Deaths from Prescription Opiates among Older Adults in Los Angeles County, 2000-2004

Concerns about prescription opiate misuse among older adults in the U.S. highlight the importance of monitoring mortality trends related to these medications. Using standardized case definitions to distinguished between different drug classes and death certificates matched to the Coroner's records, we conducted a retrospective case review of all cases of unintentional and intentional poisonings in Los Angeles County (n = 510) from 2000 to 2004. We examined the prevalence and characteristics of, and methods for identifying fatal poisonings caused by prescription opiates in adults aged 55 and older. Cases were compared by socio-demographics, co-morbid health conditions, circumstances surrounding the fatal incident, and toxicology data. Of the 510 cases, 13% were caused by prescription opiates, 24% by heroin, 13% by cocaine, 4% by alcohol, 1% by amphetamines, 32% by other prescription medications, and 13% by poisonings such as carbon monoxide. Although prescription opiates did not account for the greatest number of deaths in our study sample, the age-adjusted mortality rates for this drug class demonstrated an increase of 168% from 0.42 per 100,000 residents in 2000 to 1.12 per 100,000 residents in 2004. This represents a substantial increase compared to age-adjusted death rates for other drug classes. We conclude that deaths due to prescription opiates is rising among older adults and that the use of multiple data sources and a standardized protocol for describing drug-related mortality is a potentially underutilized method for monitoring prescription opiate-related deaths in the aging population, as these data are generally not available from vital statistics alone.