Magnitude and Trends in Cocaine, Other Psychostimulant, and Benzodiazepine-related Poisoning Deaths Massachusetts Residents,

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1 Magnitude and Trends in Cocaine, Other Psychostimulant, and Benzodiazepine-related Poisoning Deaths Massachusetts Residents, Holly Hackman, MD, MPH Jeanne Hathaway, MD, MPH Massachusetts Department of Public Health

2 Background Increase in all poisoning deaths in U.S. and MA Past 2-3 decades Largely due to unintentional drug poisoning Heightened surveillance of poisoning i events and expanded prevention initiatives/partnerships Most focusing on opioids Need for routine surveillance of poisoning events associated with other agents of abuse/misuse Single agent or co-occurrence with other agents Useful for prevention and evaluation efforts

3 Data Sources and Timeframe Massachusetts Data MA Death File Registry of Vital Records and Statistics, MA Dept. of Public Health MA Inpatient Hospital and Emergency Department Discharge Databases, MA Division of Health Care Finance and Policy. FY U.S. Data National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)

4 ICD based Definitions Acute Poisoning Death: X40-X49, X60-X69, X85-X90, Y10-Y19, Y35.2, U01(.6-.7) or F10.0 in underlying cause of death field Associated with: Opioid: T40.0-T and T40.6* Cocaine: T40.5 Benzodiazepine: T42.4 Psychostimulants with abuse potential (excluding cocaine): T43.6 Ethyl and Unspecified Alcohol: T51.0, T51.9 or F10.00 *Substantial proportion of opioid-related deaths in MA receive this code.

5 US and MA Age-Adjusted Adjusted All Poisoning Death Rates, per 100,000 0 Age Adju usted Rate persons s U.S. Massachusetts Year Sources: Registry of Vital Records and Statistics, MA Department of Public Health; Centers for Disease Control and Prevention; NCIPC, CDC, WISQARS (Accessed 4/19/2012).

6 MA Poisoning Death Rates by Intent, Crude Ra ate per 100, suicide unintentional+undetermined intent Year Source: Registry of Vital Records and Statistics, MDPH

7 Poisoning Deaths Associated with Selected Agents/Class of Agents, MA Residents Age-Ad djusted Rate per 100, N=363 Opioid Cocaine Benzodiazepines Alcohol Other Psychostimulants N=627 N=171 N= 163 Benzo, N =17 Benzo, N = Year Source: Registry of Vital Records and Statistics, MA Department of Public Health Categories are not mutually exclusive.

8 Poisoning Deaths Associated with Opioids by Selected Age Subgroups, MA Residents ,000 persons Rate per Year Source: Registry of Vital Records and Statistics, MA Department of Public Health

9 Sex: Poisonings Associated with Opioids by Select Demographics and Intent, MA Residents Male rate remained stable or decreased since 2006 M:F rate ratio 2.4:1 in 2009 Race/ethnicity: White, NH rates > Black, NH > Hispanic in 2009 Since 2006: Hispanic rates have consistently declined White, NH rates relatively stable Intent: 96% unintentional or undetermined intent

10 Poisonings Associated with Cocaine by Select Demographics and Intent, MA Residents Age: Slight aging of peak rates over the decade (45-54 in 2008, 2009 vs earlier in decade) Lowest rates in 2009 were among year olds Rates among year olds higher in latter part of decade compared with earlier Sex: M > F rate ratio 3.3:1 in 2009 Race/ethnicity: it Highest rates in Black, NH throughout decade; all race/ethnic rates declining in latter part of decade Intent: 98% unintentional or undetermined intent

11 Poisonings Associated with Benzodiazapines by Select Demographics and Intent, MA Residents Age: Sex: Increased death rates in all age grps (greatest % changes in 25-34, 45-54, 54, yr olds) Highest ave. annual rate ( ) in yr olds M:F rate ratio 1.8:1 in 2009 Race/ethnicity: Increase in death rates is overwhelmingly among White, NH residents Intent: 81% unintentional or undetermined intent

12 Co-Occurrences of Select Agents among Poisoning Deaths, MA Residents Perc cent of Total % of cocaine among opioid % of opioid among cocaine % of benzo among opioid % of opioid id among benzo Year

13 Emergency Department Discharges Associated with Mention of Nonfatal Opioid, Benzodiazepine, Cocaine and Other Psychostimulant Poisoning, MA Residents, FY Number of ED Encou unters with Mention Opioid Benzo Psychostimulant Cocaine Year Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy *Categories are not mutually exclusive.

14 Inpatient Hospital Discharges Associated with Mention of Nonfatal Opioid, Benzodiazepine, Cocaine and Other Psychostimulant Poisoning, MA Residents, FY Numb ber of Hosp pitalization with Mention n Opioid Benzo Psychostimulant Cocaine Year Source: MA Inpatient Hospital Discharge Database, MA Division of Health Care Finance and Policy *Categories are not mutually exclusive.

15 Limitations Secondary data sources Possible changes in ascertainment (toxicology testing) Changes in death certificate completion practices over time

16 Conclusion/Discussion ICD coded death data may be useful to identify emerging trends in poisoning deaths from agents beyond opioids Enhanced surveillance may be necessary to validate and interpret findings Overall trends may vary substantially across demographic groups Examining trends in co-occurrences occurrences of agents may help in directing and evaluating prevention efforts

17 Contact t Info: Holly Hackman holly.hackman@state.ma.us hackman@state Jeanne Hathaway jeanne.hathaway@state.ma.us t t