Jul 2 2013
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Preventing Drug Overdoses: A Look at Data, Laws and Policies

While men are more likely to die of a prescription painkiller overdose, since 1999 the percentage increase in deaths has been greater among women than among men, according to the Vital Signs monthly health indicator report released today by the Centers for Disease Control and Prevention (CDC). The increase in deaths between 1999 and 2010 has been 400 percent in women compared to 265 percent in men, according to the new report. The overdoses killed nearly 48,000 women during that time period.

“Prescription painkiller deaths have skyrocketed in women…” says CDC Director Tom Frieden, MD, MPH. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”

Key findings include:

  • About 42 women die every day from a drug overdose.
  • Since 2007, more women have died from drug overdoses than from motor vehicle crashes.
  • Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010.
  • More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010. 

For the Vital Signs report, CDC analyzed data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network public use file (2004-2010).

According to the CDC, studies have shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).

CDC recommends prevention steps including state prescription drug monitoring programs; educating health care providers and the public about prescription drug misuse, abuse and suicide; and increasing access to substance abuse treatment. One critical public health effort to reduce deaths from opioid overdose, whether from heroin or pharmaceutical opioids, has been expanded use of the drug naloxone (Narcan) to reverse the overdose. However, the drug often isn’t on hand when it’s needed. According to a recent review by the Network for Public Health Law, many states have laws or regulations that make it difficult to for medical professionals to prescribe the drug to people who are not their patients and make it difficult for the drug to be dispensed in non-traditional settings such as social service organizations. And fear of arrest for suspected drug possession can discourage bystanders who are drug users from calling 911 to report an overdose.

More than a dozen states, most recently New Jersey, have recently modified one or more laws to make it easier for professionals and bystanders to administer naloxone. Overdose prevention and take-home naloxone laws expand naloxone access to drug users and their loved ones by providing comprehensive training on overdose prevention, recognition, and response (including calling 911 and administering rescue breathing) in addition to prescribing and dispensing naloxone for use in an emergency.

Experts at the Network for Public Health Law say expanding these laws to more states could save thousands of lives each year.

Caleb Banta-Green

NewPublicHealth recently spoke with Caleb Banta-Green, PhD, MPH, MSW, Research Scientist at the Alcohol and Drug Abuse Institute and Affiliate Assistant Professor at the University of Washington School of Public Health, about his work in this area.

NewPublicHealth: Your evaluation of Washington’s 2010 overdose prevention and take-home naloxone law is the first in the country?

Caleb Banta-Green: Yes, we examined the legal intent of the law and how it came to be passed. We then focused on whether and how it had been implemented.

NPH: You have some concerns about aspects of recent legislation in other states, however?

Banta-Green: We think the legislation is getting too prescriptive. Some recent legislation has included prescriptive language about overdose education requirements to accompany take-home naloxone distribution; Washington’s law has no such language. There is a great deal of free educational materials out there already; nobody needs to start from scratch. It’s really quite straightforward and naloxone has essentially no side effects or contraindications – it’s a very safe medication. I’ve been impressed that with no specific educational requirements in Washington, each of the overdose and take-home naloxone programs has developed education appropriate to their population.

NPH: Is there any research that shows that having to use naloxone is a scary enough experience that addicts may then look to end their addiction?

Banta-Green: We know that 50,000 people have been trained to use naloxone and there have been 10,000 overdose reversals, but there has been no longitudinal study so we don’t know what happened to the other 40,000 people. Are they dead? Did they stop using? Are they using in a safer way? I am heading the first randomized controlled trial of an overdose intervention funded by NIH that we’re a year into and we hope will begin to answer that question.

The study is based in the emergency department of the main public health hospital in Washington State looking at 500 heroin users and 500 prescription opiate users with an elevated risk for overdose. We’re having them complete an overdose risk assessment tool. The intervention arm is they get feedback on their own overdose risk, they are given overdose education, they’re shown how to take naloxone and we provide them with take-home naloxone.

The point of the study is to capture the unintended consequences. So what we’re doing at the end of the intervention is having them come up with their own personalized overdose risk reduction plan. And, since they can’t reverse their own overdose they need to talk to somebody else about how to respond to an overdose. Hopefully they’ll also reduce their overdose risk behaviors, but talking about overdose risk with someone in their social circle is also important.

We are very clear with the trial participants that using opiates is the number one risk factor for overdose, so certainly getting your use under control reduces risk. What we’re looking at in terms of outcomes are fatal and nonfatal overdose, overdose risk behaviors, drug treatment enrollment, health services utilization and cost. The whole nine yards in terms of outcomes.

NPH: Are you working on broader dissemination of information for drug users on naloxone and drug treatment?

Banta-Green: I have a small grant from our State Attorney General’s Office to develop online overdose training, which we’re doing acceptability and feasibility analyses on. The website is stopoverdose.org and includes training videos, a review of information, a knowledge quiz, links to services and referrals and information about state laws.

NPH: How could police fit into community efforts to reverse drugs overdoses and connect drug users with community services and education?

Banta-Green: One way is that they can help to be part of the publicity and implementation about naloxone and Good Samaritan Laws. What typically keeps people from helping during an overdose is fear of the police. So the unexpected messenger of a police officer actively promoting and spreading the word, I think is very, very, very powerful. In Seattle we surveyed all the police and found many didn’t know the law and were confused by naloxone. (A manuscript with findings from these surveys is forthcoming in the Journal of Urban Health.) The follow-up to that was a police training video. In Quincy, Massachusetts, there’s a program that has police carry naloxone. In some communities law enforcement may be the most feasible entry point for overdose education and wider availability of naloxone.

Tags: Addiction, Centers for Disease Control and Prevention, Prescription drugs, Substance use