Journal of General Internal Medicine

, Volume 28, Issue 4, pp 522–529 | Cite as

Unintentional Prescription Opioid-Related Overdose Deaths: Description of Decedents by Next of Kin or Best Contact, Utah, 2008–2009

  • Erin M. Johnson
  • William A. Lanier
  • Ray M. Merrill
  • Jacob Crook
  • Christina A. Porucznik
  • Robert T. Rolfs
  • Brian Sauer
Original Research

ABSTRACT

BACKGROUND

Little is known about the characteristics that may predispose an individual to being at risk for fatal overdose from prescription opioids.

OBJECTIVE

To identify characteristics related to unintentional prescription opioid overdose deaths in Utah.

DESIGN

Interviews were conducted (October 2008–October 2009) with a relative or friend most knowledgeable about the decedent’s life.

SUBJECTS

Analyses involved 254 decedents aged 18 or older, where cause of death included overdose on at least one prescription opioid.

KEY RESULTS

Decedents were more likely to be middle-aged, Caucasian, non-Hispanic/Latino, less educated, not married, or reside in rural areas than the general adult population in Utah. In the year prior to death, 87.4 % were prescribed prescription pain medication. Reported potential misuse prescription pain medication in the year prior to their death was high (e.g., taken more often than prescribed [52.9 %], obtained from more than one doctor during the previous year [31.6 %], and used for reasons other than treating pain [29.8 %, almost half of which “to get high”]). Compared with the general population, decedents were more likely to experience financial problems, unemployment, physical disability, mental illness (primarily depression), and to smoke cigarettes, drink alcohol, and use illicit drugs. The primary source of prescription pain medication was from a healthcare provider (91.8 %), but other sources (not mutually exclusive) included: for free from a friend or relative (24 %); from someone without their knowledge (18.2 %); purchase from a friend, relative, or acquaintance (16.4 %); and purchase from a dealer (not a pharmacy) (11.6 %).

CONCLUSIONS

The large majority of decedents were prescribed opioids for management of chronic pain and many exhibited behaviors indicative of prescribed medication misuse. Financial problems, unemployment, physical disability, depression, and substance use (including illegal drugs) were also common.

KEY WORDS

chronic pain illicit drug use mental illness opioids overdose overprescribed prescription pain medication 

Supplementary material

11606_2012_2225_MOESM1_ESM.docx (40 kb)
Online Appendix(DOCX 40 kb)

REFERENCES

  1. 1.
    Kuehn BM. Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA. 2007;297(3):249–51.PubMedCrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR. 2011;60(43):1487–92.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. CDC taking steps to combat opioid deaths. Available at: http://asam-365.ascendeventmedia.com/Highlight.aspx?id=4452&p=368. Accessed July 23, 2012.
  4. 4.
    Centers for Disease Control and Prevention. Prescription painkiller overdoses in the U.S. Available at: http://www.cdc.gov/Features/Vitalsigns/PainkillerOverdoses/. Accessed July 23, 2012.
  5. 5.
    Schonfeld L, King-Kallimanis BL, Duchene DM, et al. Screening and brief intervention for substance misuse among older adults: the Florida BRITE project. Am J Public Health. 2010;100(1):108–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107–12.PubMedCrossRefGoogle Scholar
  7. 7.
    White AG, Birnbaum HG, Schiller M, Tang J, Katz NP. Analytic models to identify patients at risk for prescription opioid abuse. Am J Manag Care. 2009;15(12):897–906.PubMedGoogle Scholar
  8. 8.
    Braden JB, Russo J, Fan MY, et al. Emergency department visits among recipients of chronic opioid therapy. Arch Intern Med. 2010;170(16):1425–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. Increase in poisoning deaths caused by non-illicit drugs—Utah, 1991–2003. MMWR. 2005;54(2):33–6.Google Scholar
  10. 10.
    Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Jamison RN, Butler SF, Budman SH, Edwards RR, Wasan AD. Gender differences in risk factors for aberrant prescription opioid use. J Pain. 2010;11(4):312–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Utah Health Code. Available at: http://le.utah.gov/code/TITLE26/htm/26_04_000700.htm. Accessed July 28, 2012.
  13. 13.
    U.S. Census Bureau. Available at: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t. Accessed July 30, 2012.
  14. 14.
    Centers for Disease Control and Prevention. Prevalence and Trends Data: All States 2009. Available at: http://apps.nccd.cdc.gov/BRFSS/page.asp?cat=OB&yr=2009&state=All#OB. Accessed July 30, 2012.
  15. 15.
    U.S. Census Bureau. Current Population Survey, 1960 to 2010 Annual Social and Economic Supplements. Available at: http://www.census.gov/hhes/www/poverty/data/incpovhlth/2009/pov09fig04.pdf. Accessed July 30, 2012.
  16. 16.
    DeNavas-Walt C, Proctor BD, Smith JC. U.S. Census Bureau, Current Population Reports, P60-238. Income, Poverty, and Health Insurance Coverage in the United States: 2009. Washington, DC: U.S. Government Printing Office; 2010.Google Scholar
  17. 17.
    National Center for Health Statistics. Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD. 2012. Table 54. Available at: http://www.cdc.gov/nchs/data/hus/hus11.pdf. Accessed July 24, 2012.
  18. 18.
    Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168–76.PubMedGoogle Scholar
  19. 19.
    Substance Abuse and Mental Health Services Administration. State Estimates of Substance Use and Mental Disorders from the 2008–2009 National Surveys on Drug Use and Health, NSDUH Series H-40, HHS Publication No. (SMA) 11-4641. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.Google Scholar
  20. 20.
    Substance Abuse & Mental Health Data Archive. For the National Survey on Drug Use and Health, 2009. Available at: http://www.icpsr.umich.edu/quicktables/quickconfig.do?29621-0001_du. Accessed July 24, 2012.
  21. 21.
    Reeves WC, Strine TW, Pratt LA, et al. Mental illness surveillance among adults in the United States. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm?s_cid=su6003a1_w. Accessed July 24, 2012.
  22. 22.
    Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617–27.PubMedCrossRefGoogle Scholar
  23. 23.
    Ives TJ, Chelminski PR, Hammett-Stabler CA, et al. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv Res. 2006;6:46.PubMedCrossRefGoogle Scholar
  24. 24.
    Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129(3):355–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Grattan A, Sullivan MD, Saunders KW, Campbell CI, Von Korff MR. Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse. Ann Fam Med. 2012;10(4):304–11.PubMedCrossRefGoogle Scholar
  26. 26.
    Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Seal KH, Shi Y, Cohen G, et al. Association of mental health disorders with prescription opioids and high-risk opioid use in US veterans of Iraq and Afghanistan. JAMA. 2012;307(9):940–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011;185(2):551–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring program and death rates from drug overdose. Pain Med. 2011;12(5):747–54.PubMedCrossRefGoogle Scholar
  30. 30.
    Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315–21.PubMedCrossRefGoogle Scholar
  31. 31.
    Edlund MJ, Martin BC, Fan MY, Devries A, Braden JB, Sullivan MD. Risks for opioid abuse and dependence among recipients of chronic opioid therapy: results from the TROUP study. Drug Alcohol Depend. 2010;112(1–2):90–8.PubMedCrossRefGoogle Scholar
  32. 32.
    McLellan AT, Turner BJ. Chronic noncancer pain management and opioid overdose: time to change prescribing practices. Ann Intern Med. 2010;152(2):123–4.PubMedGoogle Scholar
  33. 33.
    Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.PubMedGoogle Scholar
  34. 34.
    Toblin RL, Paulozzi LJ, Logan JE, Hall AJ, Kaplan JA. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J Clin Psychiatry. 2010;71(4):491–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Michna E, Ross EL, Hynes WL, et al. Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 2004;28(3):250–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Utah Department of Health, Center for Health Data Indicator-Based Information System for Public Health. Percentage of adults who reported current cigarette smoking by education, Utah adults aged 25 and older, 2009; 2011. Available at: http://ibis.health.utah.gov/indicator/view/CigSmokAdlt.Edu.html. Accessed 5 January, 2012.
  37. 37.
    Centers for Disease Control and Prevention. State-specific prevalance of cigarette smoking and smokeless tobacco use among adults—United States, 2009. MMWR. 2010;59(43):1400–6.Google Scholar
  38. 38.
    Wiesbeck GA, Kuhl HC, Yaldizli O, Wurst FM, WHO/ISBRA Study Group on Biological State and Trait Markers of Alcohol Use and Dependence. Tobacco smoking and depression—results from the WHO/ISBRA study. Neuropsychobiology. 2008;57(1–2):26–31.PubMedCrossRefGoogle Scholar
  39. 39.
    Von Korff M, Deyo RA. Potent opioids for chronic musculoskeletal pain: flying blind? Pain. 2004;109(3):207–9.CrossRefGoogle Scholar
  40. 40.
    Kidner CL, Mayer TG, Gatchel RJ. Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009;91(4):919–27.PubMedCrossRefGoogle Scholar
  41. 41.
    Volinn E, Fargo JD, Fine PG. Opioid therapy for nonspecific low back pain and the outcome of chronic work loss. Pain. 2009;142(3):194–201.PubMedCrossRefGoogle Scholar
  42. 42.
    Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain. 2001;89(2–3):127–34.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Erin M. Johnson
    • 1
  • William A. Lanier
    • 2
  • Ray M. Merrill
    • 3
  • Jacob Crook
    • 4
  • Christina A. Porucznik
    • 5
  • Robert T. Rolfs
    • 1
  • Brian Sauer
    • 6
  1. 1.Utah Department of Health, Prescription Pain Medication ProgramSalt Lake CityUSA
  2. 2.Epidemic Intelligence Service, Centers for Disease Control and PreventionAtlantaUSA
  3. 3.Department of Health ScienceBrigham Young UniversityProvoUSA
  4. 4.Utah Department of Health, Communicable Disease Epidemiology ProgramSalt Lake CityUSA
  5. 5.Department of Family and Preventive Medicine, Division of Public HealthUniversity of Utah School of MedicineSalt Lake CityUSA
  6. 6.IDEAS Center, George E. Wahlen Department of Veterans Affairs Medical CenterSalt Lake CityUSA

Personalised recommendations