacute-care hospitalizationswhereopioid abuse orpoisoningwasconsidered asoneofthediagnosesatdischarge. Source:MAHospital Discharge Database,CenterforHealth DataexcludeshospitalizationsatVeteransAffairs, psychiatric, Infonnation, Statistics, Researchand Evaluation, MDPH. rehabilitativeorlong-termcarefacilitiesanddeathsthatoccunred duringhospitalization.Trendswereonlyevaluatedfrom 1994 onwardfordataqualityreasons. Opioids: Trendsand CurrentStatusin Massachusetts Page3 Injury Surveillance Program, MDPH BOSTON AREA EMERGENCY DEPARTMENT VISITS'^ MAGNITUDE AND TRENDS Figure 6. ED Mentions for Heroin and Other • The estimated emergency department Narcotics, Estimates for (ED) visits due to heroin use for the greater Greater Boston, 1994-2001 Boston area increased 52% from 1999 to 2001. — — Heroin • For the greater Boston area, the estimated 5,000 -1 ED visits due to the use of narcotic § 4,000 - analgesics and narcotic combinations, excluding heroin, increased 95% from i 3,000 1999 to 2001. Q 2,000 - o 1 1,000 E z 0 -\ '^o ^7 '^e <>o Year Source:DrugAbuseWarning Networl< (DAWN), Substance Abuseand Mental Health ServicesAdministration. USDHHS. * Source: DrugAbuseWarning Network (DAWN), SubstanceAbuseand Mental HealthServicesAdministration, US Dept.ofHealthand HumanServices, http://dawninfo.samhsa.gov. DAWNisanational public health surveillancesystemthatmonitorstrendsindrugabuserelated emergencydepartmentvisits. Localestimatesarederivedfromasample ofhospitalsin5countiesinthegreaterBoston area. Eachdrugfora reported caseiscalled a"mention."Onedrug-related EDvisitcan have uptofourspecificsubstanceslisted. DAWNdataarenotcollectedin otherareasofMassachusetts. Opioids: TrendsandCurrentStatusin Massachusetts Page4 Injury Surveillance Program, MDPH TREATMENT AND PREVENTION^ TREATMENT FORADULT HEROIN USERS Figure 7. Admissions to Substance Abuse Treatment Services in MA: • In 2002, there were 51,715 admissions Adult Heroin Users, 1992-2002 among Massachusetts adults (ages 18 and over) for substance abuse treatment 60,000 n services who reported having used heroin. 51,715 w This represents a 17% increase between co 50,000 - 1999 and 2001, and an overall increase of '55 216% from 1992 through 2002. 1a(A 40,000 - < 30,000 - o PATIENT CHARACTERISTICS FOR 2002 n 20,000 - E3 16,337 • 73% (n=37,721) of patients were male and z 10,000 - 27% (n=13,988) were female. 0 - • Over one third oftreatment admissions in 2002 were among persons between the ?o <9o ^^o '^(h ages of 30 and 39 (n=19,041); the mean Year age was 33.6 years. • 65% of patients were white, 9% were black, and 22% were Latino. Source:BureauofSubstanceAbuseServices, Management Infomnation System, MDPH. • 66.7% of patients reported injection drug use during the past year. • 87.9% were unemployed, 24.7% were homeless, and 24.3% had received prior mental health treatment. RESOURCES SubstanceAbuseand Mental Health Massachusetts DepartmentofPublic Health ServicesAdministration vwvw.samhsa.qov Bureau ofSubstanceAbuseServices 250 Washington Street, 3rd Floor Centerfor Substance Abuse Prevention Boston MA, 02108 Tel. (301)443-0365 www.samhsa.gov/centers/csap/csap.html Tel. (617)624-5111 Fax (617) 624-5185 Centerfor Substance Abuse Treatment TTY(617) 536-5186 Tel. (301)443-5700 www.state.nna.us/dph/bsas/BSAS.htm National ClearinghouseforAlcohol and Drug Massachusetts DepartmentofPublic Health Information (NCADI) CenterforHealth Information, Statistics, Research & Tel. 1-800-729-6686 Evaluation Injury Surveillance Program MassachusettsCommunity Health Information 2 Boylston Street, 6th Floor Profile (MassCHIP) vwvw.masschip.state.ma.us/ Boston MA, 02116 Tel. (617) 988-3317 Tel. 1-888-MAS-CHIP Fax (617)988-3331 (in Massachusetts) www.state.ma.us/dph/bhsre/isp/isp.htm *Source: Bureau ofSubstanceAbuseServicesManagementInformation System(SAIVIIS), IVIDPH. SAMISincludesdata provided byall BSASlicensedsubstanceabusetreatmentprograms. Datareflectadmissions, notpatients. Patientscan havemultipleadmissions. Opioids: Trendsand CurrentStatusin Massachusetts Page5 InjurySurveillance Program, MDPH Massachusetts Department of Public Health Center for Health Information, Statistics, Research and Evaluation Injury Surveillance Program (ISP) 2 Boylston Street, 6*^ Floor Boston, MA 02116 ISP Director Holly Hackman ProjectStaff: MariaCaterinaCiampi,Intern KateChamberlin , DakshaGopal BethC. Hume LaurieJannelli Cheng Mao LoretaMcKeown PatriceMelvin BridgetNestor LaVonneOrtega VictoriaOzonoff VeronicaVieira This publication was supported bygrants #U17/CCU119390 and #U17/CCU119400fromthe CentersforDisease Control and Prevention. Its contents are solelythe responsibilityofthe authorsand do notrepresenttheofficial views ofthe Centersfor Disease Control and Prevention. For Information on Substance Treatment and Services: Contact the Department's Bureau of Substance Abuse Services on-line at www.state.ma.us/dph/bsas/BSAS.htm OR Call the MASubstance Abuse Information and Education HELPLINE® 1-800-327-5050 1