Diverted Prescription Drugs by HD4u6mus

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									     Benzodiazepines
A Common Cause of Poisoning
       Extent of the Problem




     Karen E. Simone, PharmD, DABAT
     Northern New England Poison Center
                (207)662-7221
              simonk@mmc.org
                   Northern New England
                       Poison Center
• Certified by the American Association of Poison Control
  Centers (AAPCC) in November 2004
    – Staff

    – Hotline

    – Outreach

    – Surveillance

    – Research

  Funding: Maine Medical Center; Fletcher Allen Health Care; States of Maine, New Hampshire and Vermont; Health
  Resources and Services Administration; United Ways of Greater Portland, York, Kennebec Valley; Purdue Pharma L.P.
  (surveillance projects)
            Learning Objectives:
• Describe the prevalence of benzodiazepines in
  overdoses reported to the Northern New England Poison
  Center (NNEPC).
• Indicate what poison data suggest regarding the
  contribution of benzodiazepines to the prescription drug
  abuse problem in the State of Maine.
• Name the most commonly abused benzodiazepines
• Discuss the prevalence of abuse of the newer hypnotics
Northern New England Poison Center Hotline Calls
                         2005
            Maine, New Hampshire and Vermont
                      N=68,722


               Human Poisonings
                     46%




                                           Animal Poisonings
                                                  4%


                                               Confirmed Non-
                                                 Exposures
                                                     <1%




                    Information Requests
                             50%
Northern New England Poison Center Hotline Calls
                            2005
                           Maine


                           N=37,109



        Human Poisonings                     Animal Poisonings
              36%                                   3%
                                               Confirmed Non-
                                                 Exposures
                                                     <1%




                                      Information Requests
                                               61%
                                          Prevalence of Benzodiazepines in Maine Calls
                                                                N = 43,267
                              50,000
                                                                                     8%
                              45,000
                                                    All Other Substances
Number of Substance Citings




                              40,000                Benzodiazepines
                              35,000

                              30,000
                                                                    11%
                              25,000

                              20,000
                                           4%
                              15,000

                              10,000

                               5,000

                                  0
                                       Poisonings         Information Requests    All Calls
                                                                Call Type

                                                               Human and Animal
   Reason for Poisoning (Maine calls)
                                                                           14, 000
             A l l Ot her Subst ances
                                                    N = 15 , 5 4 3                         1%
             B enzodi azepi nes
3, 000                                                                     12, 000

                                         14%
2, 500                                                                     10, 000



2, 000                                                                      8, 000



1, 500                                                                      6, 000
              9%
1, 000                                                                      4, 000


  500
                                                                            2, 000
                                                                 25%
    0
                                                                                0
         A buse/ M i suse         Sui ci de A t t empt        Unknown
                                                                                     Uni nt ent i onal
                                     R e a s on                      33%              R e a s on


Substance Citings
                                                                                          Human
                                           Human
                                 Prevalence of Benzodiazepine Poisoning by Age (Maine Calls)
                                                         N = 15,857 (all ages)
                              1800
                                                                   All Other Substances
                                      3%       7%
                              1600                                 Benzodiazepines

                                                         9%            11%
                              1400
Number of Substance Citings




                              1200
                                                                                  5%      3%
                              1000


                              800


                              600


                              400


                              200


                                0
                                     13-19     20s       30s           40s        50s     > 60
                                                          Age in Years
                                                               Human
                                      Prevalence of Benzodiazepine Information Requests by Age
                                                            (Maine calls)
                                                                N = 25,512 (all ages)
                              12000

                                                13%

                              10000

                                                                      All Other Substances
Number of Substance Citings




                                                                      Benzodiazepines
                              8000



                              6000
                                                          13%

                                        10%
                              4000

                                                                         13%
                                                                                                       6%
                              2000
                                                                                        10%   4%


                                 0
                                       13-19     20s      30s            40s            50s   > 60   Unknow n
                                                                    Age in Years

                                                          Human and Animal
County ME


                                                                                                                                                                                 Public Medical and
                                                                                                                                                                                 Other Information


        Fact
                                                                                                                                                                                                                                                                                             Group Name
 7000
                                                                                                                                                                                                                                                                                              Opioids

 6000                                                                                                                                                                                                                                                                                         Benzodiazepines/Benzodiazepine-like

                                                                                                                                                                                                                                                                                              Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)
 5000
                                                                                                                                                                                                                                                                                              Unknown Drug
 4000
                                                                                                                                                                                                                                                                                              Antidepressants

 3000                                                                                                                                                                                                                                                                                         Cardiovascular (Heart)

                                                                                                                                                                                                                                                                                              Skeletal Muscle Relaxants
 2000
                                                                                                                                                                                                                                                                                              Stimulants and Street Drugs
 1000
                                                                                                                                                                                                                                                                                              Antibiotics and Other Anti-infectives, Vaccines

    0                                                                                                                                                                                                                                                                                         Other Drug (Chemotherapy, Radiopharmaceuticals, Diagnostic,
                                                                                                                                                                                                                                                                                              Hormones, Antidiabetic, Antithyroid)
        Quarter 1

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                       2001                                            2002                                            2003                                            2004                                            2005                                         2006


                                                                                                                            Year                 Quarter
County ME


                                                                                                                                                                                                 Law Enforcement Information


            Fact
 1200



 1000
                                                                                                                                                                                                                                                                                                                                                              Group Name
                                                                                                                                                                                                                                                                                                                                                                Opioids
  800                                                                                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like
                                                                                                                                                                                                                                                                                                                                                                Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)
                                                                                                                                                                                                                                                                                                                                                                Antidepressants
  600                                                                                                                                                                                                                                                                                                                                                           Unknown Drug
                                                                                                                                                                                                                                                                                                                                                                Antibiotics and Other Anti-infectives, Vaccines
                                                                                                                                                                                                                                                                                                                                                                Skeletal Muscle Relaxants
  400                                                                                                                                                                                                                                                                                                                                                           Cardiovascular (Heart)
                                                                                                                                                                                                                                                                                                                                                                Stimulants and Street Drugs
                                                                                                                                                                                                                                                                                                                                                                Stomach and Bladder (other than opioid or anticholinergics)
  200



    0
            Quarter 3

                              Quarter 4

                                              Quarter 1

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         2001
 County ME                                                      2002                                                             2003                                                               2004                                                             2005                                                           2006

                                                                                                                                                            Year                       Quarter
                                                                                                                                                                                                                          Public Medical and
                                                                                                                                                                                                                          Other Information


                Fact
                                                                                                                                                                                                                                                                                                                                                              Group Name
   7000
                                                                                                                                                                                                                                                                                                                                                               Opioids

   6000                                                                                                                                                                                                                                                                                                                                                        Benzodiazepines/Benzodiazepine-like

                                                                                                                                                                                                                                                                                                                                                               Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)
   5000
                                                                                                                                                                                                                                                                                                                                                               Unknown Drug
   4000
                                                                                                                                                                                                                                                                                                                                                               Antidepressants

   3000                                                                                                                                                                                                                                                                                                                                                        Cardiovascular (Heart)

                                                                                                                                                                                                                                                                                                                                                               Skeletal Muscle Relaxants
   2000
                                                                                                                                                                                                                                                                                                                                                               Stimulants and Street Drugs
   1000
                                                                                                                                                                                                                                                                                                                                                               Antibiotics and Other Anti-infectives, Vaccines

        0                                                                                                                                                                                                                                                                                                                                                      Other Drug (Chemotherapy, Radiopharmaceuticals, Diagnostic,
                                                                                                                                                                                                                                                                                                                                                               Hormones, Antidiabetic, Antithyroid)
                  Quarter 1

                                  Quarter 2

                                                Quarter 3

                                                            Quarter 4

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                                      2001                                              2002                                                                2003                                               2004                                                         2005                                                    2006


                                                                                                                                                              Year                        Quarter
County ME


                                                                                                                                                               Public Medical and
                                                                                                                                                               Other Information


        Fact                                                                                                                                                                                                                                              Group Name
 1000                                                                                                                                                                                                                                                     Sub Group Name
  900                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

  800                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

  700                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

  600                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

  500                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

  400                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)

  300                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

  200                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide
                                                                                                                                                                                                                                                           (Librium®)
  100                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

    0                                                                                                                                                                                                                                                      Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone
                                                                                                                                                                                                                                                           (Lunesta®, Imovane®)
         Quarter 4

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        2001                         2002                                            2003                                            2004                                            2005                                        2006

                                                                                                            Year                 Quarter
County ME


                                                                                                                                                                             Law Enforcement Information


           Fact
 250                                                                                                                                                                                                                                                                                          Group Name
                                                                                                                                                                                                                                                                                              Sub Group Name
                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

 200                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

 150                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

 100                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide
                                                                                                                                                                                                                                                                                               (Librium®)
                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone
  50                                                                                                                                                                                                                                                                                           (Lunesta®, Imovane®)
                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Triazolam (Halcion®)

                                                                                                                                                                                                                                                                                               Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)
   0
           Quarter 4

                           Quarter 1

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County 2001
        ME                                    2002                                                        2003                                                     2004                                                2005                                          2006

                                                                                                                                       Year                    Quarter
                                                                                                                                                                                                 Public Medical and
                                                                                                                                                                                                 Other Information


            Fact                                                                                                                                                                                                                                                                              Group Name
 1000                                                                                                                                                                                                                                                                                         Sub Group Name
  900                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

  800                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

  700                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

  600                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

  500                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

  400                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)

  300                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

  200                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide
                                                                                                                                                                                                                                                                                               (Librium®)
  100                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

       0                                                                                                                                                                                                                                                                                       Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone
                                                                                                                                                                                                                                                                                               (Lunesta®, Imovane®)
               Quarter 4

                              Quarter 1

                                             Quarter 2

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           2001                                   2002                                                        2003                                                   2004                                                2005                                        2006

                                                                                                                                         Year                  Quarter
County ME


                                                                                                                                                                                   Exposure Abuse


       Fact
 250                                                                                                                                                                                                                                                                                         Group Name
                                                                                                                                                                                                                                                                                              Stimulants and Street Drugs

                                                                                                                                                                                                                                                                                              Opioids
 200
                                                                                                                                                                                                                                                                                              Alcohol/Alcohol-containing (mouthwash, hair spray)

                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like
 150
                                                                                                                                                                                                                                                                                              Asthma, Cold and Cough, Eye, Ear, Nose and Throat

                                                                                                                                                                                                                                                                                              Antidepressants
 100
                                                                                                                                                                                                                                                                                              Non-Opioid Analgesics without sedatives (aspirin,
                                                                                                                                                                                                                                                                                              Tylenol®)
                                                                                                                                                                                                                                                                                              Antipsychotics (atypical)
  50
                                                                                                                                                                                                                                                                                              Antihistamines (sedating)

                                                                                                                                                                                                                                                                                              Anticonvulsants/Mood Stabilizers
   0
       Quarter 1

                   Quarter 2

                               Quarter 3

                                           Quarter 4

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                      2001                                            2002                                            2003                                             2004                                            2005                                         2006

                                                                                                                               Year              Quarter
County ME


                                                                                                                                                                                           Exposure Abuse


      Fact                                                                                                                                                                                                                                                                                   Group Name
 40
                                                                                                                                                                                                                                                                                             Sub Group Name
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Clonazepam
 35                                                                                                                                                                                                                                                                                           (Klonopin®)
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Alprazolam
                                                                                                                                                                                                                                                                                              (Xanax®)
 30
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Diazepam
                                                                                                                                                                                                                                                                                              (Valium®)
 25                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Lorazepam
                                                                                                                                                                                                                                                                                              (Ativan®)
 20                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Other/unknown
                                                                                                                                                                                                                                                                                              benzodiazepine
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Zolpidem
 15                                                                                                                                                                                                                                                                                           (Ambien®)
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Temazepam
 10                                                                                                                                                                                                                                                                                           (Restoril®)
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Oxazepam
                                                                                                                                                                                                                                                                                              (Serax®)
  5                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide
                                                                                                                                                                                                                                                                                              (Librium®)
  0                                                                                                                                                                                                                                                                                           Benzodiazepines/Benzodiazepine-like -
                                                                                                                                                                                                                                                                                              Eszopiclone/Zopiclone (Lunesta®, Imovane®)
      Quarter 1

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                      2001                                           2002                                            2003                                              2004                                             2005                                        2006

                                                                                                                              Year              Quarter
County ME


                                                                                                                                                                                 Exposure Suicide


       Fact
 700                                                                                                                                                                                                                                                                                         Group Name
                                                                                                                                                                                                                                                                                              Antidepressants
 600
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like

 500                                                                                                                                                                                                                                                                                          Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

                                                                                                                                                                                                                                                                                              Antipsychotics (atypical)
 400
                                                                                                                                                                                                                                                                                              Alcohol/Alcohol-containing (mouthwash, hair spray)

 300                                                                                                                                                                                                                                                                                          Anticonvulsants/Mood Stabilizers

                                                                                                                                                                                                                                                                                              Opioids
 200
                                                                                                                                                                                                                                                                                              Cardiovascular (Heart)


 100                                                                                                                                                                                                                                                                                          Non-Opioid Analgesics with Sedatives (Fiorinal®, Fioricet®,
                                                                                                                                                                                                                                                                                              Midrin®, Tylenol PM®)
                                                                                                                                                                                                                                                                                              Antihistamines (sedating)
   0
       Quarter 1

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                      2001                                             2002                                           2003                                              2004                                           2005                                         2006

                                                                                                                               Year               Quarter
County ME


                                                                                                                                                                                        Exposure Suicide


       Fact
 120                                                                                                                                                                                                                                                                                         Group Name
                                                                                                                                                                                                                                                                                             Sub Group Name
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)
 100
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)
  80
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

  60                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Other/unknown
                                                                                                                                                                                                                                                                                              benzodiazepine
  40                                                                                                                                                                                                                                                                                          Benzodiazepines/Benzodiazepine-like - Zaleplon (Sonata®)

                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide
  20                                                                                                                                                                                                                                                                                          (Librium®)
                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

                                                                                                                                                                                                                                                                                              Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone
   0                                                                                                                                                                                                                                                                                          (Lunesta®, Imovane®)
       Quarter 1

                   Quarter 2

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                                                                                                                                            Quarter 4

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                                                                                                                                                                    Quarter 2

                                                                                                                                                                                Quarter 3

                                                                                                                                                                                            Quarter 4

                                                                                                                                                                                                        Quarter 1

                                                                                                                                                                                                                    Quarter 2

                                                                                                                                                                                                                                Quarter 3

                                                                                                                                                                                                                                            Quarter 4

                                                                                                                                                                                                                                                        Quarter 1

                                                                                                                                                                                                                                                                     Quarter 2

                                                                                                                                                                                                                                                                                 Quarter 3
                      2001                                            2002                                            2003                                             2004                                            2005                                         2006

                                                                                                                               Year               Quarter
County ME


                                                                                                                                                                                         Law Enforcement Information


           Fact
 400                                                                                                                                                                                                                                                                                                                                                  Group Name
                                                                                                                                                                                                                                                                                                                                                      Sub Group Name
 350                                                                                                                                                                                                                                                                                                                                                   Opioids - Oxycodone (OxyContin®, Percocet®)

                                                                                                                                                                                                                                                                                                                                                       Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)
 300
                                                                                                                                                                                                                                                                                                                                                       Opioids - Methadone (Dolophine®, Methadose®)
 250
                                                                                                                                                                                                                                                                                                                                                       Opioids - Propoxyphene (Darvocet®, Darvon®)

 200                                                                                                                                                                                                                                                                                                                                                   Opioids - Morphine (Avinza®, Kadian®, MS Contin®,
                                                                                                                                                                                                                                                                                                                                                       Oramorph®)
                                                                                                                                                                                                                                                                                                                                                       Opioids - Tramadol (Ultram®)
 150
                                                                                                                                                                                                                                                                                                                                                       Opioids - Buprenorphine (Suboxone®)
 100
                                                                                                                                                                                                                                                                                                                                                       Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

  50                                                                                                                                                                                                                                                                                                                                                   Opioids - Hydromorphone (Dilaudid®, Palladone®)

                                                                                                                                                                                                                                                                                                                                                       Opioids - Meperidine (Demerol®)
   0
           Quarter 3

                          Quarter 4

                                        Quarter 1

                                                     Quarter 2

                                                                 Quarter 3

                                                                              Quarter 4

                                                                                            Quarter 1

                                                                                                           Quarter 2

                                                                                                                           Quarter 3

                                                                                                                                            Quarter 4

                                                                                                                                                              Quarter 1

                                                                                                                                                                                 Quarter 2

                                                                                                                                                                                                     Quarter 3

                                                                                                                                                                                                                         Quarter 4

                                                                                                                                                                                                                                            Quarter 1

                                                                                                                                                                                                                                                              Quarter 2

                                                                                                                                                                                                                                                                               Quarter 3

                                                                                                                                                                                                                                                                                               Quarter 4

                                                                                                                                                                                                                                                                                                              Quarter 1

                                                                                                                                                                                                                                                                                                                             Quarter 2

                                                                                                                                                                                                                                                                                                                                          Quarter 3
               2001                                      2002                                                   2003                                                                  2004                                                                        2005                                                      2006

County ME                                                                                                                              Year                         Quarter


                                                                                                                                                                                                                     Public Medical and
                                                                                                                                                                                                                     Other Information


            Fact                                                                                                                                                                                                                                                                                                                                      Group Name
 3000                                                                                                                                                                                                                                                                                                                                                 Sub Group Name
                                                                                                                                                                                                                                                                                                                                                       Opioids - Oxycodone (OxyContin®, Percocet®)

 2500                                                                                                                                                                                                                                                                                                                                                  Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)

                                                                                                                                                                                                                                                                                                                                                       Opioids - Tramadol (Ultram®)
 2000
                                                                                                                                                                                                                                                                                                                                                       Opioids - Morphine (Avinza®, Kadian®, MS Contin®,
                                                                                                                                                                                                                                                                                                                                                       Oramorph®)
 1500                                                                                                                                                                                                                                                                                                                                                  Opioids - Methadone (Dolophine®, Methadose®)

                                                                                                                                                                                                                                                                                                                                                       Opioids - Propoxyphene (Darvocet®, Darvon®)
 1000
                                                                                                                                                                                                                                                                                                                                                       Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

                                                                                                                                                                                                                                                                                                                                                       Opioids - Hydromorphone (Dilaudid®, Palladone®)
  500
                                                                                                                                                                                                                                                                                                                                                       Opioids - Buprenorphine (Suboxone®)

       0                                                                                                                                                                                                                                                                                                                                               Opioids - Meperidine (Demerol®)
              Quarter 1

                            Quarter 3

                                         Quarter 4

                                                     Quarter 1

                                                                 Quarter 2

                                                                             Quarter 3

                                                                                          Quarter 4

                                                                                                        Quarter 1

                                                                                                                       Quarter 2

                                                                                                                                       Quarter 3

                                                                                                                                                        Quarter 4

                                                                                                                                                                          Quarter 1

                                                                                                                                                                                             Quarter 2

                                                                                                                                                                                                             Quarter 3

                                                                                                                                                                                                                                Quarter 4

                                                                                                                                                                                                                                                  Quarter 1

                                                                                                                                                                                                                                                                   Quarter 2

                                                                                                                                                                                                                                                                                   Quarter 3

                                                                                                                                                                                                                                                                                                  Quarter 4

                                                                                                                                                                                                                                                                                                                Quarter 1

                                                                                                                                                                                                                                                                                                                              Quarter 2

                                                                                                                                                                                                                                                                                                                                          Quarter 3




                          2001                                       2002                                                 2003                                                                   2004                                                                     2005                                              2006

                                                                                                                                        Year                          Quarter
County ME


                                                                                                                                                                                       Exposure Suicide


      Fact
 60                                                                                                                                                                                                                                                                                         Group Name
                                                                                                                                                                                                                                                                                            Sub Group Name
                                                                                                                                                                                                                                                                                             Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)
 50
                                                                                                                                                                                                                                                                                             Opioids - Oxycodone (OxyContin®, Percocet®)

                                                                                                                                                                                                                                                                                             Opioids - Propoxyphene (Darvocet®, Darvon®)
 40
                                                                                                                                                                                                                                                                                             Opioids - Methadone (Dolophine®, Methadose®)

 30                                                                                                                                                                                                                                                                                          Opioids - Tramadol (Ultram®)

                                                                                                                                                                                                                                                                                             Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

 20                                                                                                                                                                                                                                                                                          Opioids - Other/unknown opioid

                                                                                                                                                                                                                                                                                             Opioids - Morphine (Avinza®, Kadian®, MS Contin®,
 10                                                                                                                                                                                                                                                                                          Oramorph®)
                                                                                                                                                                                                                                                                                             Opioids - Fentanyl (Duragesic®, Sublimaze®)

                                                                                                                                                                                                                                                                                             Opioids - Buprenorphine (Suboxone®)
  0
      Quarter 1

                  Quarter 2

                              Quarter 3

                                          Quarter 4

                                                      Quarter 1

                                                                  Quarter 2

                                                                              Quarter 3

                                                                                          Quarter 4

                                                                                                      Quarter 1

                                                                                                                  Quarter 2

                                                                                                                               Quarter 3

                                                                                                                                           Quarter 4

                                                                                                                                                       Quarter 1

                                                                                                                                                                   Quarter 2

                                                                                                                                                                               Quarter 3

                                                                                                                                                                                           Quarter 4

                                                                                                                                                                                                       Quarter 1

                                                                                                                                                                                                                   Quarter 2

                                                                                                                                                                                                                               Quarter 3

                                                                                                                                                                                                                                           Quarter 4

                                                                                                                                                                                                                                                       Quarter 1

                                                                                                                                                                                                                                                                    Quarter 2

                                                                                                                                                                                                                                                                                Quarter 3
                      2001                                            2002                                            2003                                            2004                                            2005                                         2006

                                                                                                                              Year               Quarter
County ME


                                                                                                                                                                                      Exposure Abuse


      Fact                                                                                                                                                                                                                                                                                  Group Name
 40
                                                                                                                                                                                                                                                                                            Sub Group Name
                                                                                                                                                                                                                                                                                             Opioids - Methadone (Dolophine®, Methadose®)
 35
                                                                                                                                                                                                                                                                                             Opioids - Oxycodone (OxyContin®, Percocet®)
 30
                                                                                                                                                                                                                                                                                             Opioids - Hydrocodone (Lortab®, Tussionex®,
                                                                                                                                                                                                                                                                                             Vicodin®)
 25                                                                                                                                                                                                                                                                                          Opioids - Buprenorphine (Suboxone®)

 20                                                                                                                                                                                                                                                                                          Opioids - Fentanyl (Duragesic®, Sublimaze®)

                                                                                                                                                                                                                                                                                             Opioids - Propoxyphene (Darvocet®, Darvon®)
 15
                                                                                                                                                                                                                                                                                             Opioids - Morphine (Avinza®, Kadian®, MS Contin®,
 10                                                                                                                                                                                                                                                                                          Oramorph®)
                                                                                                                                                                                                                                                                                             Opioids - Other/unknown opioid

  5                                                                                                                                                                                                                                                                                          Opioids - Tramadol (Ultram®)

  0                                                                                                                                                                                                                                                                                          Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with
                                                                                                                                                                                                                                                                                             codeine)
      Quarter 1

                  Quarter 2

                              Quarter 3

                                          Quarter 4

                                                      Quarter 1

                                                                  Quarter 2

                                                                              Quarter 3

                                                                                          Quarter 4

                                                                                                      Quarter 1

                                                                                                                  Quarter 2

                                                                                                                               Quarter 3

                                                                                                                                           Quarter 4

                                                                                                                                                       Quarter 1

                                                                                                                                                                   Quarter 2

                                                                                                                                                                               Quarter 3

                                                                                                                                                                                           Quarter 4

                                                                                                                                                                                                       Quarter 1

                                                                                                                                                                                                                   Quarter 2

                                                                                                                                                                                                                               Quarter 3

                                                                                                                                                                                                                                           Quarter 4

                                                                                                                                                                                                                                                       Quarter 1

                                                                                                                                                                                                                                                                    Quarter 2

                                                                                                                                                                                                                                                                                Quarter 3
                     2001                                             2002                                            2003                                            2004                                             2005                                        2006

                                                                                                                              Year              Quarter

								
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