Emergency Physicians See More Nonmedical Opioid Use

Major Finding: Emergency department visits for nonmedical use of prescription analgesics more than doubled during 2004-2008.

Data Source: A review by the Centers for Disease Control and Prevention of 5-year data on ED visits involving the nonmedical use of prescription drugs from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network.

Disclosures: None were reported.

Emergency department visits for nonmedical use of opioids increased by nearly 112% between 2004 and 2008, with a 29% increase between 2007 and 2008 alone, according to the Centers for Disease Control and Prevention.

Together with the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC reviewed the latest available 5 years of data on emergency department (ED) visits for nonmedical use of prescription drugs from SAMHSA's Drug Abuse Warning Network (DAWN). ED visits involving nonmedical use of opioid analgesics rose from 144,600 in 2004 to 305,900 in 2008, according to the report published in the CDC's June 18 Morbidity and Mortality Weekly Report. By 2008, the number of ED visits for misused prescription and over-the-counter drugs matched the number of ED visits involving illicit drugs for that year, the report noted (MMWR 2010 June 18;59:705-9).

The DAWN definition of nonmedical use of a prescription or over-the-counter drug includes taking a higher-than-recommended dose, taking a drug that was prescribed for another person, drug-facilitated assault, and misuse or abuse—all of which must be documented in a patient's medical record. It does not include suicide attempts, patients seeking detoxification, and unintentional ingestions, which are tracked in other categories.

The highest numbers of ED visits involving prescription drugs in this review were for oxycodone, hydrocodone, and methadone, each of which showed significant increases during the 5-year study. Among these drugs, the greatest increase was noted for oxycodone, with an estimated 41,700 ED visits in 2004 and 105,200 ED visits in 2008, representing a 144% increase.

Additionally, ED visits for nonmedical use of benzodiazepines increased 89%, from 143,500 in 2004 to 271,700 in 2008, with significant increases observed for each of the individual benzodiazepine drugs reviewed, including alprazolam, clonazepam, diazepam, and lorazepam. Significant increases were also noted for ED visits involving the sleep aid zolpidem and the muscle relaxant carisoprodol.

Peak visit rates for both opioids and benzodiazepines were observed in the age ranges 21-24 and 25-29 years, which represents a shift from previous report periods, in which peak visit rates were seen in the 30- to 34- and 35- to 44-year age ranges, according to an editorial note accompanying the report.

“As late as 2006, the peak mortality rate for fatal drug overdoses involving opioid analgesics had been in the 35-54 years age group,” according to the note.

The 5-year increase in ED visits probably reflects “substantial increases in the prescribing of these classes of drugs,” the CDC authors suggested. “The increase also might reflect an increase in the rate of nonmedical use of prescription drugs per 1,000 prescriptions, as has been observed for selected opioids.”

The report is limited by a number of factors, according to the authors. “First, the drugs involved in ED visits might not all be identified and documented. The extent to which ED staff members document drug involvement might have increased over time,” they wrote.

Additionally, information on the motivation behind nonmedical drug use might be incomplete, for instance by not noting a suicide attempt; population-based rates cannot be used to establish per-patient or per-prescription risk; and the distinction between nonmedical and medical reasons for taking drugs is not always clear, particularly when other drugs are involved.

Despite these limitations, “these increases in nonmedical use of pharmaceuticals suggest that previous prevention measures, such as provider and patient education and restrictions on use of specific formulations, have not been adequate,” the authors wrote.

Additional interventions, including more systematic provider education, universal use by providers of prescription-drug monitoring programs, routine monitoring of insurance claims information, and stepped up efforts by providers and insurers to intervene at signs of drug misuse are “urgently needed,” they stressed.

Major Finding: Emergency department visits for nonmedical use of prescription analgesics more than doubled during 2004-2008.

Data Source: A review by the Centers for Disease Control and Prevention of 5-year data on ED visits involving the nonmedical use of prescription drugs from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network.

Disclosures: None were reported.

Emergency department visits for nonmedical use of opioids increased by nearly 112% between 2004 and 2008, with a 29% increase between 2007 and 2008 alone, according to the Centers for Disease Control and Prevention.

Together with the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC reviewed the latest available 5 years of data on emergency department (ED) visits for nonmedical use of prescription drugs from SAMHSA's Drug Abuse Warning Network (DAWN). ED visits involving nonmedical use of opioid analgesics rose from 144,600 in 2004 to 305,900 in 2008, according to the report published in the CDC's June 18 Morbidity and Mortality Weekly Report. By 2008, the number of ED visits for misused prescription and over-the-counter drugs matched the number of ED visits involving illicit drugs for that year, the report noted (MMWR 2010 June 18;59:705-9).

The DAWN definition of nonmedical use of a prescription or over-the-counter drug includes taking a higher-than-recommended dose, taking a drug that was prescribed for another person, drug-facilitated assault, and misuse or abuse—all of which must be documented in a patient's medical record. It does not include suicide attempts, patients seeking detoxification, and unintentional ingestions, which are tracked in other categories.

The highest numbers of ED visits involving prescription drugs in this review were for oxycodone, hydrocodone, and methadone, each of which showed significant increases during the 5-year study. Among these drugs, the greatest increase was noted for oxycodone, with an estimated 41,700 ED visits in 2004 and 105,200 ED visits in 2008, representing a 144% increase.

Additionally, ED visits for nonmedical use of benzodiazepines increased 89%, from 143,500 in 2004 to 271,700 in 2008, with significant increases observed for each of the individual benzodiazepine drugs reviewed, including alprazolam, clonazepam, diazepam, and lorazepam. Significant increases were also noted for ED visits involving the sleep aid zolpidem and the muscle relaxant carisoprodol.

Peak visit rates for both opioids and benzodiazepines were observed in the age ranges 21-24 and 25-29 years, which represents a shift from previous report periods, in which peak visit rates were seen in the 30- to 34- and 35- to 44-year age ranges, according to an editorial note accompanying the report.

“As late as 2006, the peak mortality rate for fatal drug overdoses involving opioid analgesics had been in the 35-54 years age group,” according to the note.

The 5-year increase in ED visits probably reflects “substantial increases in the prescribing of these classes of drugs,” the CDC authors suggested. “The increase also might reflect an increase in the rate of nonmedical use of prescription drugs per 1,000 prescriptions, as has been observed for selected opioids.”

The report is limited by a number of factors, according to the authors. “First, the drugs involved in ED visits might not all be identified and documented. The extent to which ED staff members document drug involvement might have increased over time,” they wrote.

Additionally, information on the motivation behind nonmedical drug use might be incomplete, for instance by not noting a suicide attempt; population-based rates cannot be used to establish per-patient or per-prescription risk; and the distinction between nonmedical and medical reasons for taking drugs is not always clear, particularly when other drugs are involved.

Despite these limitations, “these increases in nonmedical use of pharmaceuticals suggest that previous prevention measures, such as provider and patient education and restrictions on use of specific formulations, have not been adequate,” the authors wrote.

Additional interventions, including more systematic provider education, universal use by providers of prescription-drug monitoring programs, routine monitoring of insurance claims information, and stepped up efforts by providers and insurers to intervene at signs of drug misuse are “urgently needed,” they stressed.

Major Finding: Emergency department visits for nonmedical use of prescription analgesics more than doubled during 2004-2008.

Data Source: A review by the Centers for Disease Control and Prevention of 5-year data on ED visits involving the nonmedical use of prescription drugs from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network.

Disclosures: None were reported.

Emergency department visits for nonmedical use of opioids increased by nearly 112% between 2004 and 2008, with a 29% increase between 2007 and 2008 alone, according to the Centers for Disease Control and Prevention.

Together with the Substance Abuse and Mental Health Services Administration (SAMHSA), the CDC reviewed the latest available 5 years of data on emergency department (ED) visits for nonmedical use of prescription drugs from SAMHSA's Drug Abuse Warning Network (DAWN). ED visits involving nonmedical use of opioid analgesics rose from 144,600 in 2004 to 305,900 in 2008, according to the report published in the CDC's June 18 Morbidity and Mortality Weekly Report. By 2008, the number of ED visits for misused prescription and over-the-counter drugs matched the number of ED visits involving illicit drugs for that year, the report noted (MMWR 2010 June 18;59:705-9).

The DAWN definition of nonmedical use of a prescription or over-the-counter drug includes taking a higher-than-recommended dose, taking a drug that was prescribed for another person, drug-facilitated assault, and misuse or abuse—all of which must be documented in a patient's medical record. It does not include suicide attempts, patients seeking detoxification, and unintentional ingestions, which are tracked in other categories.

The highest numbers of ED visits involving prescription drugs in this review were for oxycodone, hydrocodone, and methadone, each of which showed significant increases during the 5-year study. Among these drugs, the greatest increase was noted for oxycodone, with an estimated 41,700 ED visits in 2004 and 105,200 ED visits in 2008, representing a 144% increase.

Additionally, ED visits for nonmedical use of benzodiazepines increased 89%, from 143,500 in 2004 to 271,700 in 2008, with significant increases observed for each of the individual benzodiazepine drugs reviewed, including alprazolam, clonazepam, diazepam, and lorazepam. Significant increases were also noted for ED visits involving the sleep aid zolpidem and the muscle relaxant carisoprodol.

Peak visit rates for both opioids and benzodiazepines were observed in the age ranges 21-24 and 25-29 years, which represents a shift from previous report periods, in which peak visit rates were seen in the 30- to 34- and 35- to 44-year age ranges, according to an editorial note accompanying the report.

“As late as 2006, the peak mortality rate for fatal drug overdoses involving opioid analgesics had been in the 35-54 years age group,” according to the note.

The 5-year increase in ED visits probably reflects “substantial increases in the prescribing of these classes of drugs,” the CDC authors suggested. “The increase also might reflect an increase in the rate of nonmedical use of prescription drugs per 1,000 prescriptions, as has been observed for selected opioids.”

The report is limited by a number of factors, according to the authors. “First, the drugs involved in ED visits might not all be identified and documented. The extent to which ED staff members document drug involvement might have increased over time,” they wrote.

Additionally, information on the motivation behind nonmedical drug use might be incomplete, for instance by not noting a suicide attempt; population-based rates cannot be used to establish per-patient or per-prescription risk; and the distinction between nonmedical and medical reasons for taking drugs is not always clear, particularly when other drugs are involved.

Despite these limitations, “these increases in nonmedical use of pharmaceuticals suggest that previous prevention measures, such as provider and patient education and restrictions on use of specific formulations, have not been adequate,” the authors wrote.

Additional interventions, including more systematic provider education, universal use by providers of prescription-drug monitoring programs, routine monitoring of insurance claims information, and stepped up efforts by providers and insurers to intervene at signs of drug misuse are “urgently needed,” they stressed.