Quantifying morbidity associated with the abuse and misuse of opioid analgesics: a comparison of two approaches.

ABSTRACT

BACKGROUND: Due to the rising nonmedical use of opioid analgesics, methods are needed to quantify the associated health-related consequences. METHODS: Using opioid analgesic intentional exposure reports from poison control centers from January 2003-June 2004, we calculated quarterly rates for 7 opioids at the 3-digit ZIP code level using population- and patient-based denominators. RESULTS: Hydrocodone was the most widely prescribed opioid (maximum 5,321,390 patients per quarter), with the largest intentional exposure caseload (range 498-1,290), and the highest aggregate population-based rate (maximum of 13.61 cases per 1,000,000 individuals). Methadone had the highest aggregate patient-based rate (maximum 2.03 cases per 1,000 patients). CONCLUSION: Population- and patient-based rates are complementary tools that address different public health questions. Population-based rates describe the health-related burden of nonmedical opioid analgesic use on the community as a whole, while patient-based rates show this burden ("risk") in relation to the level of corresponding medicinal use ("benefit") within a given area.