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National Estimates from the Drug Abuse Warning Network

National Estimates from the Drug Abuse Warning Network. CAPT Kathy Poneleit United States Public Health Service Office of Applied Studies Substance Abuse & Mental Health Services Administration November 13, 2008 http://DAWNinfo.samhsa.gov. Today's Agenda. No conflicts of interest

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National Estimates from the Drug Abuse Warning Network

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  1. National Estimates from the Drug Abuse Warning Network CAPT Kathy Poneleit United States Public Health Service Office of Applied Studies Substance Abuse & Mental Health Services Administration November 13, 2008 http://DAWNinfo.samhsa.gov

  2. Today's Agenda • No conflicts of interest • Overview of DAWN • Key findings from 2007 • Nonmedical use of opiates/opioids • 2004-2007 comparisons • Extended- vs. immediate-release oxycodone • Extended- vs. immediate-release morphine 2

  3. DAWN Survey Design • Stratified probability sample of hospitals • Short-term, general, non-Federal hospitals with 24-hour emergency departments (EDs) • National estimates account for: • Sample design • Unit nonresponse • Partial nonresponse in responding hospital 3

  4. Oversample areas (urban)+ Remainder area (urban & rural) National Estimates 4

  5. Source of DAWN Estimates, 2004-2007 5

  6. DAWN Data Collection: Retrospective Review of Medical Records Charts reviewed 10,038,897 ED visits reviewed Cases found 375,031 Drug-related ED visits not reviewed National estimates Source: DAWN, 2007 data, 11/11/2008 6

  7. Analysis Domains 7

  8. Definition: Nonmedical Use of Pharmaceuticals • Based on retrospective chart review • Exceeded prescribed or recommended dose • Used drugs prescribed for another • Malicious poisoning • Substance abuse • Excludes drug-related suicide attempts • Includes suicide ideation, plan, gesture 8

  9. *Significant change, 2004 vs. 2007 2005 vs. 2007 Drug-Related ED Visit Rates, 2004-2007 No significant change 2006 vs. 2007 Source: National estimates from DAWN, 2004-2007 9

  10. Oxycodone Controlled and Immediate Release 10

  11. CI upper bound CI lower bound Estimate Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 * Single- & multi-ingredient formulations Source: National estimates from DAWN, 2007 11

  12. CI upper bound CI lower bound Estimate Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 * Single- & multi-ingredient formulations Source: National estimates from DAWN, 2007 12

  13. Controlled release (CR) OxyContin (99%) Alternate terms: Generic OxyContin Teva OxyContin Impax OxyContin Oxycodone CR Oxycodone ER Oxycodone SR Immediate release (IR) acetaminophen-oxy e.g., Percocet (92%) aspirin-oxy e.g., Percodan ibuprofen-oxy e.g., Combunox oxycodone e.g., Roxicodone Classification of Oxycodone Reports 13

  14. Unknown release type (UK) Oxycodone (95%) alternate terms: Free oxycodone M-Oxy Oxycodone hydrochloride Oxycodone metabolites Classification of Oxycodone Reports (cont'd) 14

  15. CI upper bound CI lower bound Estimate Nonmedical Use of Pharmaceuticals, Oxycodone, by Release Type, 2004-2007 Controlled Immediate Unknown Source: National estimates from DAWN, 2004-2007 15

  16. *Significant change, 2004 vs. 2007 2005 vs. 2007 Oxycodone, CR vs. IR – All Visits No significant change 2006 vs. 2007 2007 2006 2005 2004 Source: DAWN estimates for the U.S., 2004-2007 16

  17. *Significant change, 2004 vs. 2007 2005 vs. 2007 Oxycodone, CR vs. IR – Medical Use No Significant change 2006 vs. 2007 2007 2006 2005 2004 Source: DAWN estimates for the U.S., 2004-2007 17

  18. *Significant change, 2004 vs. 2007 2005 vs. 2007 Oxycodone, CR vs. IR – Nonmedical Use No significant change 2006 vs. 2007 2007 2006 2005 2004 Source: DAWN estimates for the U.S., 2004-2007 18

  19. Oxycodone, CR vs. IR Nonmedical use Medical use % of visits Source: DAWN estimates for the U.S., 2004-2007 19

  20. Hydrocodone Oxycodone: UK IR ER Nonmedical Use: Hydrocodone and Oxycodone by Release Type, 2004-2007 Source: DAWN estimates for the U.S., 2004-2006 20

  21. Nonmedical Use: All Opiates/Opioids, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 21

  22. Nonmedical Use: All Hydrocodone, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 22

  23. Nonmedical Use: All Oxycodone, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 23

  24. Nonmedical Use: Oxycodone CR,ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 24

  25. Nonmedical Use: Oxycodone IR,ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 25

  26. Nonmedical Use: Oxycodone UK,ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 26

  27. Nonmedical Use: Disposition from ED,Oxycodone by Release Type, 2007 % of ED visits No evidence of follow-up care Some follow-up Controlled Immediate Unknown Source: DAWN estimates for the U.S., 2007 27

  28. 1 drug Nonmedical Use: Number of Drugs,Oxycodone by Release Type, 2007 % of ED visits Multiple drugs Controlled Immediate Unknown Source: DAWN estimates for the U.S., 2007 28

  29. Nonmedical Use ED Visits: Conclusions • Opioid analgesics nearing 287,000 visits • ¼ Oxycodone  ¼ Hydrocodone •  in immediate and unknown release types • Highest visit rates in patients aged 21-54 • Majority of patients treated and released • Polydrug use was higher for immediate versus controlled release 29

  30. Morphine Controlled and Immediate Release 30

  31. CI upper bound CI lower bound Estimate Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2007 * Single- & multi-ingredient formulations Source: National estimates from DAWN, 2007 31

  32. Controlled release (CR) MS Contin (71%) Alternate terms: Avinza Kadian Morphine Sulfate SR Oramorph SR Morphine Extended Release Morphine Patches Immediate release (IR) Morphine Sulfate Morphine Pill Morphine IR Morphine Rapi-Ject Roxanol Morphelan Classification of Morphine Reports 32

  33. CI upper bound CI lower bound Estimate Nonmedical Use of Pharmaceuticals, Morphine, by Release Type, 2004-2007 Immediate Controlled Source: National estimates from DAWN, 2004-2007 33

  34. *Significant change, 2004 vs. 2007 2005 vs. 2007 Morphine, CR vs. IR – All Visits No significant change 2006 vs. 2007 2007 2006 2005 2004 Source: DAWN estimates for the U.S., 2004-2007 34

  35. *Significant change, 2004 vs. 2007 2005 vs. 2007 Morphine, CR vs. IR – Medical Use No Significant change 2006 vs. 2007 Source: DAWN estimates for the U.S., 2004-2007 35

  36. *Significant change, 2004 vs. 2007 2005 vs. 2007 Morphine, CR vs. IR – Nonmedical Use No significant change 2006 vs. 2007 Source: DAWN estimates for the U.S., 2004-2007 36

  37. Morphine, CR vs. IR Nonmedical use Medical use % of visits Source: DAWN estimates for the U.S., 2004-2007 37

  38. Hydrocodone Morphine: UK IR CR Nonmedical Use: Hydrocodone and Morphine by Release Type, 2004-2007 Source: DAWN estimates for the U.S., 2004-2006 38

  39. Nonmedical Use: All Morphine, ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 39

  40. Nonmedical Use: Morphine CR,ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 40

  41. Nonmedical Use: Morphine IR,ED Visit Rates, 2007 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2007 41

  42. Nonmedical Use: Disposition from ED,Morphine by Release Type, 2007 % of ED visits No evidence of follow-up care Some follow-up Controlled Immediate Unknown Source: DAWN estimates for the U.S., 2007 42

  43. 1 drug Nonmedical Use: Number of Drugs,Morphine by Release Type, 2007 % of ED visits Multiple drugs Controlled Immediate Unknown Source: DAWN estimates for the U.S., 2007 43

  44. Nonmedical Use ED Visits: Conclusions • Morphine related ED visits nearing 30,000 • Immediate release  • Controlled release is similar 2004-2007 • Highest visit rates in patients aged 21-54 • Majority of patients treated and released • Polydrug use is typical 44

  45. Important Considerations:DAWN Depends on ED Medical Records • Link between ED visit and use of drug • Dose levels and source of drug unavailable • Nonspecific drug reports • Opiates/opioids, unspecified (unnamed) • Unknown release-type • Unique names for immediate versus extended release enable better surveillance 45

  46. Acknowledgements • Rong Cai, Statistician 46

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