MMWR News Synopsis for March 16, 2017

Characteristics of the Initial Opioid Prescription Episode and the Likelihood of Long-Term Opioid Use Among Opioid-Naïve Patients — United States, 2006–2015

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For patients receiving their first opioid prescription, clinician choices can greatly influence the chances of opioid use one and three years later. Supplying three or fewer days of opioids in an initial opioid prescription reduces the likelihood of chronic opioid use. Among cancer-free people prescribed at least a one-day supply of an opioid prescription, 1 in 17 will be on an opioid one year later according to nationally representative prescription records. This number jumps to 1 in 2 for those prescribed five consecutive opioid prescriptions at the outset of opioid treatment. The likelihood of chronic opioid use increases with each additional day of medication supplied starting on the third day and increases the sharpest after the sixth and 31st day on therapy. Likelihood of chronic opioid use also increases sharply when a second prescription is authorized or refilled. People starting on a long-acting opioid or Tramadol were more likely to remain on opioids than those prescribed hydrocodone or oxycodone. These data show that initial prescriptions of three days or fewer of opioids can reduce the chances of long term opioid use.

Trends in Suicide by Level of Urbanization — United States, 1999–2015

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Suicide rates across all levels of urbanization gradually increased during the study period and the gap between less urban and more urban areas began to widen more quickly in 2007-2008. Suicide rates in the U.S. are higher in less urban areas. During 1999–2015, suicide rates gradually increased across all levels of urbanization. The study found that the gap in suicide rates between less urban and more urban areas steadily widened over the study period and in 2007–2008 began to widen more quickly. The increases in suicide rates in less urban areas might reflect the influence of the economic recession, which disproportionately impacted such areas. Less urban areas also face other suicide-related problems such as limited access to mental health care, increases in opioid overdose, and social isolation.

Mercury Spill Responses — Five States, 2012–2015

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In order to reduce harmful exposures to elemental mercury and the high costs associated with the cleanup of large mercury spills, continued efforts are needed to educate the public on the health effects of exposure to elemental mercury, the potential sources of mercury in our homes and workplaces, and the options for safe disposal of items containing mercury. Despite efforts to educate the public on the dangers of mercury, mercury spills continue to occur, primarily in homes, schools, and healthcare facilities. Mercury spills require costly cleanup to prevent exposures to harmful levels of mercury vapor. In order to protect the public’s health after a mercury spill, it is critical that local, state, and federal agencies communicate and coordinate effectively to ensure a quick response that minimizes the spread of contamination. To reduce the number of elemental mercury spills that occur in the United States, public health officials should increase awareness of exchange programs for mercury-containing items and educate citizens, school staff, and healthcare workers about sources of mercury and how to dispose of them properly.

Investigation of Salmonella Enteritidis Outbreak Associated with Truffle Oil — District of Columbia, 2015

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Public health officials and consumers should be aware that truffle oil has been implicated as the likely source of a salmonella outbreak and could possibly harbor this pathogen. In September 2015, the District of Columbia Department of Health (DCDOH) received reports of gastrointestinal illness and hospitalizations among people who had eaten at a single District of Columbia restaurant. Laboratory tests performed on stool cultures from the initial case-patients identified Salmonella Enteritidis. DCDOH issued a summary suspension of restaurant A’s license because of increasing concern about a potential outbreak. Further investigation identified 159 people who experienced illness after eating at the restaurant during July 1–September 10, 2015. Results from a case-control study using restaurant patron data identified a novel food vehicle, truffle oil, as the likely source of infection in this outbreak. Consumption of a truffle oil-containing item was reported by 89% of case-patients compared with 57% of control subjects (p < 0.001).

Notes from the Field:

• Investigation of Patients Testing Positive Postvaccination for Yellow Fever Viral RNA During a Mass Vaccination Campaign — Angola, 2016

Quick Stats:

• Age-Adjusted Rate for Suicide, by Sex — National Vital Statistics System, United States, 1975–2015

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