Unintentional drug poisoning deaths in New York City (NYC), opioid analgesic and heroin trends, 2000–2012

Background: Recent increases in the annual number of persons in the United States who used heroin for the first time have raised concerns about transitioning from opioid analgesics to heroin.

Methods: We linked death certificates and files from the Office of the Chief Medical Examiner to conduct a retrospective review of unintentional opioid poisonings in NYC 2000-2012. Joinpoint regression modeling was used to measure annual percent change in mortality rates and to detect significant linear trends between years.

Results: During 2000­–2012, there were 9,085 unintentional drug overdose deaths in NYC. Seven in ten deaths involved an opioid; of those, 50% involved heroin and 18% involved an opioid analgesic; 7% involved both heroin and opioid analgesics. The rate of unintentional drug overdose deaths increased from 2000–2006 and 2010–2012 by 2.4% (p=0.08) and 17.4% (p=0.11) respectively; the rate decreased annually by 11% from 2006­–2010 (p=0.02). The rate for deaths involving opioids showed similar trends from 2000–2012, with notable decreases from 2006­–2010, 9.9% annually, (p<0.05). From 2000–2012 the rate for deaths involving opioid analgesics (without heroin) increased annually by 10% (p<0.05). In contrast, rates for deaths involving heroin (without opioid analgesics) decreased annually by 5.3% (p<0.05) from 2000–2012.

Conclusions: Despite decreases in heroin-associated mortality from 2000-2012, rates of opioid analgesic involved deaths steadily trended upwards. Ongoing surveillance and analysis of trends by demographic and geographic characteristics can inform public health initiatives that can prevent overdose death.