Patterns of abuse among unintentional pharmaceutical overdose fatalities.

CONTEXT Use and abuse of prescription narcotic analgesics have increased dramatically in the United States since 1990. The effect of this pharmacoepidemic has been most pronounced in rural states, including West Virginia, which experienced the nation's largest increase in drug overdose mortality rates during 1999-2004. OBJECTIVE To evaluate the risk characteristics of persons dying of unintentional pharmaceutical overdose in West Virginia, the types of drugs involved, and the role of drug abuse in the deaths. DESIGN, SETTING, AND PARTICIPANTS Population-based, observational study using data from medical examiner, prescription drug monitoring program, and opiate treatment program records. The study population was all state residents who died of unintentional pharmaceutical overdoses in West Virginia in 2006. MAIN OUTCOME MEASURES Rates and rate ratios for selected demographic variables. Prevalence of specific drugs among decedents and proportion that had been prescribed to decedents. Associations between demographics and substance abuse indicators and evidence of pharmaceutical diversion, defined as a death involving a prescription drug without a documented prescription and having received prescriptions for controlled substances from 5 or more clinicians during the year prior to death (ie, doctor shopping). RESULTS Of 295 decedents, 198 (67.1%) were men and 271 (91.9%) were aged 18 through 54 years. Pharmaceutical diversion was associated with 186 (63.1%) deaths, while 63 (21.4%) were accompanied by evidence of doctor shopping. Prevalence of diversion was greatest among decedents aged 18 through 24 years and decreased across each successive age group. Having prescriptions for a controlled substance from 5 or more clinicians in the year prior to death was more common among women (30 [30.9%]) and decedents aged 35 through 44 years (23 [30.7%]) compared with men (33 [16.7%]) and other age groups (40 [18.2%]). Substance abuse indicators were identified in 279 decedents (94.6%), with nonmedical routes of exposure and illicit contributory drugs particularly prevalent among drug diverters. Multiple contributory substances were implicated in 234 deaths (79.3%). Opioid analgesics were taken by 275 decedents (93.2%), of whom only 122 (44.4%) had ever been prescribed these drugs. CONCLUSION The majority of overdose deaths in West Virginia in 2006 were associated with nonmedical use and diversion of pharmaceuticals, primarily opioid analgesics.

[1]  A. Gilson,et al.  Improving State Pain Policies: Recent Progress and Continuing Opportunities , 2007, CA: a cancer journal for clinicians.

[2]  J. Inciardi,et al.  Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. , 2007, Pain medicine.

[3]  L. Hourani,et al.  Results from the 2008 National Survey on Drug Use and Health: National Findings , 2007 .

[4]  J. Gerberding,et al.  Unintentional poisoning deaths--United States, 1999-2004. , 2007, MMWR. Morbidity and mortality weekly report.

[5]  L. Paulozzi,et al.  Opioid analgesics and rates of fatal drug poisoning in the United States. , 2006, American journal of preventive medicine.

[6]  K. Wells,et al.  Association between mental health disorders, problem drug use, and regular prescription opioid use. , 2006, Archives of internal medicine.

[7]  Yongli Xi,et al.  Increasing deaths from opioid analgesics in the United States , 2006, Pharmacoepidemiology and drug safety.

[8]  L. Manchikanti,et al.  Opioid guidelines in the management of chronic non-cancer pain. , 2006, Pain physician.

[9]  James D. Toombs,et al.  Methadone treatment for pain states. , 2005, American family physician.

[10]  Model policy for the use of controlled substances for the treatment of pain. , 2005, Journal of pain & palliative care pharmacotherapy.

[11]  D. Makuc,et al.  Health, United States, 2003; with chartbook on trends in the health of Americans , 2003 .

[12]  Dma Janet M. Coggan Mls.  A Review of the Centers for Disease Control and Prevention Web Site , 2003 .

[13]  K. Foley,et al.  Dismantling the barriers: providing palliative and pain care. , 2000, JAMA.

[14]  D. Carr,et al.  The use of opioids for the treatment of chronic pain. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. , 1998, The Clinical journal of pain.

[15]  Practice guidelines for chronic pain management. A report by the American Society of Anesthesiologists Task Force on Pain Management, Chronic Pain Section. , 1997, Anesthesiology.