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Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

ABSTRACT: Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates.Reported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities.Adjusted involvement rates of opioid analgesic mentions in 2012 were 54.3 % (95 % confidence interval [CI]: 53.6 %-55 %), 40.8 % higher than the reported 38.6 % rate. Adjusted rates for all narcotics, other narcotics, sedatives, or psychotropics, and multiple drug use were 81.5 % (95 % CI: 80.9 %-82.2 %), 38.4 % (95 % CI: 37.8 %-39 %), 30 % (95 % CI: 29.4 %-30.7 %), 26 % (95 % CI: 25.4 %-26.6 %) and 42.8 % (95 % CI: 42.1 %-43.5 %) in 2012, compared to reported proportions of 60.7, 27.9, 18.7, 18 and 26.9 %. The adjustments typically had similar or slightly smaller effects on the estimates in 1999, and larger impacts on subcategories of drug types such benzodiazepines and antipsychotic medications. Based on the adjusted proportions, 22,534, 15,933, 12,457, 10,798, and 17,670 drug deaths in 2012 were estimated to involve opioid analgesics, other narcotics, sedatives, psychotropic medications, and drug combinations, compared to death certificate reports of 16,007, 11,567, 7,754, 7,467, and 11,176.Death certificates substantially understate the involvement of opioid analgesics, sedatives, psychotropics, and drug combinations in fatal drug poisonings. Adjustment procedures that account for cases where only unspecified drugs are reported on death certificates provide more accurate information.

SUBMITTER: Ruhm CJ

PROVIDER: S-EPMC4714527 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

Ruhm Christopher J CJ

Population health metrics 20160115

<h4>Background</h4>Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates.<h4>Methods</h4>Reported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities.<h4>Resul ...[more]

PMID: 26778921

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Project description:It is important to document patterns of prescription drug use to inform both clinical practice and research.To evaluate trends in prescription drug use among adults living in the United States.Temporal trends in prescription drug use were evaluated using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Participants included 37,959 noninstitutionalized US adults, aged 20 years and older. Seven NHANES cycles were included (1999-2000 to 2011-2012), and the sample size per cycle ranged from 4861 to 6212.Calendar year, as represented by continuous NHANES cycle.Within each NHANES cycle, use of prescription drugs in the prior 30 days was assessed overall and by drug class. Temporal trends across cycles were evaluated. Analyses were weighted to represent the US adult population.Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% [95% CI, 3.8%-12%]; P for trend <.001). The prevalence of polypharmacy (use of ?5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% [95% CI, 4.4%-8.2%]; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants.In this nationally representative survey, significant increases in overall prescription drug use and polypharmacy were observed. These increases persisted after accounting for changes in the age distribution of the population. The prevalence of prescription drug use increased in the majority of, but not all, drug classes.

Project description:Importance:The use of benzodiazepines or alcohol together with opioids increases overdose risk, but characterization of co-involvement by predominant opioid subtype is incomplete to date. Understanding the use of respiratory depressants in opioid overdose deaths (OODs) is important for prevention efforts and policy making. Objective:To assess the prevalence and number of alcohol- or benzodiazepine-involved OODs by opioid subtypes in the United States from 1999 to 2017. Design and Setting:This repeated cross-sectional analysis used data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database of all opioid-involved poisoning deaths from January 1, 1999, to December 31, 2017, for the United States. State-level binge drinking prevalence rates for 2015 to 2017 were obtained from the Behavior Risk Factor Surveillance System of the Centers for Disease Control and Prevention, and benzodiazepine prescribing rates for 2012 (most recent available data) were obtained from IMS Health, a commercial database. Data were analyzed from July 10, 2018, to May 16, 2019. Main Outcomes and Measures:Prevalence of alcohol or benzodiazepine co-involvement for all OODs and by opioid subtype, nationally and by state. Results:From 1999 to 2017, 399 230 poisoning deaths involved opioids, of which 263 601 (66.0%) were male, and 204 560 (51.2%) were aged 35 to 54 years. Alcohol co-involvement for all opioid overdose deaths increased nonlinearly from 12.4% in 1999 to 14.7% in 2017. By opioid subtype, deaths involving heroin and synthetic opioids (eg, fentanyl; excluding methadone) had the highest alcohol co-involvement at 15.5% and 14.9%, respectively, in 2017. Benzodiazepine co-involvement in all OODs increased nonlinearly from 8.7% in 1999 to 21.0% in 2017. Benzodiazepines were present in 33.1% of prescription OODs and 17.1% of synthetic OODs in 2017. State-level rates of binge drinking were significantly correlated with alcohol co-involvement in all OODs (r = 0.34; P = .02). State benzodiazepine prescribing rates were significantly correlated with benzodiazepine co-involvement in all OODs (r = 0.57; P < .001). Conclusions and Relevance:This study found that alcohol and benzodiazepine co-involvement in opioid-involved overdose deaths was common, varied by opioid subtype, and was associated with state-level binge drinking and benzodiazepine prescribing rates. These results may inform state policy initiatives in harm reduction and overdose prevention efforts.

Dataset Information

Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

Publications

Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

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