Identification of Factors Associated with Prescription Opioid Overdose Death Through Next-of-Kin Interviews

Background: Prescription opioid deaths in Utah increased by >500% during 1999–2007. Knowledge is limited regarding associated factors. Understanding characteristics of prescription opioid decedents can guide prevention. Methods: During October 2008–August 2009, drug overdose decedents were identified from medical examiner records and next-of-kin interviewed. We focused on unintentional or intent-undetermined deaths where a prescription opioid, but not an illicit drug, was causally implicated. History of substance abuse, mental illness, and prescriptions were assessed. Substance abuse history was defined as ever using heroin, cocaine, hallucinogens, or methamphetamine, or ever receiving substance abuse treatment. Mental illness history was defined as having a chronic mental illness, diagnosis of mental illness by a provider, or nondrug-related psychiatric hospitalization. Results: Of 155 prescription opioid overdose decedents, 82 (53%) were female. Median age of females (46 years) was higher than males (32 years) (P<.0001). Substance abuse history was reported for 93 (60%) decedents, prior heroin use for 31 (20%), and mental illness history for 89 (57%). Overall, 124 (80%) reportedly had used their own prescribed pain medication during their last year. Use of prescribed pain medication during their last year was common for decedents with history of substance abuse (n=75; 81%), heroin use (n=22; 71%), and mental illness (n=70; 79%). Conclusions: The majority of prescription-opioid–overdose decedents in Utah had a history of substance abuse or mental illness. The majority used prescribed pain medication during their last year. Providers should use caution when prescribing opioids to patients with history of substance abuse or mental illness.