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PDF | Drug Overdose Deaths --- Florida, 2003--2009

Summary/Abstract

Centers Disease Control and Prevention Report on Florida Drug Overdose deaths between 2003-2009. Report Release July 2011.

Content

July 8, 2011 / 60(26);869-872 SEE ATTACHED PDF FOR STATISTICAL TABLES AND CHARTS In the United States in 2007, unintentional poisonings were the second leading cause of injury death (after motor-vehicle crashes) (1); approximately 93% of all unintentional poisoning deaths were caused by drug poisoning, also known as drug overdose (2). From 1990 to 2001 in Florida, the nonsuicidal poisoning death rate increased 325% (3). To characterize recent trends in drug overdose death rates in Florida, CDC analyzed data from the Florida Medical Examiners Commission. This report summarizes the results of that analysis, which found that, from 2003 to 2009, the number of annual deaths in which medical examiner testing showed lethal concentrations of one or more drugs increased 61.0%, from 1,804 to 2,905, and the death rate increased 47.5%, from 10.6 to 15.7 per 100,000 population. During 2003--2009, death rates increased for all substances except cocaine and heroin. The death rate for prescription drugs increased 84.2%, from 7.3 to 13.4 per 100,000 population. The greatest increase was observed in the death rate from oxycodone (264.6%), followed by alprazolam (233.8%) and methadone (79.2%). By 2009, the number of deaths involving prescription drugs was four times the number involving illicit drugs. These findings indicate the need to strengthen interventions aimed at reducing overdose deaths from prescription drugs in Florida. Medical examiner records are a timely, population-based source for data regarding overdose deaths from specific drugs. The data in this report and subsequent analyses can be used to design and measure the effectiveness of interventions. Florida has a system of regional state medical examiners whose jurisdiction includes all drug-related deaths. Drug overdose data were obtained for the period 2003--2009 from datasets of the Florida Medical Examiners Commission, which contain information on 34 types of drugs frequently abused, including ethanol (grain or beverage alcohol), prescription drugs, and illicit drugs (4). Drug-related deaths are divided into two categories: 1) drug-caused deaths, for which postmortem medical examiner toxicology testing determined that drugs were present in lethal amounts; and 2) drug-present deaths, for which drugs were found in nonlethal amounts. This analysis included only drug-caused deaths, referred to in this report as drug overdose deaths. Using U.S. Census resident population estimates, annual drug overdose death rates per 100,000 population were calculated for all drugs, prescription drugs, illicit drugs (including specifically heroin and cocaine), opioid analgesics (including specifically methadone, hydrocodone, oxycodone, and morphine), benzodiazepines (including specifically alprazolam), and ethanol. To test for the statistical significance of changes in death rates from 2003 to 2009, z-tests were conducted in categories with annual counts >100, and examination of overlapping confidence intervals from gamma distributions was used with counts <100. During 2003--2009, a total of 16,550 drug overdose deaths were recorded by Florida medical examiners. The annual number of deaths increased 61.0%, from 1,804 to 2,905, and the death rate increased 47.5%, from 10.6 to 15.7 per 100,000 population. In 2009, approximately eight drug overdose deaths occurred each day. During 2003--2009, 85.9% of drug overdose deaths were unintentional, 11.1% were suicides, 2.6% were of undetermined intent, and 0.4% were homicides or pending. Prescription medications were implicated in 76.1% of all drug overdose deaths, and illicit drugs were implicated in 33.9% of deaths; in 10.0% of deaths, both prescription and illicit drugs were found in lethal concentrations. In 85.5% of all drug overdose deaths, at least one of the seven specific drugs examined in this study was detected at a lethal concentration. Analysis of drug-specific death rates revealed different trends for different drugs during 2003--2009 (Table, Figure). The death rate for prescription drugs increased 84.2%, from 7.3 to 13.4 per 100,000 population from 2003 to 2009. The greatest increase in death rate was observed for the prescription drug oxycodone (264.6%), followed by alprazolam (233.8%), methadone (79.2%), hydrocodone (34.9%), and morphine (26.2%). Conversely, the death rate for heroin decreased 62.2% from 2003 to 2009, and the death rate for cocaine increased until 2007 and then decreased 39.1% from 2007 to 2009 (Table). In 2003, among the seven specific drugs examined, the highest death rate was for cocaine (3.2 per 100,000 population), followed by methadone (2.2), oxycodone (1.7), heroin (1.4), morphine and alprazolam (1.3), and hydrocodone (1.1). In 2009, the number of deaths involving prescription drugs was four times the number involving illicit drugs, and the highest death rate was for oxycodone (6.4 per 100,00 population), followed by alprazolam (4.4), methadone (3.9), cocaine (2.8), morphine (1.6), hydrocodone (1.4), and heroin (0.5) (Figure). Reported by Bruce Goldberger, PhD, W.R. Maples Center for Forensic Medicine, Univ of Florida College of Medicine. Jon Thogmartin, MD, State of Florida District Six Medical Examiner. Hal Johnson, MPH, Substance Abuse Program Office, Florida Dept of Children and Families. Leonard Paulozzi, MD, Rose Rudd, MSPH, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control; Aybaniz Ibrahimova, MD, EIS Officer, CDC. Corresponding contributor: Leonard Paulozzi, [email protected]. Editorial Note This report documents an increasing problem with fatal overdoses of prescription drugs, based on Florida medical examiner data, which are more timely and specific than national data available from death certificates. Recent national data indicate increasing numbers of deaths involving opioid analgesics and cocaine through 2006 (5). This report indicates a worsening problem in Florida with overdoses involving prescription drugs, especially oxycodone and alprazolam, and a recent sharp decline in cocaine-related deaths. Large national increases in rates of emergency department visits involving oxycodone and alprazolam occurred during 2004--2009 (6).