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Opioid Overdose Deaths

Opioid overdose death rates in Wyoming are leveling off, while they continue to rise regionally and nationally

Age-adjusted death rates per 100,000 population for opioid poisonings

Note: Aggregate of ICD-10 Codes: Underlying Causes: X40 X41 X42 X43 X44 X60 X61 X62 X63 X64 X85 Y10 Y11 Y12 Y13 Y14; Contributing Causes: T40.0, T40.1, T40.2, T40.3, T40.4, and T40.6. In order to stabilize data, rates were trended across years

Source

The Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) is a collection of databases that allows for public access and analysis of extensive public health data. It includes detailed mortality data from U.S. death certificates, including information related to opioid-related overdose deaths. These deaths are identified using ICD-10 codes for poisoning deaths, both unintentional and intentional. Contributing causes due to both illicit and prescription opioids are included. Opioids include opium, heroin, methadone, other opioids, and other synthetic narcotics.

This graph includes data from Wyoming, the United States, and the Mountain census division, which includes Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming.

Limitations

  • Using death certificate data to identify overdose deaths has some inherent limitations. There can be some misclassification of cause of death, and the diagnoses listed on the death certificate are sometimes miscoded (CDC).
  • Death certificates in cases of opioid overdoses may be underestimated due to missing information. The drugs associated with overdose cases may not be mentioned or may use unclear language. When states have a decentralized coroner system, as is the case in Wyoming, this type of missing data has been reported to occur more frequently (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547584/).
  • “Death investigation practice and reporting, including substances tested for and the circumstances under which the tests are performed, may vary by jurisdiction, decedent, and over time” (CDC).

Interpretation

While opioid overdose death rates began to stabilize in Wyoming around 2013, they have been continuing to rise both regionally and nationally. The rise at the national level may be due to a surge in overdose deaths due to synthetic opioids such as fentanyl (CDC). With synthetic opioid overdoses concentrated in the eastern portion of the U.S. (JAMA), they may not have as strong of an impact on Wyoming rates. Despite the leveling off, Wyoming’s opioid overdose death rate remains over four times higher than it was from 2003-2005.

Opioid Treatment Admissions

The rate of people seeking opioid treatment in Wyoming is similar to the region, but well below the national rate

Number of treatment admissions with opiates as the primary substance per 100,000 people

Source

The Treatment Episode Data Set (TEDS) collects information on individuals admitted to and discharged from substance abuse treatment. Data collected includes demographic information (age, gender, race/ethnicity, etc.) and substance abuse characteristics (substances used, frequency of use, previous admissions, etc.). Admissions with opiates as the primary substance is highlighted here.

This graph includes data from Wyoming, the United States, and the Mountain census division, which includes Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming.

Limitations

  • This data set does not collect information on individual people. Because people may be admitted to treatment multiple times, these numbers may be slightly inflated.
  • TEDS data is compiled from state agency data systems and may not include privately funded admissions.
  • It is possible that users of multiple substances, including opioids, may have had a different drug recorded as their primary substance, thus excluding them from this count.

Interpretation

Treatment admissions for opioids has been rising at the national, regional, and state level over the past decade. The national rate is much higher than both the regional and state rate, which might be reflective of regional differences in opioid treatment needs. The steady rise in treatment admissions in Wyoming suggests that additional resources may be required to prevent opioid addiction.

While opioid treatment rates continue to rise, self-reported misuse, overdose, and prescribing rates are stabilizing or declining. The increase may reflect improved funding, access to care, or a reduction in stigma related to opioid treatment. This, or other factors, could result in more individuals seeking treatment for opioid addiction.

Opioid Prescriptions

Opioid prescription fills are slightly higher in Wyoming than the nation, but follow a similar trend

Retail opioid prescriptions dispensed per 100 people per year

Source

The CDC releases U.S. prescribing rate maps and data tables, showing annual opioid prescribing rates from 2006 to 2018, both by state and county. IQVIA Xponent 2006-2018 is the source of the prescribing data, based on a sample of approximately 50,000 retail (non-hospital) pharmacies, which dispense nearly 90% of all retail prescriptions in the U.S.

Interpretation

Wyoming and national rates of opioid prescription fills have been declining since 2013, following a similar trend. This decline is likely due to increased efforts to promote responsible opioid prescribing and limit the risk of abuse and dependence. These efforts have occurred at both the state and national level.

Naloxone Use

Wyoming has seen declines in both the number of naloxone administrations and the number of patients receiving naloxone

Comparison of naloxone administration rate versus patient rate. Both rates are per 100,000 people.

Note: American Community Survey 5-year population estimates were used to determine rates

Source

The Wyoming Ambulance Trip Reporting System (WATRS) is available to all Wyoming emergency medical services (EMS) agencies at no charge. It is an electronic medical records system for transporting, non-transporting and air ambulances used for prehospital care. The use of naloxone (the opioid overdose reversal agent commonly known as Narcan®), which is an opioid overdose reversal agent, is highlighted here. The graph indicates both the administration rate (based on the number of doses delivered) and the patient rate (based on the number of patient receiving naloxone).

Limitations

  • Naloxone administration rates include only those delivered by EMS personnel. Administrations by law enforcement or bystanders are not included.
  • Reports by non-transporting first response agencies may have resulted in some duplicate counts in Laramie, Natrona, and Sweetwater counties.

Interpretation

Naloxone administration rates and patient rates have been declining in Wyoming since 2016. Because naloxone may be administered to a patient multiple times, these numbers have the potential to be inflated.  However, both rates follow a similar trend, indicating that fewer people are receiving naloxone in an emergency medical setting.

Prescription Drug Misuse by College Students

While misuse of prescription pain relievers among university students has decreased, misuse of prescription stimulants has increased slightly

Comparison of prescription drug misuse among University of Wyoming students from 2009 to 2019.

Source

The National College Health Assessment (NCHA) is implemented by the American College Health Association and provides data on students’ health habits, behaviors, and perceptions.  It includes questions on the misuse of different types of prescription drugs.  During spring 2019, 67,792 students at 98 institutions participated in the survey.  Results specific to the University of Wyoming are presented here.

Limitations

  • Limitations of the NCHA include sampling, recall, and social desirability response biases.

Interpretation

Most rates of prescription drug misuse among University of Wyoming students have remained low from 2009-2019.  Notably, rates of prescription pain reliever misuse has declined from 9.4% to 4.0%.  Rates of prescription stimulant misuse rose from 2.7% in 2009 to 6.1% in 2017, then dropped slightly to 4.8% in 2019.

Prescription Drug Misuse

Prescription pain reliever misuse in Wyoming has a similar rate as the nation

Self-reported prevalence of non-medical use of prescription pain relievers in the past year among residents ages 12 and older in Wyoming and the United States.

Prescription pain reliever misuse in Wyoming is highest among young adults

Self-reported prevalence of non-medical use of prescription pain relievers in the past year among Wyoming residents ages 12 and older by age group.

Source

The National Survey on Drug Use and Health (NSDUH) provides national and state-level data on the use of tobacco, alcohol, illicit drugs, and prescription drugs among U.S. non-institutionalized civilians ages 12 and older. It also includes data on substance use disorders, substance abuse treatment, and mental health. Nearly 70,000 randomly selected individuals are interviewed for the NSDUH and the estimates derived are nationally representative.

This survey collects information on self-reported nonmedical use of prescription pain relievers. Nonmedical use of prescription pain relievers is defined as use of these drugs “in any way a doctor did not direct you to use it/them;” use of over-the-counter (OTC) drugs and legitimate use of these drugs are not included. The National Survey on Drug Use and Health (NSDUH) uses a definition of prescription pain relievers that includes: hydrocodone products; oxycodone products; tramadol products; codeine products; morphine products; fentanyl products; buprenorphine products; oxymorphone products; meperidine products; hydromorphone products; and methadone products. (https://nsduhweb.rti.org/respweb/homepage.cfm, https://www.samhsa.gov/data/sites/default/files/NSDUH-RedesignChanges-2015.pdf)

Limitations

  • Limitations of the NSDUH include sampling, recall, and social desirability response biases.
  • Data from the NSDUH are weighted to representative of the state and not available at the local level.

Interpretation

Past-year prescription pain reliever misuse is declining a similar rates in Wyoming as the nation, although the overall change is less than one percent. However, misuse rates among young adults (ages 18-25) have remained consistently higher than other age groups.