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Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances.
Drug Alcohol Depend. 2017 09 01; 178:501-511.DA

Abstract

BACKGROUND

Prescription opioid (PO) overdose deaths increased sharply over the last decade. Changes in PO deaths in combination with other psychoactive substances may provide a partial explanation.

METHODS

PO deaths from the National Multiple-Cause-of-Death Files for 2002-03 (N=15,973) and 2014-15 (N=41,491) were analyzed. We calculated (1) changes in proportions of deaths in combination with benzodiazepines, antidepressants, heroin, alcohol, cocaine between the two periods, and (2) proportions of increase in deaths attributable to each substance among PO and synthetic opioids other than methadone (SO-M) deaths, by age, gender, race/ethnicity.

RESULTS

Between 2002-03 and 2014-15, PO deaths increased 2.6 times; SO-M deaths 5.6 times, especially for ages 18-34, males, African-Americans. For PO deaths, most frequent combinations at both periods were with benzodiazepines; for SO-M, benzodiazepines, antidepressants in 2002-03, heroin, benzodiazepines in 2014-15. The largest increases occurred in combination with heroin among all PO (4.6% to 15.4%, change ratio=3.3[95%CI=3.1-3.6]), but especially SO-M deaths (1.2% to 24.5%, change ratio=21.3[95%CI=15.0-30.3]). Deaths involving cocaine decreased among PO, increased among SO-M deaths. One-fifth of increased PO or SO-M deaths were attributable to any of the five substances. Increased PO deaths were equally attributable to benzodiazepines and heroin; deaths attributable to heroin were higher among ages 18-49, males, and non-Hispanic whites. Increased SO-M deaths were attributable mostly to heroin among all groups.

CONCLUSIONS

Increased PO overdose deaths over the last decade may be partially explained by increased deaths in combination with other psychoactive substances. Use of other substances should be considered in efforts toward reducing prescription opioid overdoses.

Authors+Show Affiliations

Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. Electronic address: dbk2@cumc.columbia.edu.Department of Psychiatry, Columbia University, New York, NY 10032, USA.Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA.Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28719884

Citation

Kandel, Denise B., et al. "Increases From 2002 to 2015 in Prescription Opioid Overdose Deaths in Combination With Other Substances." Drug and Alcohol Dependence, vol. 178, 2017, pp. 501-511.
Kandel DB, Hu MC, Griesler P, et al. Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances. Drug Alcohol Depend. 2017;178:501-511.
Kandel, D. B., Hu, M. C., Griesler, P., & Wall, M. (2017). Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances. Drug and Alcohol Dependence, 178, 501-511. https://doi.org/10.1016/j.drugalcdep.2017.05.047
Kandel DB, et al. Increases From 2002 to 2015 in Prescription Opioid Overdose Deaths in Combination With Other Substances. Drug Alcohol Depend. 2017 09 1;178:501-511. PubMed PMID: 28719884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances. AU - Kandel,Denise B, AU - Hu,Mei-Chen, AU - Griesler,Pamela, AU - Wall,Melanie, Y1 - 2017/07/04/ PY - 2017/04/13/received PY - 2017/05/26/revised PY - 2017/05/27/accepted PY - 2017/7/19/pubmed PY - 2018/4/4/medline PY - 2017/7/19/entrez KW - Benzodiazepines KW - Heroin KW - Overdose deaths KW - Prescription opioids KW - Synthetic opioids other than methadone SP - 501 EP - 511 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 178 N2 - BACKGROUND: Prescription opioid (PO) overdose deaths increased sharply over the last decade. Changes in PO deaths in combination with other psychoactive substances may provide a partial explanation. METHODS: PO deaths from the National Multiple-Cause-of-Death Files for 2002-03 (N=15,973) and 2014-15 (N=41,491) were analyzed. We calculated (1) changes in proportions of deaths in combination with benzodiazepines, antidepressants, heroin, alcohol, cocaine between the two periods, and (2) proportions of increase in deaths attributable to each substance among PO and synthetic opioids other than methadone (SO-M) deaths, by age, gender, race/ethnicity. RESULTS: Between 2002-03 and 2014-15, PO deaths increased 2.6 times; SO-M deaths 5.6 times, especially for ages 18-34, males, African-Americans. For PO deaths, most frequent combinations at both periods were with benzodiazepines; for SO-M, benzodiazepines, antidepressants in 2002-03, heroin, benzodiazepines in 2014-15. The largest increases occurred in combination with heroin among all PO (4.6% to 15.4%, change ratio=3.3[95%CI=3.1-3.6]), but especially SO-M deaths (1.2% to 24.5%, change ratio=21.3[95%CI=15.0-30.3]). Deaths involving cocaine decreased among PO, increased among SO-M deaths. One-fifth of increased PO or SO-M deaths were attributable to any of the five substances. Increased PO deaths were equally attributable to benzodiazepines and heroin; deaths attributable to heroin were higher among ages 18-49, males, and non-Hispanic whites. Increased SO-M deaths were attributable mostly to heroin among all groups. CONCLUSIONS: Increased PO overdose deaths over the last decade may be partially explained by increased deaths in combination with other psychoactive substances. Use of other substances should be considered in efforts toward reducing prescription opioid overdoses. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/28719884/Increases_from_2002_to_2015_in_prescription_opioid_overdose_deaths_in_combination_with_other_substances_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(17)30326-5 DB - PRIME DP - Unbound Medicine ER -