According to a recent Centers for Disease Control and Prevention (CDC) analysis of drug poisoning deaths in New York State, there was a 23% increase in opioid related deaths between 2003 and 2012. Unlike the national trend of a more rapid increase in opioid analgesic-related deaths among women, the rate of increase is slightly higher in men in New York State. The highest rate of mortality from opioid poisoning occurred in white males, ages 45-64, non-New York City residents enrolled in Medicaid.
Medicaid enrollee mortality from opioid poisoning has increased substantially faster than those not enrolled. From 2003 to 2012, rates in those enrolled in Medicaid increased fivefold while the non-Medicaid enrolled counterparts had a fourfold increase in mortality due to opioid poisoning. Even when age and sex of Medicaid enrollees was accounted for, the difference was significant. The CDC cited articles which postulated increased rates of mental illness and substance abuse in the Medicaid population could factor in to the difference in rates.
The CDC also concluded that a majority of deaths from opioid poisoning involve more than one drug. In 2012, 624 of 883 (70.7%) deaths involved at least one additional drug, most commonly benzodiazepines, cocaine and antidepressants.
What providers can do to help curb the trend
- Prescribers need to be vigilant of their prescribing and monitor the use of opioids in the populations that are mentioned above as early identification of abuse and addiction should be of the utmost importance.
- Special attention should be paid to patients with comorbid mental health issues, high-risk substance abuse screenings and concomitant high-risk drugs when prescribing opioids.
- Use the prescription registry and urine drug toxicity screening to check patient's medication history and compliance when prescribing opioids. Generally, benzodiazepines should be avoided in patients who are prescribed opioids however, when necessary, communication between various specialists is crucial and agreements should be made between providers about who will prescribe specific medications.
- If addiction or abuse is suspected in one of your patient’s, seek counsel from an addiction specialist and keep lines of communication open between all health care professionals involved in your patient’s care including the pharmacist.