Changes in Drug Abuse Patterns in West Virginia 2012 to 2014
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The Post SB 437 Landscape: Changes in Drug Abuse Patterns in West Virginia 2012 to 2014 Emerging Public Health Challenges? Jim Kaplan MD OCME - WV
Transcript of Changes in Drug Abuse Patterns in West Virginia 2012 to 2014
The Post SB 437 Landscape: Changes in Drug Abuse Patterns in
West Virginia 2012 to 2014
Emerging Public Health Challenges?
Jim Kaplan MD
OCME - WV
SB 437
• Passed March 10, 2012; effective June 8
• Defines Chronic Pain
• DHHR regulation of Pain Clinics and OTPs
• Mandatory CSMP queries
• Timely and comprehensive CSMP reporting
• Defines/reviews best prescribing practices
• Mandatory training for all CS providers
• CSMP Review Committee: investigative role
2010 2011 2012 2013 2014
MPE/100k
WV: Multiple Provider Episode Rate, by Quarter: 2010 to 2014
SB 437
WV BOP - CSMP
44
61
122 133 133
161 177
247 227
270
237
330
381
290
236
271
0
50
100
150
200
250
300
350
400
450
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Pharmaceutical Drug Overdose Deaths by Year, 1999-2014 West Virginia Occurrences
Pharmaceuticals
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
1 8
31 33
53
44
61
87
72
86
97
138
171
142 137
133
0
20
40
60
80
100
120
140
160
180
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Hydrocodone West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
6 9
39
83
71
116 120
141
109
95
78
83
61
65
55
39
0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
150
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Methadone West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
14
10
26
23
19
26 27
26
36
22
19
27
2 0 0
2
0
5
10
15
20
25
30
35
40
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Propoxyphene West Virginia Occurrences by Year, 1999-2014
SB 437
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
0 0 0 0 0 2 0 1 6
14 17
77
182
72
32
48
0
20
40
60
80
100
120
140
160
180
200
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Oxymorphone West Virginia Occurrences by Year, 1999-2014
SB 437
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
3 14
39 49 45 46
58
83
112
140
141
223 224
182
199 199
0
50
100
150
200
250
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Oxycodone West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
78
123
212 243
286
367
406
475 490
521
479
568
656
558 586
626
44 61
122 133 133 161
177
247 227
270 237
330
381
290
236
271
10 16 40 60 89
122 146 140 166 150
143 152 164 166
267
258
0
100
200
300
400
500
600
700
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths by Year, 1999-2014 Involving All Pharmaceuticals and at Least One Illicit Drug
West Virginia Occurrences
All Overdoses
Pharmaceuticals
Illicit
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
1 2 9
7 5 10
14 11
22 38
38 34
41
67
157 165
0
20
40
60
80
100
120
140
160
180
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Heroin West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
4 5
11
20
26
38
50
62
68
48
43
39
45
54
48
68
0
10
20
30
40
50
60
70
80
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Morphine West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
SB 437
4 5
11
20
26
38
50
62
68
48
43
39
45
54
48
68
0
10
20
30
40
50
60
70
80
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Morphine West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
HEROIN?
0 0
9
17
36
46
54
39
60 57
49
44
51
32
40
55
0
10
20
30
40
50
60
70
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Fentanyl West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
0 0
9
17
36
46
54
39
60 57
49
44
51
32
40
55
0
10
20
30
40
50
60
70
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Drug Overdose Deaths Involving Fentanyl West Virginia Occurrences by Year, 1999-2014
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
*NPF?
* CDC Warning: Illicit manufacture of Fentanyl ; 10/26/2015
0 0 0 0 0 0 0 0 0 0 0 0
0
32 40
55
96
0
20
40
60
80
100
120
19992000200120022003200420052006200720082009201020112012201320142015
Drug Overdose Deaths Involving Acetylfentanyl West Virginia Occurrences by Year, 1999-2014
SB 437
Note: 2013 is preliminary data, 2014 is cumulative/unedited data. Source: West Virginia Health Statistics Center – Vital Surveillance System
*
*CASES AS OF october 2015
A Changing Landscape
• Illicit drugs v. pharmaceuticals
– Contamination? Composition? Dosage strength? Route of administration?
– A different provider base
• Heroin/acetyl fentanyl: needle drug abuse
– Cardiovascular, pulmonary, hepato-renal, osteomyelitis and CNS disorders
HIV infection as a function of IVDA, 1998 NIDA, NIH, DHHS
A Changing Landscape
• IVDA lifestyle impact on treatment
–Frequent flyers
–Late presentation and the cost of treatment
–Patient non-compliance
–Narrowed treatment options
$169,261
$227,021
$144,713
$6,775 $88,151
$119,765
$194,227
$520,779
$92,377 $46,204
$275,062
$541,978
$1,068,412
$1,515,334
$990,735 $952,000
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Total Costs For Drug Abuse Inpatient Discharges by Year Charleston Area Medical Center, 2000 Thru September 2015
SB 437
* Note: 2015 data is incomplete.
Source: Charleston Area Medical Center
*
