Research article
Hospitalizations for Poisoning by Prescription Opioids, Sedatives, and Tranquilizers

https://doi.org/10.1016/j.amepre.2010.01.022Get rights and content

Background

Unintentional poisoning deaths have been increasing dramatically over the past decade, and the majority of this increase has resulted from overdoses of specific prescription drugs. Despite this trend, there are limited existing data examining hospitalizations for poisonings, both unintentional and intentional, associated with prescription drugs. A better understanding of these hospitalizations may help identify high-risk populations in need of intervention to prevent subsequent mortality.

Purpose

This article aims to describe the incidence and characteristics of hospitalizations resulting from poisoning by prescription opioids, sedatives, and tranquilizers in the U.S. from 1999 to 2006 and make comparisons to hospitalizations for all other poisonings during this time period.

Methods

Hospitalizations for poisonings were selected from the Nationwide Inpatient Sample (NIS), a stratified, representative sample of approximately 8 million hospitalizations each year, according to the principal discharge diagnosis. Intentionality of the poisoning was determined by external cause of injury codes. SAS callable SUDAAN software was used to calculate weighted estimates of poisoning hospitalizations by type and intentionality. Demographic and clinical characteristics of poisoning cohorts were compared. Data were analyzed in 2009.

Results

From 1999 to 2006, U.S. hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers increased a total of 65%. This increase was double the increase observed in hospitalizations for poisoning by other drugs and substances. The largest increase in the number of hospitalized cases over the 7-year period was seen for poisonings by benzodiazepines, whereas the largest percentage increase was observed for methadone (400%). In comparison to patients hospitalized for poisoning from other substances, those hospitalized for prescription opioids, sedatives, and tranquilizers were more likely to be women, aged >34 years, and to present to a rural or urban nonteaching hospital.

Conclusions

Prescription opioids, sedatives, and tranquilizers are an increasing cause of hospitalization. The hospital admission provides an opportunity to better understand the contextual factors contributing to these cases, which may aid in the development of targeted prevention strategies.

Introduction

Unintentional poisoning is now the second-leading cause of unintentional injury death in the U.S.1 Among people aged 35–54 years, unintentional poisoning surpassed motor-vehicle crashes as the leading cause of unintentional injury death in 2005. Although several high-profile cases involving Hollywood celebrities have brought the problem to recent public attention, the rates of unintentional poisoning deaths have been increasing for more than 15 years.2 From 1999 to 2004, unintentional drug poisoning deaths increased by 68%,3 and the majority of this increase has been attributed to deaths associated with prescription opioid analgesics.4 In addition to opioids, other controlled substances including those classified as sedatives or tranquilizers (e.g., diazepam, alprazolam, phenobarbital) have been found to contribute to the recent rise in unintentional overdose fatalities.5

In the 1990s, several initiatives6, 7, 8, 9 were undertaken to increase awareness of the problem of inadequately treated pain. Since this time, data collected by the Drug Enforcement Agency10 have shown substantial increases in the total quantity of opioids prescribed in the U.S. Along with the increase in legitimate use of opioids, the use of these drugs for recreational purposes has also increased. In 2007, the nonmedical use of prescription drugs ranked second to only marijuana as the most prevalent category of drug abuse (excluding alcohol), and was the category with the largest number of new initiates.11 From 2004 to 2006, emergency department visits associated with prescription drugs increased by 44%, whereas there was no corresponding increase in emergency department visits associated with illegal drugs.12

Despite these recent trends, there are limited data examining hospitalizations for unintentional poisonings and the associated characteristics of these patients. Although emergency department data can demonstrate the prevalence and trends among nonfatal cases, these data provide little specific information on the most serious cases requiring hospitalization. To our knowledge, no previous report has described the incidence and characteristics of hospitalizations for unintentional poisonings associated with prescription opioids, sedatives, and tranquilizers. In addition, few studies have examined the relative contribution of these prescription drugs to intentional overdoses. Hospitalization data may improve understanding of the epidemiology of this problem and may also help delineate a high-risk population in need of specific interventions.

The objective of this study was to describe hospitalizations for poisonings in the U.S. from 1999 to 2006 with specific focus on poisonings from prescription opioids, sedatives, and tranquilizers. For the current study, the focus was on these classes of drugs because of their well-documented contribution to the increasing number of poisoning fatalities. Both intentional and unintentional drug poisonings were examined, and hospitalizations for prescription opioids, sedatives, and tranquilizers were compared with hospitalizations for all other poisonings to determine similarities and differences within selected demographic and clinical variables.

Section snippets

Design

Data were obtained from the Nationwide Inpatient Sample (NIS), a data set from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), for the 7-year period 1999–2006, and were analyzed in 2009. The NIS is the largest inpatient database in the U.S., and contains data for approximately 8 million hospitalizations each year. Because it contains a stratified sampling of U.S. community hospitals, NIS data can be weighted to produce national estimates. The

Incidence of Poisoning Hospitalizations

From 1999 to 2006, estimated hospitalizations in the U.S. for poisoning by prescription opioids, sedatives, and tranquilizers increased by a total of 65%. In comparison, during this same period, hospitalizations for poisoning by other drugs, medicinal, and biological substances increased by 33%, whereas all other hospitalizations increased by little more than 11% (Table 1 and Figure 1). Unintentional poisonings involving prescription opioids, sedatives, and tranquilizers increased by 37% during

Discussion

These data provide the first comprehensive examination of nationwide hospitalizations associated with prescription opioids, sedatives, and tranquilizers. Between 1999 and 2006, hospitalizations in the U.S. for these increased by 65%, almost twice as much as the increase observed in hospitalizations for poisonings by all other drugs and medicinal substances. This overall trend parallels recent reports examining fatality trends in the U.S.3, 19 In addition, these data reveal an increasing

Conclusion

Hospitalizations for poisonings from prescription opioids, sedatives, and tranquilizers increased 65% from 1999 to 2006 in the U.S. This increase mirrors the trend observed in mortality from prescription drug overdose during this time period, and may point to an opportunity to intervene to prevent subsequent mortality. Although the majority of these hospitalized poisonings are classified as unintentional, substantial increases were also demonstrated for intentional overdoses associated with

References (26)

  • P. Lanser et al.

    Pain management: the fifth vital sign

    Healthcare Benchmarks

    (2001)
  • U.S. Department of Veterans Affairs website

  • ARCOS: Automation of Reports and Consolidated Orders System

  • Cited by (0)

    View full text