Drug Overdose
Recent Dramatic Increases
in Deaths & New Answers
that Save Lives
T. Stephen Jones, MD
Centers for Disease Control and Prevention (retired)
Public Health Consultant, Florence MA
Keeping It Real Conference 2009
September 30, 2009
Main Points
• Bad news – Overdose deaths have
increased dramatically – mostly deaths
caused by prescription painkillers
• Good News – new approaches to
preventing overdose and overdose deaths
are saving lives
1
Unintentional Poisoning Deaths (~90%
Drug Overdoses), US, 1999 & 2005
22,448 deaths
Source: adapted from CDC Wonder. Compressed mortality file, 1999--2005. Available at http://wonder.cdc.gov/cmf-icd10.html. .
Prescription Painkillers Have
Become Much More Important
than Heroin as Causes of Drug
O d
Overdoses
2
Unintentional drug overdose deaths
by major type of drug, U.S., 1999-2005
opioid analgesic
cocaine
heroin
9,000
Number of deaths
8,000
7,000
6,000
5,000
4,000
3,000
2,000
,
1,000
0
'99
'00
'01
'02
'03
'04
'05
Source: L. Paulozzi talk December 2008 CDC meeting
Prescription painkillers involved
in drug overdose deaths
• Methadone
• Hydrocodone (Vicodin ®)
• Oxycodone (OxyContin®, Percocet®
Percodan®)
• Fentanyl
3
Source: NC State Center for Health Statistics, T‐codes 40.1, 40.5, 40.2 and 40.4 40.3, 8/ 2007
Source: L. Paulozzi talk December 2008 CDC meeting
4
What is the most prescribed drug in the United States?
(number of prescriptions filled)
5
y Hydrocodone w/APAP
92,719,975
y Lipitor®
69,766,431
y Lisinopril
46 206 563
46,206,563
y Atenolol
44,162,229
y Synthroid®
44,056,176
y Amoxicillin
41,393,538
y Hydrochlorothiazide
41,345,733
y Zithromax®
37,171,754
y Furosemide
F
id
36,508,251
y Norvasc®
34,729,004
Source: http://www.rxlist.com/top200.htm
1.
2
2.
3.
4.
5.
6.
7.
8.
9.
10.
Hydrocodone (Vicodin®)
Lipitor®
Amoxicillin
Lisinopril
Hydrochlorothiazide
Atenolol
Zithromax®
Furosemide
Alprazolam (Zanax®)
Toprol-XL®
Source: http://www.rxlist.com/script/main/hp.asp
6
Good News – Manyy New
Community/Public Health OD
Prevention Programs Around the
United States
Overdose Prevention
• For the first time,
time substantial
government money and staff devoted to
preventing OD deaths
• Even so, much more money and effort
are needed
7
Overdose Prevention
• Community
Community-based,
based public health OD
prevention programs are spreading
(Baltimore, Chicago, New York, Boston,
San Francisco, Philadelphia, Pittsburg,
Springfield MA, and many other cities)
• Train drug users, friends, and family about
how to recognize ODs and what to do
• Provide naloxone to reverse opioid ODs
8
Teaching how to position a person who
has overdosed
9
Naloxone (Narcan)
• Used by EMTs
(ambulances) & in
emergency rooms
• Rapidly reverses opioid
overdose
30-90
90
• Works for 30
minutes
• Delivered by injection
or sprayed into the nose
Source: adapted from slides of Nab Dasgupta
10
Nasal Naloxone
• 2 mL pre-loaded
syringes (1 mg/mL)
• Nasal adaptor
• Spray
p y into nose
• No needles
Through a support group, I got to know people who have used naloxone
to save their children during an opioid overdose, so when I had a chance
to obtain some at the meeting, I did.
Our son overdosed on heroin in April, 2009. We discovered him in his
room, turning gray with a respiration rate of barely 3 breaths per minute.
After trying in vain to wake him up, we administered naloxone. He
started breathing very slow, ragged breaths. The ambulance took 12
minutes to arrive and if my husband and I had not administered the drug,
g from
our son would have pprobablyy been dead or severelyy brain damaged
the lack of oxygen. The police and the hospital were really, really (and
not in a good way) interested in where we got the drug and how we knew
how to use it.
- Mother of Michael
11
Thank you
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