Tags

Type your tag names separated by a space and hit enter

Patterns of abuse among unintentional pharmaceutical overdose fatalities.
JAMA. 2008 Dec 10; 300(22):2613-20.JAMA

Abstract

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.

Authors+Show Affiliations

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ajhall@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19066381

Citation

Hall, Aron J., et al. "Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities." JAMA, vol. 300, no. 22, 2008, pp. 2613-20.
Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613-20.
Hall, A. J., Logan, J. E., Toblin, R. L., Kaplan, J. A., Kraner, J. C., Bixler, D., Crosby, A. E., & Paulozzi, L. J. (2008). Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA, 300(22), 2613-20. https://doi.org/10.1001/jama.2008.802
Hall AJ, et al. Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities. JAMA. 2008 Dec 10;300(22):2613-20. PubMed PMID: 19066381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of abuse among unintentional pharmaceutical overdose fatalities. AU - Hall,Aron J, AU - Logan,Joseph E, AU - Toblin,Robin L, AU - Kaplan,James A, AU - Kraner,James C, AU - Bixler,Danae, AU - Crosby,Alex E, AU - Paulozzi,Leonard J, PY - 2008/12/11/pubmed PY - 2008/12/17/medline PY - 2008/12/11/entrez SP - 2613 EP - 20 JF - JAMA JO - JAMA VL - 300 IS - 22 N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/19066381/Patterns_of_abuse_among_unintentional_pharmaceutical_overdose_fatalities_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2008.802 DB - PRIME DP - Unbound Medicine ER -