Quantifying morbidity associated with the abuse and misuse of opioid analgesics: A comparison of two approaches

Abstract

Background. Due to the rising nonmedical use of opioid analgesics, methods are needed to quantify the associated health-related consequences. Methods. Using opioid analgesic intentional exposure reports from poison control centers from January 2003–June 2004, we calculated quarterly rates for 7 opioids at the 3-digit ZIP code level using population- and patient-based denominators. Results. Hydrocodone was the most widely prescribed opioid (maximum: 5,321,390 patients per quarter), with the largest intentional exposure caseload (range: 498–1,290), and the highest aggregate population-based rate (maximum of 13.61 cases per 1,000,000 individuals). Methadone had the highest aggregate patient-based rate (maximum 2.03 cases per 1,000 patients). Conclusion. Population- and patient-based rates are complementary tools that address different public health questions. Population-based rates describe the health-related burden of nonmedical opioid analgesic use on the community as a whole, while patient-based rates show this burden (“risk”) in relation to the level of corresponding medicinal use (“benefit”) within a given area.

Keywords :

• Opioid analgesic abuse and morbidity
• Denominator
• Intentional exposure
• Drug abuse rates
• Poison control centers

Notes

^‡The 8 centers reporting for the entire study period included: Blue Ridge Poison Center; California Poison Control System; Cincinnati Drug and Poison Information Center; Florida Poison Information Center, Miami Division; Kentucky Regional Poison Control Center; Northern New England Poison Center; Rocky Mountain Poison and Drug Center; and Virginia Poison Center. The seven centers that contributed data for the final 3 quarters of the study period included: Florida Poison Information Center, Jacksonville Division; Indiana Poison Center; Louisiana Drug and Poison Information Center; Middle Tennessee Poison Center; Regional Poison Center & Prevention Serving Massachusetts and Rhode Island; West Virginia Poison Center; and Wisconsin Poison Center.