EpiNews Volume 19 #3: October/November, 2009
Public Health: Always working for a safer & healthier community.
Deaths in Snohomish
County: Opioids Most
Unintentional injuries were the third leading cause of death in
2007 in Snohomish County. Unintentional poisonings became
the leading cause of unintentional injury death in 2004
surpassing motor vehicle collisions (Fig 1). The age-adjusted
unintentional poisoning death rate increased five-fold since
1990 to 14 deaths per 100,000 residents in 2007. Age-
adjusted hospitalization rates doubled in the same period to
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
From 2005 through 2007, most unintentional poisoning deaths (97%, n= 271) were the result of a drug
overdose. Of the unintentional poisoning deaths, 79% included at least one opioid, and 63% were
prescription opioids, such as methadone, morphine, oxycodone, and hydrocodone. Multiple drugs were
County, 1990 - 2007
most often the cause. On average 3.3 drugs were reported at death, and 1.3 were prescription opioids.
More than 50% of the deaths with more than one prescription opioid were due to a combination ofprescription opioids and nonopioid prescriptions drugs, e.g., antidepressants (Celexa), antianxiety(Diazapam, Valium, Diastat), central nervous system stimulants (Cocaine), antihistamines (Benadryl). Inaddition to prescription opioids, over-the-counter opioids were also found. Alcohol was present in 18% ofdeaths that also included at least one prescription opioid. Illicit drugs, such as cocaine and LSD, werepresent in 18% of unintentional poisoning deaths from prescription opioids and were often used with atleast one other type of drug.
Males were more likely to die of unintentional poisonings than females, but were equally likely to behospitalized. Middle-aged adults (35-54 years) had the highest death rate from unintentional poisonings.
Older adults (65+) had the highest hospitalizations rates. Areas with higher poverty had higher rates ofunintentional poisoning deaths and hospitalizations.
Deaths and hospitalizations are the most severe consequences of unintentional poisonings. However,many prescription drugs (including opioids) are now being used recreationally by teens and young adults.
Almost 11% of 10th graders in our county reported using pain relievers to get “high.” Young adults(18-29 years old) admitted to treatment centers for opioid addiction increased 30% since 2005.
These unintentional poisoning deaths are preventable with the use of multiple approaches. The first stepis to increase the awareness of the dangers of taking too many medications and to follow dosinginstructions. Government agencies are responsible for ensuring that medications meet certain safetystandards and for providing general education to physicians and patients. Physicians and pharmacist areresponsible for understanding the uses, side effects, and potential drug interactions of the medicationsthey are prescribing. Patients need to understand their prescribed medications, how to use them, andinform physicians of all medications they are taking.
Clinical and practice guidelines for health care providers on safe prescribing of opioids are available atwww.agencymeddirectors.wa.gov/opioiddosing.asp. Collaborative Opioid Prescribing Education (COPE)is an online training created by the University of Washington Medical Center to improve doctor-patientcommunication (http://depts.washington.edu/cme/online/course/EN0705). There are also “UnwantedMedicine Return Programs” aimed at keeping unwanted
Report Snohomish County
medicines from negatively impacting the environment
and reducing their availability for misuse.
STD's: 425.339.5298/Fax: 425.339.8707
More information about unintentional poisonings and
Tuberculosis: 425.339.5225/Fax: 425.339.5217
prevention is available in the recently released report
Communicable Diseases: 425.339.5278
published by the Health Statistics and Assessment
Program at Snohomish Health District. “Unintentional
After hours emergency only: 425.339.5295
Poisonings in Snohomish County” is available at
24-hr Reporting: 425.339.5235
H1N1: 425.339.5278 Fax: 425.339.8706
Health Statistics &
3020 Rucker Ave
Everett, WA 98201
CD Cases Reported Jan – Aug
H1N1 in Snohomish County
Snohomish Health District (SHD) has joined with health care partners throughout
Snohomish County to make preparations for receiving H1N1 vaccine and vaccinating
prioritized persons per Centers for Disease Control guidelines. The first supplies of
H1N1 vaccine, in the form of live attenuated nasal mist, were released by the federal
government and made available locally mid-October. The first doses of FluMist are
being administered to health care providers who are eligible for its use (healthy persons
through age 49 who are not pregnant). Health care providers are a priority group for
vaccination, as they are at high risk of exposure and could put patients at risk if they
Other priority persons include:
• Pregnant women and family members of pregnant women
• Persons who live with or care for children younger than 6 months of age
• Persons between the ages of 6 months and 24 years old
• First Responders, including emergency medical services and law enforcement
• Persons between 25 through 64 years of age with chronic health conditions or
Additional shipments of vaccine are expected to arrive by the 4th week of October.
*Includes probable and confirmed cases §
Mass Immunization clinics to vaccinate priority group persons will be held at nine sites
Previously counted by date reported; now counted by date of
throughout the county, beginning October 31st, if the vaccine shipments arrive as
expected. When vaccine supplies are sufficient to cover the demands in the prioritized groups, vaccinewill be available to all interested individuals. A media campaign is being planned to announce the vaccineavailability and mass clinic information. Vaccine will also be available through traditional channels,including Snohomish Health District, regular health care providers, pharmacies, and other commercialvendors.
The Washington State Secretary of Health signed the order temporarily suspending Washington’sThimerosal law for administration of H1N1 vaccine. This allows people to have the choice to receivevaccine containing Thimerosal as a preservative if no vaccine without the preservative is available.
Parents of children and pregnant women will be informed prior to administration of the vaccine.
Flu vaccine is a federally-owned drug and will be provided at no cost. Health care providers, pharmacies,and commercial vendors may charge an administration fee, and most insurers will reimburseadministration costs. To ensure that all individuals will be served, no administration fee will be charged atcommunity vaccination clinic sites.
Under emergency rule, influenza is now reportable. Report the following to the Snohomish Health District
Communicable Disease Program within one business day either by phone (425.339.5278) or by faxing a
completed case report form to 425.339.8706:
All hospitalized patients with lab-confirmed influenza infection of any type. Report hospitalized
patients through the hospital infection control program.*
Deceased patients with lab-confirmed influenza infection* Deceased and critically ill patients (i.e. admitted to ICU) suspected to have influenza, even if
*Laboratory confirmation includes confirmation by a positive rapid influenza test, real-time PCR test, direct orindirect fluorescent antibody test, or viral isolate from cell culture.
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