Prescription Drugs: Impacts of Misuse and Accidental Overdose in Mississippi. Signe Shackelford, MPH Policy Analyst November 19, 2013

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1 Prescription Drugs: Impacts of Misuse and Accidental Overdose in Mississippi Signe Shackelford, MPH Policy Analyst November 19, 2013

2 Center for Mississippi Health Policy Independent, non-profit organization Mission is to inform health policy decisions by providing sound research and analysis Do not advocate or lobby for particular solutions 2

3 Deaths per 100,000 population Poisoning and Motor Vehicle Deaths Trends in United States ( ) 25 Motor Vehicle Crash Poisoning Drug Poisoning Source: Warner, M., Chen, L.H., Makuc, D.M., Anderson, R.N., & Miniño, A.M. (December 2011). Drug poisoning deaths in the United States, NCHS Data Brief. 81: p. 3. Updated with 2009 and 2010 mortality data. 3

4 Deaths per 100,000 population Poisoning and Motor Vehicle Deaths Trends in Mississippi ( ) Motor Vehicle Crash Poisoning Drug Poisoning Source: Mississippi State Department of Health, Public Health Statistics. Underlying cause of death from the MSTAHRS online query system compiled from information on death certificates received from doctors, coroners, and funeral home directors by Mississippi Vital Records. Accessed at 4

5 Unintentional Drug Poisoning Deaths by Public Health District ( ) Source: Mississippi State Department of Health, Public Health Statistics. Underlying cause of death from the MSTAHRS online query system compiled from information on death certificates received from doctors, coroners, and funeral home directors by Mississippi Vital Records. Accessed at Rate is per 100,000 population. 5

6 Overview-Mississippi (2011) Unintentional Poisoning by Drug Deaths 232 deaths: o years of age o 50 percent Male/50 percent Female o 90 percent White 6

7 Number of Deaths Unintentional Poisoning by Drugs Number of Deaths in MS by Age (2011) Age Group N=232 7

8 Unintentional Poisoning by Drugs Deaths in MS by Race (2011) 209 9% 1% 21 White Black Other 2 90% White Black Other N=232 8

9 Unintentional Poisoning by Drugs Deaths in MS by Level of Education (2011) 25% 39% < High School High School Graduate > High School 36% N=232 9

10 Drug Poisoning Deaths Drug Type, United States (2008) 25% 41% Opioid Analgesics (14,800) Non-Opioid Drugs (12,408) Drug-Related (Drug Not Specified) (9,242) 34% Source: Warner, M., Chen, L.H., Makuc, D.M., Anderson, R.N., & Miniño, A.M. (2011). Drug poisoning deaths in the United States, NCHS Data Brief. 81: p

11 Unintentional Drug Poisoning Deaths Drug Type, Mississippi (2011) 1% 5% ICD 9 CODES 16% X40: Non-Opioid Analgesics, Antipyretics, & Antiheumatics 78% X41: Anti-Epileptic, Sedative- Hypnotic, Antiparkinsonism, & Psychotropic Drugs X42: Narcotics and Psychodysleptics (Hallucinogens) x44: Unspecified Drugs, Medicaments, & Biological Substances N=232 11

12 Unintentional Drug Poisoning Deaths Drug Type, Mississippi (2011) Top T-Codes Mentioned on Death Certificates (2011) 1. Other and unspecified (T509): Other opioids (Codeine and Morphine) (T402): Benzodiazepines (T424): Cocaine (T405): Tricyclic and tetracyclic antidepressants (T430): Other synthetic narcotics (Pethidine/Demerol) (T404): Methadone (T403): 11 (tied) 8. Other unspecified antidepressants (T432): 11 (tied) Source: Mississippi State Department of Health, Public Health Statistics

13 Data Match Project Partners Mississippi State Department of Health Office of Vital Records Pharmacy MS Board of Pharmacy MS Prescription Monitoring Program 13

14 Project Overview-Background 232 Unintentional Drug Overdose Deaths (2011) records not admissible for study: o No PMP record (40) o In PMP, no Rx for study period (12) decedents included in study

15 Project Findings: Total Prescriptions and Quantity Total Number of Prescriptions per Person Minimum 1 15 Maximum ,072 Median ,957.5 Mean ,780.5 Total Number of Doses per Person 15

16 Project Findings: Descriptive Statistics-Males Total: 82 deaths Mean Age: 40 years Mean # Prescriptions: 38 Mean # Prescribers: 6.5 Mean # Dispensers: 4 16

17 Project Findings: Descriptive Statistics-Females Total: 98 deaths Mean Age: 45 years Mean # Prescriptions: 47 Mean # Prescribers: 7 Mean # Dispensers:

18 Project Findings: Distribution by Drug Schedule 3% 4% 19% I III II IV 43% V 31% 18

19 Project Findings: Prescriptions by Drug Category 5% 2% 3% 53% 37% Pain Killers Sedatives Muscle Relaxants Stimulants Other 19

20 Number Decedents Project Findings: Number of Unique Opioid Rxs Number of Unique Opioid Prescriptions 20

21 Project Findings: Number of Prescribers per Decedent 4% 2% 2% 13% 26% 27% 26%

22 Project Findings: Prescriptions Written per Prescriber 15% 3% < % 22

23 Project Findings: Number of Dispensers per Decedent 6% 3% 15% 28% 48%

24 Impact of Abuse and Misuse of Prescription Pain Medication For every one death there are: 10 treatment admissions for abuse 32 ER visits for misuse or abuse 130 people who abuse or are dependent 825 nonmedical users Source: Centers for Disease Control. (2011). Policy Impact: Prescription Painkiller Overdoses. 24

25 Prescription Drug Misuse: Prevalence and Cost Estimated annual health care cost comparison study: $15,884: opioid abuser $1,830: non-abuser Annual cost of opioid diversion and abuse to health insurers: $72.5 billion 25

26 Prescription Drug Misuse: Policy Options for States Prescription monitoring programs Law enforcement solutions Drug disposal options Delivery system regulations Coordination between stakeholders Public education 26

27 Example of Other Data Sets: Mississippi Emergency Medical Services Information System (MEMSIS) Year TOTAL 1,228 Naloxone Administration 27

28 Contact Information Center for Mississippi Health Policy 120 N Congress Street, Suite 700 Jackson, MS (601)

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