title: Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009.
abstract: The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (POD) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of POD and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between POD and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in POD and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals POD predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years POD by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.
authors: School of Social Work, University of Maryland, Baltimore, MD, USA. junick@ssw.umaryland.edu
authors: George Jay
authors: GJ
authors: Unick
authors: Daniel
authors: D
authors: Rosenblum
authors: Sarah
authors: S
authors: Mars
authors: Daniel
authors: D
authors: Ciccarone
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000506:poisoning*; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000506:poisoning*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D055553:Prescription Drugs / Q000008:administration & dosage / Q000506:poisoning; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D003932:Heroin
references: Pharmacoepidemiol Drug Saf. 2008 Oct;17(10):997-1005
references: 18512264
references: J Subst Abuse Treat. 2013 Feb;44(2):241-7
references: 22980450
references: J Forensic Sci. 2008 Mar;53(2):452-4
references: 18366578
references: Subst Use Misuse. 2011;46(9):1142-50
references: 21370963
references: Drug Alcohol Depend. 2008 Apr 1;94(1-3):221-33
references: 18242879
references: AIDS. 2005 Jun 10;19(9):935-42
references: 15905674
references: Int J Drug Policy. 2009 Sep;20(5):392-401
references: 19201184
references: Drug Alcohol Depend. 2011 Nov 1;118(2-3):100-10
references: 21515001
references: JAMA. 2008 Jan 2;299(1):70-8
references: 18167408
references: J Urban Health. 2005 Jun;82(2):303-11
references: 15872192
references: Int J Drug Policy. 2009 Mar;20(2):131-6
references: 18434126
references: NCHS Data Brief. 2009 Sep;(22):1-8
references: 19796521
references: Am J Public Health. 2009 May;99(5):788-91
references: 19363214
references: Pain Med. 2011 Jun;12 Suppl 2:S77-85
references: 21668761
references: MMWR Morb Mortal Wkly Rep. 2012 Feb 17;61(6):101-5
references: 22337174
references: Drug Alcohol Depend. 2002 Mar 1;66(1):45-50
references: 11850135
references: N Engl J Med. 2012 Jul 12;367(2):187-9
references: 22784140
references: Addiction. 2008 Jun;103(6):979-89
references: 18422830
references: MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60(43):1487-92
references: 22048730
references: Pain Physician. 2007 May;10(3):399-424
references: 17525776
references: Addict Behav. 2011 Dec;36(12):1282-7
references: 21868170
references: Addiction. 2008 Jan;103(1):126-36
references: 18028518
references: Addict Behav. 2006 May;31(5):907-12
references: 16139434
references: Am J Prev Med. 2010 May;38(5):517-24
references: 20409500
references: MMWR Morb Mortal Wkly Rep. 2010 Jun 18;59(23):705-9
references: 20559200
references: Pain Physician. 2006 Jul;9(3):215-25
references: 16886030
references: Am J Epidemiol. 2012 Feb 15;175(4):302-8
references: 22227793
references: MMWR Morb Mortal Wkly Rep. 2007 Feb 9;56(5):93-6
references: 17287712
references: Clin J Pain. 2011 Mar-Apr;27(3):194-202
references: 21178601
references: Pain Physician. 2012 Jul;15(3 Suppl):ES231-6
references: 22786460
references: J Urban Health. 2007 Mar;84(2):292-306
references: 17334938
references: Int J Drug Policy. 2012 Jan;23(1):37-44
references: 21689917
references: Pain Physician. 2006 Oct;9(4):287-321
references: 17066115
references: N Engl J Med. 2010 Nov 18;363(21):1981-5
references: 21083382
references: JAMA. 2011 Apr 6;305(13):1346-7
references: 21467287
references: Harm Reduct J. 2007 Jan 25;4:3
references: 17254345
references: Am J Drug Alcohol Abuse. 2009;35(1):18-23
references: 19152201
references: CMAJ. 2012 Apr 17;184(7):E345-6
references: 22451692
references: J Psychoactive Drugs. 2012 Jul-Aug;44(3):259-65
references: 23061326