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Most states have implemented prescription drug monitoring programs. There is little known about their use in public health surveillance efforts or for targeted prevention programs. Most rate estimates of hospitalizations or deaths use the general population without estimating potential risk for exposure. A method is described to better account for exposure, target interventions and focus outreach efforts.
METHODS:
Only unintentional hospitalizations or deaths were counted.
There are three separate databases used. The first is the Oregon Prescription Drug Monitoring Program (PDMP). The first year in use provided a count of unique individuals receiving a prescription opioid, methadone, or benzodiazepine from January 1, 2012 through December 31, 2012.
The second database is the Oregon Vital Record system for births and deaths. An average of three years (2009-2011) were used to estimate the number of deaths for 2012 since the records are currently incomplete.
The final database is the Oregon Hospital Discharge Dataset. An average of three years (2009-2011) were used to estimate the number of hospitalizations for 2012 since only the first half of 2012 is available.
The average 2009-2011 population rates per 100,000 were then used as the established estimation for deaths and hospitalizations. A second estimation was used by dividing the average number of deaths and hospitalizations by the number of unique people receiving a prescription opioid, methadone, or a benzodiazepine.
RESULTS:
The estimated hospital population rates were 9.6, 2.6, and 3.6 for prescription opioid drugs, methadone and benzodiazepines with prescription opioid drugs being the highest rate. Estimated death rates were 4.5, 2.2 and 0.7 again with prescription opioids being the highest.
The estimated populations receiving prescription showed a different leader when attempting to better approximate exposure using PDMP counts. The rates were 36.8, 566.3, and 42.1 for prescription opioids, methadone and benzodiazepines with methadone being the highest rate. Estimated death rates were 17.3, 497.0 and 7.7 again with methadone being the highest.
The relative risk ratios were 3.8, 222.0 and 11.7 times greater using the prescription drug monitoring program population as a proxy for exposure compared to the general population.
CONCLUSIONS:
By better approximating exposure, there is greater potential to target risks, focus intervention efforts and tailor prevention programs to maximize therapeutic benefits to the population exposed. Individuals who overdose but are not prescribed the above drugs can be estimated in the near future using the databases and linkage.