Prescription-Opioid Overdose Deaths Examined
Dawson W and Leavitt S. Pain Treatment Topics. November-December 2008 News/Research Update.December 22, 2008
Along with increases in prescription opioid analgesic use, rates of abuse and overdose also have risen in certain locales. Deaths from overdose are highest in rural areas, and unintentional overdoses during 1999-2004 in West Virginia represented the highest increases in the United States. An updated report by the Centers for Disease Control and other government agencies, recently published in the Journal of the American Medical Association, evaluated West Virginia 2006 data on overdose deaths, pharmaceutical diversion* rates, and related factors. [*Pharmaceutical diversion was defined as "death involving a prescription drug without a documented prescription” or “having received prescriptions for controlled substances from 5 or more clinicians (doctor shopping)."]
Data from the state medical examiner’s office was combined with records from state prescription drug monitoring programs and 8 opioid-treatment programs for analysis. The following facts were noted:
- Two thirds of the 295 opioid-associated overdose decedents in West Virginia were male.
- Prescription opioids were involved in 93% of all opioid-related deaths, but fewer than half (44%) of decedents had been personally prescribed those medications.
- Most of the deaths involved prescription-opioid diversion (63%) or doctor shopping (21%).
- Diversion was most prevalent in younger decedents aged 18-24.
- Doctor shopping was significantly more prevalent among female decedents and individuals aged 35-44.
- Multiple substances – 2 prescription drugs on average (range 1-5) – were evident in almost 80% of deaths.
- Psychotherapeutic drugs contributed to almost 49% of deaths; 79% of those were benzodiazepines.
The authors also noted that risk for opioid abuse increased with lower education and living in the poorest counties of the state. They did not evaluate sources of opioids in this study but cited data from a 2008 regional report by the National Drug Intelligence Center indicating that sources of diversion largely involved illegal sales by healthcare professionals, employee theft, forged prescriptions, and Internet purchases.
Practice Pointers: In proper context, it must be considered that these data may point toward important trends of concern but are not representative of the entire U.S. The authors reaffirm the need for healthcare practitioners to counsel patients prescribed opioids on the risks of overdose for themselves and to caution against sharing drugs. Furthermore, clinicians are again reminded to follow pain management guidelines and to contact state prescription-drug monitoring programs to help identify patients who are seeing other practitioners for scheduled drugs.
References:
Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008(Dec 10);300(22):2613-2620.
National Drug Intelligence Center. Drug Market Analysis 2008: Appalachia High Intensity Drug Trafficking Area. Washington, DC: U.S. Dept of Justice; 2008. Report 2008-R0813-001.
