National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999–2009

Abstract

Background: Pharmaceutical opioid related deaths have increased. This study aimed to place pharmaceutical opioid overdose deaths within the context of heroin, cocaine, psychostimulants, and pharmaceutical sedative hypnotics, examine demographic trends, and describe common combinations of substances involved in opioid related deaths. Methods: We reviewed deaths among 15-64 year olds in the US from 1999-2009 using death certificate data available through the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Database. We identified International Classification of Disease-10 codes describing accidental overdose deaths, including poisonings related to stimulants, pharmaceutical drugs, and heroin. We used crude and age adjusted death rates (deaths/100,000 person years [p-y] and 95% confidence interval [CI] and multivariable Poisson regression models, yielding incident rate ratios (IRRs), for analysis. Results: The age adjusted death rate related to pharmaceutical opioids increased almost 4-fold from 1999 to 2009 (1.54/100,000 p-y [95% CI 1.49-1.60] to 6.05/100,000 p-y [95% CI 5.95-6.16; p<0.001). From 1999 to 2009, pharmaceutical opioids were responsible for the highest relative increase in overdose death rates (IRR 4.22, 95% CI 3.03-5.87) followed by sedative hypnotics (IRR 3.53, 95% CI 2.11-5.90). Heroin related overdose death rates increased from 2007 to 2009 (1.05/100,000 persons [95% CI 1.00-1.09] to 1.43/100,000 persons [95% CI 1.38-1.48; p<0.001). From 2005-2009 the combination of pharmaceutical opioids and benzodiazepines was the most common cause of polysubstance overdose deaths (1.27/100,000 p-y (95% CI 1.25-1.30). Conclusion: Strategies, such as wider implementation of naloxone, expanded access to treatment, and development of new interventions are needed to curb the pharmaceutical opioid overdose epidemic.

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…[1][2][3][4][5][6][7][8][9][10][11] Greater opioid prescribing contributed to increased opioid availability for abuse and overdose. [12][13][14] Primary care physicians (PCPs) and internists prescribe the majority of opioids.…”

A Prospective Randomized Study Analyzing Preoperative Opioid Counseling in Pain Management After Carpal Tunnel Release Surgery

“…[1][2][3][4][5] Between the years 1999-2010, rates of opioid sales, deaths, and treatment admission have each more than tripled. 1 In the same period of time, overdose deaths from pharmaceutical opioids represented the highest relative increase of overdose death rates among all drug types in the United States, with a nearly 4-fold increase.…”

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders

“…19 Calcaterra and colleagues reported that opioids plus benzodiazepines were the most common cause of polysubstance overdose deaths in a national study from 1999 to 2009, and increased the risk of drug overdose associated with opioids. 1 In our cohort, benzodiazepines significantly increased the risk of overdose but did not disproportionately affect persons with mental health disorders. However, we did find that the odds of overdose progressively rose with longer duration of benzodiazepine therapy.…”

“…1 Of the more than 22,000 unintentional pharmaceutical overdose deaths nationally in 2010, three-quarters involved opioid analgesics, while benzodiazepines were identified in one-quarter and antidepressants in nearly 20 %. 2 Concurrent use of these drugs appears to carry an even higher risk.…”

“…The combination of prescribed opioids and benzodiazepines is the most common cause of polysubstance overdose deaths nationally. 1 Persons with mental health disorders are more likely to be treated for chronic pain with high-dose opioid therapy that has also been associated with more coprescribed sedative-hypnotic therapy. 3 However, we are unaware of studies examining the risk of drug overdose for complex interrelationships of multiple drugs commonly used by persons with chronic pain and comorbid mental health disorders.…”