Drug Overdose DeathsThe Allegheny County and National Experience“Addressing the Problem”May 2 2008 Dr. Karl Williams, MD,MPH Medical Examiner
Methodology • Mortality counts are based on death certificate information only. • Coroners and medical examiners determine person’s intent and drug(s) responsible. • “Unintentional” poisoning deaths include “accidental” ingestion, overmedication, and overdoses of drugs used nonmedically (“drug overdoses”). • Suicides and deaths of undetermined intent are not included.
Unintentional Drug Poisoning Mortality Rates, US, 1970-2004 ? Crack cocaine Heroin
Unintentional Deaths From “Narcotics” And “Other/Unspecified Drugs” By Type Of Opioid Analgesic, US, 1999-2004
Unintentional Drug Poisoning Mortality Rates and Total Sales of Opioid Analgesics (Morphine Equivalents)
Trend by Causes of Death 252 155 96 71
OD Deaths: 1998-2006 2001 252 104
OD Deaths by the Number of Drugs: 2006 One Drug: 97 Two Drugs: 63 Three Drugs: 47 Four Drugs: 27 Five Drugs: 11 Over Five Drugs: 7
Top Five OD by One Drug Cocaine 43 Heroin 12 Methadone 11 Alcohol 8 Fentanyl 8 Oxycodone 5
Top Five OD by Two Drugs Cocaine + Methadone 13 Cocaine + Heroin 6 Alcohol + Methadone 5 Alcohol + Heroin 4 Cocaine + Morphine 4 Cocaine + Fentanyl 4
Top Four OD by Three Drugs Heroin + Cocaine + Fentanyl 3 Cocaine + Morphine + Oxycodone 2 Cocaine + Heroin +Alcohol 2 Heroin + Cocaine + Codeine 2
National:Characteristics of Heroin Users • Users: • In 1996, estimates 2.4 million people • New Users are under the age 26
National:Characteristics of Heroin Users Sex: 67% Male 22% 12-17 y/o 21% 35+ y/o Race: 69% White 21% Black 9% Hispanic Education: 41% < H.S. 15% College Student
Lessons Learned • Regulated prescription drugs taken mostly by mouth can produce a larger overdose epidemic than illicit drugs of uncertain strength taken intravenously, such as heroin. • Just as a drug that is efficacious in clinical trials may not be effective in the community, drugs “safe” in terms of abuse in controlled settings may be abused in the community.
Epidemiology of opioid use versus opioid abuse • Males are more likely to abuse and overdose with opioids; females are more likely to use. • People in 20s and 40s are more likely to abuse opioids; people over 65 are more likely to use. • Many people dying of prescription overdoses have a history of substance abuse. • Overdoses are therefore more likely to represent abuse than overmedication.
Overdose Deaths are Increasing • Overdose and death due to overdose affects all races and age groups. • Prescription drugs are prominent in overdose deaths. • Polysubstance use increases the risk of overdose. • Many substances involved with overdoses and overdose deaths would respond to naloxone. • Poor health increases the risk of overdose. • Stigma and fear of legal consequences associated with drug use contributes to overdose deaths.