Characterizing drugs involved in opioid analgesic related poisoning deaths, United States 2004-2006

The number of deaths involving opioid analgesics is increasing. The objective of this paper is to examine the role of other drugs in opioid analgesic deaths.

Deaths among persons ages 15-64 years with an underlying external cause of poisoning were selected from the 2004-2005 (2006 when available) National Vital Statistics Multiple Cause-of-Death files. Drug substances were defined by ICD-10 record axis codes T36 to T50.9. Opioid analgesics include T40.2 (Other opioids), T40.3 (Methadone), or T40.4 (Other synthetic narcotics). Mean number and common combinations of drugs mentioned in poisonings deaths mentioning opioid analgesics were identified.

The mean number of drug substances mentioned in poisoning deaths with an opioid analgesic mentioned was 2.3 which is significantly higher than the mean mentions (1.7) in all poisoning deaths that involved drugs. Females had a higher mean number mentioned compared to males overall (2.4 compared to 2.2) and for all age groups. Of the poisoning deaths with an opioid analgesic mentioned, about 33% only mentioned an opioid analgesic and an additional 18% mentioned only an opioid analgesic and a non-specific substance. About 13% mentioned cocaine or heroin, 16% mentioned benzodiazepine and 3% mentioned both.

Characterizing drug combinations in deaths involving opioid analgesics provides essential information for prevention efforts. Benzodiazepines alone are not deadly but are present in nearly one fifth of deaths involving opioid analgesics. The presence of multiple drugs and specifically those involving illicit drugs such as heroin or cocaine, present specific challenges for prevention or intervention strategies.