文章基本信息

标题：Consistency Between Opioid-Related Mortality Trends Derived From Poison Center and National Vital Statistics System, United States, 2006–2016
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作者：Janetta L. Iwanicki ; S. Geoff Severtson ; Zachary Margolin 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2018
卷号：108
期号：12
页码：1639-1645
DOI：10.2105/AJPH.2018.304728
语种：English
出版社：American Public Health Association
摘要：Objectives. To determine the association between poison center opioid exposure calls and National Vital Statistics System (NVSS) deaths. Methods. We categorized Centers for Disease Control and Prevention NVSS mortality and the Researched Abuse, Diversion and Addiction-Related Surveillance System poison center program cases from 2006 to 2016 by International Classification of Diseases, Tenth Revision, codes (heroin [T40.1]; natural or semisynthetic opioids [T40.2]; methadone [T40.3]; synthetic opioids, other than methadone [T40.4]). We scaled rates by 100 000 population and calculated Pearson correlation coefficients. Sensitivity analysis excluded polysubstance cases involving either heroin or synthetic opioids as well as natural and semisynthetic opioids. Results. The NVSS mortality and poison center program exposure rates showed similar trends from 2006 to 2012, and diverged after 2012 for all opioids combined, natural and semisynthetic opioids, and synthetic opioids (r = −0.37, −0.12, and 0.30, respectively). Sensitivity analysis with removal of heroin or synthetic opioid polysubstance deaths markedly improved correlations for all opioids combined and natural and semisynthetic opioids (r = 0.87 and 0.36, respectively). Conclusions. The NVSS mortality and poison center exposure rates showed similar trends from 2006 to 2012 then diverged, with sensitivity analysis suggesting polysubstance cases also involving heroin or illicit fentanyl as the cause. Public Health Implications. The NVSS and poison center program may provide complementary data when trends diverge. Public health interventions must include both licit and illicit opioids for maximal impact. Over the past 25 years, increased prescribing of opioids has led to an epidemic of opioid abuse, diversion, and overdose throughout the United States. 1 From 1999 to 2016, the Centers for Disease Control and Prevention (CDC) has estimated that more than 200 000 people died from overdoses related to prescription opioids. 2 As both federal and state agencies work to develop strategies to address this epidemic, a more nuanced understanding of the drugs involved that lead to greater mortality will allow the development of focused and specific interventions. On a national level, the National Vital Statistics System (NVSS) is the most widely cited and referenced data set used to identify nationwide trends in cause-specific mortality. 3 The NVSS multiple cause-of-death mortality files originate from state and territorial health departments, are centralized and maintained by CDC (released annually), and provide data on demographic, geographic, and cause-of-death information across the United States. 4 Because all deaths are legally required to be included, this data source is considered a complete case accounting of mortality in the United States. Literal causes of death from death certificates are assigned primarily by local medical examiners and coroners, and cause-of-death information in NVSS has been aggregated by using the International Classification of Disease, Tenth Revision ( ICD-10 ), codes since 1999. 5 Although these data are the most comprehensive mortality data available, some shortcomings include the lack of real-time data availability with a typical lag time of 1 to 2 years after the close of the calendar year, inability to obtain greater context for individual cases within the larger set of data, and lack of product specificity. As the US Food and Drug Administration seeks to provide more useful regulation and guidance regarding prescription opioids, product-specific information is crucial to guiding decisions. In addition, more detailed and specific data are needed to understand the root cause of prescription opioid deaths. Although less comprehensive in some regards, data from other sources may be more specific and more rapidly available. One example is the nationwide network of poison centers that gather data on spontaneous reports of exposures and acute medical events such as overdose and death. 6 Poison center cases are classified into 2 major types: information cases and exposure cases. Information cases are those in which the caller is looking for information, but no substance has been consumed. Not surprisingly, in recent years, a good portion of information cases have gone silent, with traffic directed to the Internet instead leading to the observed decline in overall call volume to US poison centers. 7 On the other hand, exposure cases are those in which actual or suspected contact with a substance that has been ingested, inhaled, absorbed, applied to, or injected into the body, regardless of toxicity or clinical manifestation. Exposure cases are further divided into human and animal exposures. Furthermore, human exposures can be classified into pharmaceutical and nonpharmaceutical exposures. Analgesics comprise one of the largest categories of pharmaceutical exposures. The analgesics category represents about 20% of all poison center cases within the pharmaceutical exposures category, including acetaminophen, aspirin, ibuprofen, and prescription opioids. 8 Given the importance of gaining a better understanding of prescription opioid deaths, we compared the rates of prescription opioid exposures and deaths from US poison centers to the mortality rates reported by NVSS. A previous analysis showed a strong correlation between methadone overdose deaths and poison center intentional exposure cases in 2006 to 2007 in a subset of poison centers. 9 To update and extend this analysis, we set out to determine the level of association between poison center calls and overdose deaths. We hypothesized that the poison center data would accurately correlate with CDC data while also containing a more nuanced report of the events and substances used surrounding the death.