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US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations.
Int J Drug Policy. 2017 08; 46:112-119.IJ

Abstract

BACKGROUND

US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opioid overdose-related (POD) and heroin overdose-related (HOD) hospitalizations.

METHODS

Data come from the National Inpatient Sample (NIS) for the years 2000 through 2014. POD and HOD hospitalizations were abstracted from ICD-9 codes. Rates of POD and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in POD and HOD rates.

RESULTS

POD hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not POD trends across the four regions between 2000 and 2014. Between 2012 and 2014 POD rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both POD and HOD rates show different demographic patterns across the nine census divisions.

CONCLUSION

Comparing POD and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These epidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics will require innovative public health research and interventions which need to consider local and regional contexts.

Authors+Show Affiliations

University of Maryland, School of Social Work, United States. Electronic address: junick@ssw.umaryland.edu.University of California San Francisco, Family and Community Medicine, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28688539

Citation

Unick, George Jay, and Daniel Ciccarone. "US Regional and Demographic Differences in Prescription Opioid and Heroin-related Overdose Hospitalizations." The International Journal On Drug Policy, vol. 46, 2017, pp. 112-119.
Unick GJ, Ciccarone D. US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. Int J Drug Policy. 2017;46:112-119.
Unick, G. J., & Ciccarone, D. (2017). US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. The International Journal On Drug Policy, 46, 112-119. https://doi.org/10.1016/j.drugpo.2017.06.003
Unick GJ, Ciccarone D. US Regional and Demographic Differences in Prescription Opioid and Heroin-related Overdose Hospitalizations. Int J Drug Policy. 2017;46:112-119. PubMed PMID: 28688539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations. AU - Unick,George Jay, AU - Ciccarone,Daniel, Y1 - 2017/07/05/ PY - 2017/05/16/received PY - 2017/05/30/revised PY - 2017/06/12/accepted PY - 2017/7/10/pubmed PY - 2018/4/27/medline PY - 2017/7/10/entrez KW - Fentanyl Overdose KW - Heroin Overdose KW - Prescription Opioid Overdose SP - 112 EP - 119 JF - The International journal on drug policy JO - Int J Drug Policy VL - 46 N2 - BACKGROUND: US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opioid overdose-related (POD) and heroin overdose-related (HOD) hospitalizations. METHODS: Data come from the National Inpatient Sample (NIS) for the years 2000 through 2014. POD and HOD hospitalizations were abstracted from ICD-9 codes. Rates of POD and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in POD and HOD rates. RESULTS: POD hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not POD trends across the four regions between 2000 and 2014. Between 2012 and 2014 POD rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both POD and HOD rates show different demographic patterns across the nine census divisions. CONCLUSION: Comparing POD and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These epidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics will require innovative public health research and interventions which need to consider local and regional contexts. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/28688539/US_regional_and_demographic_differences_in_prescription_opioid_and_heroin_related_overdose_hospitalizations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(17)30166-4 DB - PRIME DP - Unbound Medicine ER -