March 09, 2018, 03:59 pm News Staff – If there was any question remaining about the extent of opioid misuse in the United States, new data from the CDC reaffirm that a full-blown opioid epidemic is sweeping across the country.
A Morbidity and Mortality Weekly Report (MMWR) released online March 6 that analyzed syndromic data from emergency departments (EDs) throughout the nation showed ED visits for suspected opioid overdoses increased about 30 percent from July 2016 through September 2017.
The news was even worse in the 16 states with known high prevalence of overdose mortality, with overdoses increasing by about 35 percent during that period.
The MMWR, along with an accompanying Vital Signs report, found opioid overdoses increased for both men and women and across all age groups and regions. Overdose rates did, however, vary by state and between rural and urban areas.
The CDC said its findings point to the need for better prevention and treatment efforts in EDs and more access to evidence-based opioid use disorder treatments, including medication-assisted treatment and harm-reduction services.
"Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses," said CDC Acting Director Anne Schuchat, M.D., in a news release. "This fast-moving epidemic affects both men and women, and people of every age. It does not respect state or county lines and is still increasing in every region in the United States."
Data on ED visits from the CDC's National Syndromic Surveillance Program (NSSP)'s BioSense platform and Enhanced State Opioid Overdose Surveillance (ESOOS) program were analyzed to track quarterly trends by region (Northeast, Southeast, Southwest, West and Midwest) and state, and between rural and urban settings, from July 2016 through September 2017.
Overall, data from 52 jurisdictions in 45 states accounted for more than 60 percent of ED visits and found that all five U.S. regions experienced increases in overdose rates. The largest was in the Midwest (nearly 70 percent), followed by the West (about 40 percent), Northeast (almost 21 percent), Southwest (about 20 percent) and Southeast (14 percent).
Launched in 2016, ESOOS currently funds 32 states and the District of Columbia to increase the timeliness of suspected nonfatal drug, opioid, and heroin opioid overdose reporting; increase the timeliness and comprehensiveness of fatal opioid overdose reporting and associated risk factors; and disseminate findings to stakeholders working to prevent or respond to opioid-involved overdoses.
Trends seen among data reported from 16 ESOOS-funded states (Delaware, Illinois, Indiana, Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Nevada, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin) included eight states from three regions that had a 28 percent or greater increase in the rate of opioid overdose ED visits.
ESOOS data for the Midwest region states, in particular, showed significant increases in opioid overdose-related ED visits: Wisconsin, about 109 percent; Illinois, almost 66 percent; Indiana, about 35 percent; Ohio, nearly 28 percent; and Missouri, slightly more than 21 percent.
States in the Northeast and Southeast saw a mix of sizeable increases and modest decreases in ED visits. In the Northeast, substantial increases were reported in Delaware (105 percent), Pennsylvania (almost 81 percent) and Maine (34 percent), but other states, including Massachusetts, New Hampshire and Rhode Island, saw nonsignificant decreases of 10 percent or less. In the Southeast, North Carolina reported an increase of about 31 percent, while Kentucky reported a statistically significant decrease of 15 percent.
Comparing the data between rural and urban areas, the highest rate increases in ED visits were seen in large central metropolitan areas with populations of 1 million or more, averaging about 54 percent.
Additionally, the CDC found that every demographic group experienced substantial increases in overdose rates, including men (about 30 percent) and women (24 percent) and people ages 25-34 (nearly 31 percent), 35-54 (slightly more than 36 percent), and 55 or older (about 32 percent).
"Research shows that people who have had an overdose are more likely to have another," said Alana Vivolo-Kantor, Ph.D., M.P.H., behavioral scientist for the CDC's National Center for Injury Prevention and Control, in the release.
"Emergency department education and post-overdose protocols, including providing naloxone and linking people to treatment, are critical needs," she added. "Data on opioid overdoses treated in emergency departments can inform timely, strategic and coordinated response efforts in the community as well."
Vivolo-Kantor co-wrote an editorial about opportunities to prevent and intervene in opioid overdose in the ED that was intended as a companion piece to the MMWR report and was published in Annals of Emergency Medicine.
In addition, on March 13 from 2-3:30 p.m. EDT, the CDC will host a webinar titled Coordinating Clinical and Public Health Responses to Opioid Overdoses Treated in Emergency Departments that will feature Schuchat; Surgeon General Jerome Adams, M.D., M.P.H.; Vivolo-Kantor and opioid overdose experts from Rhode Island.
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