Adult opioid poisonings by drug, intent, and resource use from the United States National Poison Data System from 2005–2018

Abstract

Introduction

Deaths due to an opioid overdose nearly doubled from 2013 to 2017. Our objective is to describe the trends in intent, healthcare resource use, and clinical outcomes among adults with opioid exposures.

Materials and methods

This study is a retrospective analysis of data from the 55 U.S. poison control centers. Adults, >19 years, with an opioid as the primary poisoning agent between 2005 and 2018 were included. These years were divided into three epochs (2005–2009, 2010–2014, and 2015–2018) to describe the trends in frequency, intent, severity, healthcare resource use, and regional differences in U.S. adults affected by prescription and illicit opioid exposures.

Results

A total of 546,049 (54.4%) of the 1,002,947 opioid-related cases reported to the U.S. poison centers met inclusion criteria. The percentage of patients with a moderate/major clinical effect increased in each epoch (24.4, 29.13, and 35.3%) as did the proportion of patients with illicit opioids (coded as heroin) as their primary substance (2.89, 5.47, and 13.95%). Illicit opioid use was associated with increased frequency of moderate/major clinical effects (54.2 vs. 27.4%), need for an ICU procedure (11.4 vs. 6.8%), and death (3.9 vs. 1.2%) compared with prescription opioid use. Suicidal intent (34.88%) followed by misuse/abuse (26.26%) were the most frequent intents. Misuse/abuse increased in frequency over each epoch in the study period (23.1 vs. 26.12 vs. 30.3%).

Discussion and conclusions: The severity of clinical effects and death following acute opioid poisonings increased over the study period, driven by suicidal intent and an increasing proportion of illicit opioid cases. This study highlights the importance of developing strategies to address suicide prevention in addition to the continued focus on opioid use disorder.

Keywords:

• Opioid
• heroin
• fentanyl
• buprenorphine
• addiction
• intensive care
• overdose

Acknowledgments

We acknowledge the Emory + Children’s Pediatric Research Biostatistics Core for help with statistical analysis. No financial support was provided for this study. Dr. Grunwell is supported by the Atlanta Pediatric Scholars Program grant K12HD072245.

The American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) maintains the national database of information logged by the country’s regional Poison Centers (PCs) serving all 50 United States, Puerto Rico, and the District of Columbia. Case records in this database are from self-reported calls: they reflect only information provided when the public or healthcare professionals report an actual or potential exposure to a substance (e.g., poisoning, inhalation, or topical exposure, etc.) or request information/educational materials. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to poison centers and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s). No endorsement or editorial restriction by AAPCC of the interpretation of these data or opinions of the authors has been implied or stated.

Author contributions

Drs. Grunwell and Land conceived the study, interpreted the data, and wrote and edited the manuscript. Ms. Martha Wetzel conducted statistical analyses, aided with data interpretation, drafted parts of and edited the manuscript. Dr. Steck aided with data interpretation and edited the manuscript. Dr. Geller acquired data and edited the manuscript. All authors read and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).