March 07, 2018
The opioid overdose epidemic isn't getting any better; on the contrary, the latest data from US emergency departments (EDs) indicate that visits for suspected opioid overdoses are on the rise across the country, according to a new report from the Centers for Disease Control and Prevention (CDC).
"This fast moving epidemic does not distinguish age, sex, or state or county lines, and is still increasing in every region of the United States," CDC Acting Director Anne Schuchat, MD, said during a media briefing. "Up until now, we've been reporting on the tragic loss of life from opioid overdoses, but for every fatal case, there are many more nonfatal cases, each one with its own emotional and economic toll."
From July 2016 through September 2017, ED visits (reported by 52 jurisdictions in 45 states) for suspected opioid overdoses increased 30% overall and 35% in 16 "hard hit" states with high prevalence of overdose deaths, according to the Vital Signs report published March 6 in the Mortality and Morbidity Weekly Report.
State-specific data show that five Midwest region states experienced significant rate increases, the largest in Wisconsin (109%), followed by Illinois (66%), Indiana (35%), Ohio (28%), and Missouri (21%), Alana Vivolo-Kantor, PhD, and colleagues at the CDC note in their report.
In the Northeast, large increases were seen in Delaware (105%), Pennsylvania (81%), and Maine (34%), while Massachusetts, New Hampshire, and Rhode Island saw nonsignificant decreases in ED visits for opioid overdose (< 10%). In the Southeast, North Carolina saw a 31% increase, while Kentucky had a 15% decrease. The decrease in Kentucky might be explained by fluctuations in drug supply and need to be confirmed, the authors said.
They found that every demographic group reported substantial rate increases, including males (30%) and females (24%) and persons in all age groups. The rate increase was 31% in people aged 25 to 34 years, 36% in those aged 35 to 54 years, and 32% in those aged 55 years or older. The highest opioid overdose rate increases occurred in large cities (54%) with a population of at least 1 million.
"Opioid overdoses continue to increase in most jurisdictions, and rapid response efforts and a multisectoral approach are needed to reduce and prevent overdoses and their associated morbidity and mortality," write Dr Vivolo-Kantor and colleagues.
"ED data can serve as an early warning system, alerting communities to changes in prevalence of overdoses and permitting a timely, informed, and localized response that could facilitate a more rapid and coordinated response," they add. The CDC encourages health departments to take the following actions:
- Alert communities to rapid increases in overdoses seen in EDs and coordinate an informed and timely response.
- Increase naloxone distribution to first responders, family and friends, and other community members in affected areas, as policies permit.
- Increase availability of and access to treatment services, including mental health services and medication-assisted treatment for opioid use disorder.
- Support programs that reduce harms that can occur when injecting opioids, including programs that offer screening for HIV and hepatitis B and C, in combination with referral to treatment.
- Support the use of the CDC Guideline for Prescribing Opioids for Chronic Pain , which encourages using prescription drug monitoring programs to inform clinical practice.
On March 13, 2018, from 2:00 to 3:30 PM ET, the CDC will host a webinar, "Coordinating Clinical and Public Health Responses to Opioid Overdoses Treated in Emergency Departments."
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SOURCE: Medscape, March 07, 2018. MMWR. Published online March 6, 2018.