US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations

Unick, George J.; Ciccarone, Daniel

doi:10.1016/j.drugpo.2017.06.003

Cited by 110 publications

(86 citation statements)

References 26 publications

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“…Prescription opioids are a major cause of opioid‐related death, especially in older adults . PIP is associated with higher odds of nonfatal opioid overdose, fatal opioid overdose, and all‐cause mortality .…”

Section: Discussionmentioning

confidence: 99%

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Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Rose

McBain

Schuler

et al. 2018

J American Geriatrics Society

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Background/Objectives: Potentially inappropriate opioid prescribing (PIP) may contribute to risk for fatal opioid overdose among older adults (age 50+). Our objective was to examine the effect of age on the likelihood of PIP exposure, as well as the effect of PIP exposure on adverse outcomes. Design: Retrospective cohort study Setting: Data from multiple state agencies in Massachusetts, 2011–2015 Participants: Over 3 million adult Massachusetts residents (3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) were older adults (age 50+). Measurements: We measured exposure to five types of PIP: high-dose opioids, co-prescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined three adverse outcomes: non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality. Results: The rate of any PIP exposure increased with age, ranging from 2% among individuals age 18–29 to 14% among those age 50 and older. Older adults also had elevated rates of exposure to two or more different types of PIP, including 5% of adults age 50–69 and 4% of adults age 70 or older, in comparison to 2.5% of age 40–49 and lower percentages in younger age groups. Among covariates assessed, increasing age was the greatest positive predictor of PIP exposure. In analyses stratified by age, exposure to both any PIP and specific types of PIP were associated with non-fatal overdose, fatal overdose, and all-cause mortality among both younger and older adults. Conclusion: Older adults are more likely to be exposed to PIP, which elevates their risk for adverse events. Strategies to reduce exposure to PIP, and to improve outcomes among those already exposed, will be instrumental to addressing the opioid crisis as it manifests among older adults.

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Section: Discussionmentioning

confidence: 99%

“…Opioid use and opioid‐related harms may be different in older (≥50) and younger adults . Prescription opioids account for more than twice as many deaths as illicit opioids in older adults . Potentially inappropriate prescribing (PIP) involves suboptimal prescribing or high‐risk medication use.…”

mentioning

confidence: 99%

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Rose

McBain

Schuler

et al. 2018

J American Geriatrics Society

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“…Unick and Ciccarone, utilizing national hospitalization data, make geographic and demographic distinctions between heroin- and prescription opioid-related overdose (Unick and Ciccarone 2017). Their analyses reveal the strong regionality of the heroin overdose epidemic: the US Census Divisions identified in their data as having the greatest increase in heroin overdose contain those states identified by the CDC as having the highest increase in rates of synthetic opioid overdose.…”

Section: Contributions To This Special Sectionmentioning

confidence: 99%

“…Their analyses reveal the strong regionality of the heroin overdose epidemic: the US Census Divisions identified in their data as having the greatest increase in heroin overdose contain those states identified by the CDC as having the highest increase in rates of synthetic opioid overdose. This suggests the intertwining of heroin and fentanyl supply, use and consequences at a US regional level (Unick and Ciccarone 2017). These authors also point out that heroin overdose is skewing to younger age groups than with pill overdose and becoming more ethnically diverse in certain regions.…”

Section: Contributions To This Special Sectionmentioning

confidence: 99%

Fentanyl in the US heroin supply: A rapidly changing risk environment

Ciccarone

2017

International Journal of Drug Policy

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376

226

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“…Though patterns continue to change, prescription opioid poisoning deaths increased by 400% between 1999 and 2014, with prescription opioids responsible for more deaths than heroin, cocaine, and stimulant poisoning combined . Prescription opioid dependence and poisoning rates have also risen in recent years . High‐risk opioid prescribing practices are a key driver of trends in prescription opioid mortality and morbidity .…”

mentioning

confidence: 99%

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

Sears

Edmonds

Fulton‐Kehoe

2019

The Journal of Rural Health

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Purpose High‐risk opioid prescribing is a critical driver of prescription opioid‐related morbidity and mortality. This study explored opioid prescribing patterns across urban‐rural and economic distress classifications. Secondarily, this study explored the urban‐rural distribution of relevant health services, economic factors, and population characteristics. Methods County‐level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012‐2017). Counties were classified using the 2013 National Center for Health Statistics Urban‐Rural Classification Scheme for Counties, and Washington State unemployment‐based distressed areas. County‐level measures from Area Health Resources Files were used to describe the urban‐rural continuum. Findings Persistent economic distress was associated with higher‐risk opioid prescribing. The large central metropolitan category had lower‐risk opioid prescribing metrics than the other 5 urban‐rural categories, which were similar to each other and not ordered by degree of rurality. High‐risk prescribing declined over time, without notable trend divergence by either urban‐rural or economic distress classifications. Conclusions The most striking urban‐rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban‐rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban‐rural continuum. Finally, the multiple intertwined burdens faced by rural communities—higher‐risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment—must be addressed as an urgent public health priority.

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US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations

Cited by 110 publications

References 26 publications

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

Fentanyl in the US heroin supply: A rapidly changing risk environment

Tracking Opioid Prescribing Metrics in Washington State (2012‐2017): Differences by County‐Level Urban‐Rural and Economic Distress Classifications

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