The Morbidity and Mortality of Kansas Drug Epidemic Fan Xiong, MPH Senior Epidemiologist Kansas Board of Pharmacy Kansas Data-Driven Prevention Initiative Program Kansas Department of Health and Environment, Bureau of Health Promotion Presented at the 2018 2 nd Annual Kansas Drugged Driving Summit Topeka, Kansas April 16, 2018
What is the Epidemic?
Since 1999, there has been more drug poisoning deaths (632,331) than the number of American military and civilian deaths during World War II (418,500).
Why Prescription Opioids Are a Concern
General Consensus of What Happened Source: Working Kansas Opioid State Plan. Draft. 5
2015 United States: 485 morphine milligram equivalent per person (excluding methadone) 1997 2011 2015 World Wide: 43.5 morphine milligram equivalent per person (excluding methadone) Source: Pain & Policy Studies Group, University of Wisconsin / WHO Collaborating Center, 2015. Available at: https://ppsg.medicine.wis c.edu/chart
2015 United States: 48% of worldwide total MME and ~4% of the world s population. 2015 Germany: 13% of worldwide total MME and 1% of the world s population. 2015 Canada: 7% of worldwide total MME and 0.5% of the world s population. Data Source: Pain & Policy Studies Group, University of Wisconsin / WHO Collaborating Center, 2015. Available at: https://ppsg.medicine.wisc.edu/chart
High-Dose Opioid Rate Ratio Opioid Use Disorders (OUD) The highest rate of developing opioid use disorders is among those patients prescribed more than 100 morphine milligram equivalent (MME) per day among those receiving 8 to 30 days of supply excluding members diagnosed with cancer or who were undergoing palliative or hospice care Note: High dosage refers to having more than 100 MME per day. Low dosage refers to having less than 100 MME per day. BCBS excluded members with cancer diagnosis, palliative care, hospice care, or end of life care. Reference group is rates of OUD Members for low-dosage opioid (<100 MME/Day). Data Source: Adapted from Exhibit 4 in Blue Cross Blue Shield. America's opioid epidemic and its effect on the nation's commercially-insured population. Online. Available at https://www.bcbs.com/the-health-of-america/reports/americas-opioid-epidemic-and-its-effect-on-the-nations-commercially-insured
What is Happening in Kansas
What Has Happened in Kansas
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Non-Heroin Opioid Poisonings Rate, 2007- Age-adjusted Emergency Department Visit Rate per 100,000 Population; Kansas 2007-2016 35 30 25 20 Female Male 19.1 Age-adjusted Hospitalization Discharge Rate per 100,000; Kansas 2007-2016 35 30 25 20 23.1 Female Male 31.2 2016 15 12.6 2015 and 2016 data contains ICD-10-CM diagnosis codes and absolute rates may not be comparable with previous years. 10 5 0 7.7 13.4 15 10 5 0 15.7 17.9 Data Source: Kansas Hospital Association. 2007-2016 Emergency Admission Database Special Request and 2007-2016 Kansas Hospital Discharge Database.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Heroin Drug Poisoning Rate, 2007-2016 2015 and 2016 data contains ICD-10-CM diagnosis codes and absolute rates may not be comparable with previous years. Age-adjusted Emergency Department Visit Rate per 100,000 Population; Kansas 2007-2016 3.5 3 2.5 2 1.5 1 0.5 0 Female 1.4 0.4 Male 3.1 1.7 Age-adjusted Hospitalization Discharge Rate per 100,000; Kansas 2007-2016 3.5 3 2.5 2 1.5 1 0.5 0 Female 1.1 0.8 Male 3.2 2.1 Data Source: Kansas Hospital Association. 2007-2016 Emergency Admission Database Special Request and 2007-2016 Kansas Hospital Discharge Database.
Data Source: Kansas Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas Mortality Files 2005-2016.
Nearly 1 out of 3 Drug Poisoning Deaths specifically mentioned a prescription opioid, such as methadone, oxycodone, or hydrocodone. Data Source: Kansas Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas Mortality Files 2005-2016.
Data Source: Kansas Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas Mortality Files 2005-2016. Meth and Heroin have recently emerged.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Amphetamine Drug Poisonings Medical Encounter Rate, 2007-2016 Age-adjusted Emergency Department Visit Rate per 100,000 Population; Kansas 2007-2016 12 10 8 6 4 3.4 Female Male 8.8 5.3 Age-adjusted Hospitalization Discharge Rate per 100,000; Kansas 2007-2016 12 10 8 6 4 Female Male 8.6 10.5 7.9 2015 and 2016 data contains ICD-10-CM diagnosis codes and absolute rates may not be comparable with previous years. 2 0 1.8 2 0 1.4 0.9
What Do We Look For in Kansas
What are the key risk factors? Image Source: CDC.gov/drugoverdose
Non-heroin opioid related emergency department admissions from 2011-2016 (right axis blue solid line) are correlated by birth cohort with patients who received > 90 MME per day of opioids in the same year (left axis dotted black line). Data Source: 2011-2016 Kansas Hospital Association, Emergency Admission Database Special Request.
Number of Deaths Most drug poisoning deaths according to vital statistics record are HIGH among Kansans born between 1950 and 1990 for prescription opioid drugs. Drug poisoning deaths by type of drug, gender, and 5-years birth year, Kansas resident decedents, 2005-2016 Rx Opioid = Prescription Opioid Non Rx Opioid = Heroin-related Methamphetamine = Any amphetamine drugs Male Female Birth Year Birth Year Data Source: Kansas Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Kansas Mortality Files 2005-2016.
Kansans with a year of birth from 1955 to 1994 (currently aged 23 to 62 years of age) also have higher prevalence of risk factors for developing substance use disorders, including opioid use disorders. Prevalence of Heavy Alcohol Consumption, Doctor-diagnosed Depressive Disorder, and 14+ Days of Mental Unhealthy Days for Kansans 18+ years of age, Kansas BRFSS, 2011-2016. Data Source: 2011 2016 Kansas Behavioral Risk Factor Surveillance Survey (BRFSS). Birth cohorts was calculated based on survey year and self-reported age. Prevalence estimates were combined across multiple years using weighted survey design weights.
Having a mental illness, history of alcohol use disorder, or other substance use disorder is a risk factor for opioid poisoning and developing an opioid use disorder. County Level Prevalence of Binge Drinker, Kansas BRFSS 2015 County Level Prevalence of Depressive Disorder, Kansas BRFSS 2015 Numerator: Male respondents having five or more drinks on one occasion in the past 30 days or females having four or more drinks on one occasion in the past 30 days. Denominator: All respondents, excluding unknowns and refusals. Numerator: Respondents who reported they had ever been told by a doctor, nurse or other health professional that they have a depressive disorder (including depression, major depression, dysthymia, or minor depression). Denominator: All respondents, excluding unknowns and refusals.
Having more than 90+ morphine milligram equivalent (MME) per day is a risk factor for opioid poisoning and developing an opioid use disorder. In 2017, there were 4 counties with at least 4.5% of residents with more than 90+ MME per day in 2017. Image Source: http://www.preventoverdoseks.org/kpdo_data.htm
Having concurrent prescriptions for opioids and benzodiazepine is a risk factor for opioid poisoning and developing an opioid use disorder. In 2017, there were 8 counties with at least 7.0% of county residents with concurrent prescriptions for opioids and benzodiazepine in 2017. Image Source: http://www.preventoverdoseks.org/kpdo_data.htm
What Is Kansas Doing
Source: Working Kansas Opioid State Plan. Draft. Current as of March 2018.
What? Increase use of K-TRACS, Kansas prescription drug monitoring program, by healthcare providers and pharmacists. Why? Reduce highrisk prescribing and dispensing patterns associated with a higher risk of developing opioid use disorders and opioid poisonings.
Contact Data-Driven Prevention Initiative Epidemiologist Kansas Board of Pharmacy Kansas Department of Health and Environment Topeka, Kansas fan.xiong@ks.gov 785-296-6580