Serious Medical Outcomes due to Single Substance Opioid Exposures
Abstract
Objectives: The present study sought to evaluate the recent trends in the severe outcomes to single substance opioid exposures (SSO) reported to the U.S. poison centers (PCs).
Background: Misuse of prescription opioids continues to be a significant public health crisis globally. According to the Centers for Disease Control and Prevention (CDC), there were more than 72,000 overdose deaths in the United States (U.S.), with 49,068 involving an opioid.
Methods: The NPDS was queried for single substance opioid exposures that were reported to the U.S. PCs from 2011 to 2011. Cases with severe outcomes (SO) were defined as exposures that resulted in either a death or major clinical outcomes. We identified and descriptively assessed the relevant demographic and clinical characteristics. Poisson regression models were used to evaluate the trends in the number and rates (per 100,000 human exposures) of single substance opioid exposures resulting in SO. Percent changes from the first year of the study (2011) were reported with the corresponding 95% confidence intervals (95% CI). Logistic regression was utilized to study the risk markers of severe outcomes.
Results: Overall there were 308,202 single substance opioid-related cases reported to the U.S. PCs during the study period. The proportion of cases from ACH increased during the study period (32.9% vs 48.9%). Among cases with severe outcomes, ages between 20 and 29 years (27.9%) constituted the most common age group. Males accounted for 57.4% cases. Most exposures with SO occurred in a residence (83.7%). Hydrocodone (25.6%) was the most common opioid reported in cases followed by oxycodone (18.7%). Intentional abuse (48.4% vs 12.7%) and suspected suicides (24.7% vs 12.9%) were more common in exposures with SO compared to those without SO. Similarly, non-oral routes of administration were more common in exposures with SO (40.9% vs 8.1%). The rate of exposures with SO increased by 71.3% (95% CI: 63.4%, 79.9%, p<0.001). The risk of SO with single substance opioid-related exposures was the highest in cases between 50 and 59 years of age (Ref: 20 – 29 years) (AOR: 1.61, 95% CI: 1.52 – 1.71). Males were 16% more likely than females to have serious outcomes (AOR: 1.16, 95% CI: 1.12 – 1.20). The risk for severe outcomes with single substance opioid exposures was significantly elevated in hydrocodone (AOR: 2.43, 95% CI: 2.30 – 2.58), oxycodone (AOR: 1.64, 95% CI: 1.55 – 1.73) and tramadol (AOR: 1.80, 95% CI: 1.69 – 1.92) exposures. Other Important predictors of a single substance opioid-related SO were suspected suicides (Ref: Unintentional exposure) (AOR: 3.82, 95% CI: 3.67 – 4.09), non-oral routes of administration (Ref: Ingestion) (AOR: 2.94, 95% CI: 2.80 – 3.00) and exposure in the west census region of the U.S. (Ref: Northeast region) (AOR: 1.21, 95% CI: 1.16 – 1.28).
Conclusion: The number of single substance opioid exposures cases handled by the PCs decreased, but those with severe outcomes increased significantly. Hydrocodone and oxycodone were the most common opioid reported for the sample. Personalized evidence-based strategies, population level interventions, creation of protective environments, and better screening of patients are some key measure to limit this trend.