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Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review.
J Clin Psychiatry. 2010 Apr; 71(4):491-6.JC

Abstract

OBJECTIVE

Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes.

METHOD

In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program.

RESULTS

Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug.

CONCLUSIONS

Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.

Authors+Show Affiliations

Office of Research and Evaluation, Federal Bureau of Prisons, 320 First St. N.W., Washington, D.C. 20534. rtoblin@bop.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20409446

Citation

Toblin, Robin L., et al. "Mental Illness and Psychotropic Drug Use Among Prescription Drug Overdose Deaths: a Medical Examiner Chart Review." The Journal of Clinical Psychiatry, vol. 71, no. 4, 2010, pp. 491-6.
Toblin RL, Paulozzi LJ, Logan JE, et al. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J Clin Psychiatry. 2010;71(4):491-6.
Toblin, R. L., Paulozzi, L. J., Logan, J. E., Hall, A. J., & Kaplan, J. A. (2010). Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. The Journal of Clinical Psychiatry, 71(4), 491-6. https://doi.org/10.4088/JCP.09m05567blu
Toblin RL, et al. Mental Illness and Psychotropic Drug Use Among Prescription Drug Overdose Deaths: a Medical Examiner Chart Review. J Clin Psychiatry. 2010;71(4):491-6. PubMed PMID: 20409446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. AU - Toblin,Robin L, AU - Paulozzi,Leonard J, AU - Logan,Joseph E, AU - Hall,Aron J, AU - Kaplan,James A, PY - 2009/07/28/received PY - 2009/10/05/accepted PY - 2010/4/23/entrez PY - 2010/4/23/pubmed PY - 2010/5/1/medline SP - 491 EP - 6 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 71 IS - 4 N2 - OBJECTIVE: Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes. METHOD: In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program. RESULTS: Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug. CONCLUSIONS: Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/20409446/Mental_illness_and_psychotropic_drug_use_among_prescription_drug_overdose_deaths:_a_medical_examiner_chart_review_ L2 - http://www.psychiatrist.com/jcp/article/pages/2010/v71n04/v71n0414.aspx DB - PRIME DP - Unbound Medicine ER -