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The Epidemiology of Fatal Drug Overdoses: Potential for Prevention

Len Paulozzi, MD, MPHNational Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Presented at “Promising Legal Responses to the Epidemic of Prescription Drug Overdoses in the United States,

December 2, 2008

Epidemics of unintentional drug overdose deaths in the U.S., 1970-2006*

0123456789

10

'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06

Year

Cru

de ra

te p

er 1

00,0

00

HeroinCrack cocaine

Prescription drugs

*2006 rate is estimated.

Numbers of drug-induced deaths, U.S., 2005

Cause of Death Manner of Death

No. of Deaths

Poisoning Unintentional 22,448Poisoning Suicide 4,240Poisoning Homicide 57Poisoning Undetermined 3,068Adverse effects NA 337Mental and behavioral disorders

NA 1,080

All other NA 2,311Total All 33,541

Unintentional drug overdose deathsby major type of drug, U.S., 1999-2005

opioid analgesic cocaine heroin

90008000

sh 7000

eat

6000

df 5000

er o 4000

mb 3000

Nu 20001000

0'99 '00 '01 '02 '03 '04 '05

TM

Distribution of first-listed specified drugs among unintentional drug overdose deaths,

U.S., 2005

Unspecified narcotic, 10.6%

Other illicit, 6.5%

Cocaine, 25.1%

Prescription opioids, 38.2%

Heroin, 7.7%

Other RX/OTC, 11.9%

0%

20%

40%

60%

80%RX/OTC Drugs, 50.1%

Illicit Drugs, 39.3%

100%

Unintentional drug overdose death rates and total sales of opioid analgesics in morphine

equivalents by year in the U.S.

012345678

'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '060100200300400500600700800

Deaths/100,000 Opioid sales (mg/person)

Unintentional drug overdose death rates in the U.S. in 2005 and opioid analgesic prescription rates in one

state in 2002, men only

0

5

10

15

20

25

<1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Deat

hs /

100,

000

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Pres

crip

tions

/ Pe

rson

Mortality Prescriptions

Age Group

Characteristics of people dying from prescription drug overdose that suggest drug

misuse/abuse, based on medical examiner studies

Large majorities have a history of substance abuse

Half or more lack prescriptions for their drugs Substantial minorities:

– Die of street drugs combined with prescription drugs

– Inject, snort or otherwise manipulate the drugs to enhance the “high.”

– Have a history of previous overdoses

Unintentional and undetermined intent drug overdose death rates by degree of

urbanization, U.S., 1999-2005

02468

10

LargeCentralMetro

LargeFringeMetro

MediumMetro

SmallMetro

Micro-politan(Non-metro)

NonCore(Non-metro)

Type of County

'99 '00 '01 '02 '03 '04 '05

Unintentional and undetermined intent drug overdose death rates by state, 2005

1.0-7.4 7.5-9.9 10.0-17.5

Rate per 100,000

7.4

7.2

4.2

3.3

7.5

3.6

1.0

3.7

4.1

8.0

6.4

7.8

7.0

8.5

13.9

3.9

17.5

5.7

7.3

9.7

11.8

7.1

6.110.014.0

HI8.6

7.6

16.9

8.8

9.2

7.8

12.8

11.9

9.6

10.8

11.8

10.9

11.6

8.8

14.9

9.9

NH 9.1VT 5.6MA 10.6RI 12.7CT 7.7NJ 8.4DE 6.4MD 10.4DC 12.3

8.3

Unintentional and undetermined intent drug overdose death rates for New York State and its neighbors, 3 time periods

0

2

4

6

8

10

CT MA NJ NY PA VT

Rat

e pe

r 100

,000

'79-'85 '89-'95 '99-'05

Oxycodone sales (mg/pin ersomnil)l ibgry 3am-digs perit zip co capide, UtSa , 2006by 3-digit zip, 2006

Source: DEA ARCOS and ESRI. Photo credit: Alex Richards, Las Vegas Sun, July 6, 2008

Unintentional and undetermined intent drug overdose death rates per 100,000 by county, New York State and

its neighbors, 1979-1985

Median rate 0.88/100,000

Unintentional and undetermined intent drug overdose death rates per 100,000 by county, New York State and

its neighbors, 1989-1995

Median rate 1.70/100,000

TM

Unintentional and undetermined intent drug overdose death rates per 100,000 by county, New York State

and its neighbors, 1999-2005

Median rate 5.07/100,000

Conclusions: Geographic Analysis

Manyfold variations exist in drug overdose mortality and prescribing rates by state

To some extent, prescribing patterns match mortality patterns

Both prescribing and mortality patterns follow state boundaries in some cases

These results suggest that state-level policies related to prescription drugs have the potential to reduce the risk of overdose.

Legal measures that states have available to address the prescription

drug problemSelected Measures Prescription

DrugsStreet Drugs

Licensure of sources √

Special prescription forms √

Tracking prescriber and dispenser behavior

√

Tracking user behavior √

Rehabilitating offenders √ √

Regulating drug disposal √

TM

Thank you

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the

Centers for Disease Control and Prevention.