April 1st, 2010

Drug deaths top traffic fatalities in four New England states

When Centers for Disease Control researchers mined mortality data from the National Vital Statistics System, they found that drugs had outstripped automobile accidents as the leading cause of injury death in 16 states, include four in New England, plus the District of Columbia.

First noted in 2003 when eight states, including Massachusetts, had more injury deaths caused by drugs than cars, the trend has continued. In 2006, the states were Conn., Mass., N.H., R.I., Colo., Ill., Md., Mich., N.J., N.Y., Nev., Ohio, Ore., Penn., Utah and Wash.

While cocaine was the number one killer from 1999 to 2006, deaths attributed to opioid analgesics, prescription painkillers like OxyContin and Vicodin, more than tripled, from 4,000 to 13,800 nationwide, an alarming surge, CDC epidemiologists say.

Additional CDC findings laid out in a Sept. 2009 report: nearly 40 percent of all 2006 poisoning deaths were caused by opioids, up from 20 percent in 1999; half the 2006 deaths involving opioids were multi-drug caused; poisoning deaths involving methadone increased sevenfold; deaths involving opiods increased for every age group from 15 to 65-plus; the opioid death rate was highest for whites, males and those between 35 and 54.

“The misconception is that it’s down-and-out drug addicts or youngsters experimenting, but the brunt of these drug deaths are borne by people who should be in their most productive years,” says N.H. Chief Medical Examiner Thomas Andrew, M.D. “And the driver is prescription opiates for varying types of pain.”

CDC data doesn’t show how or why people were taking the drugs, but researchers are tracing death certificates back to medical records.

Andrew is way ahead of them. He has parsed state data up to the most recent full calendar year and they reflect national trends.

From 2004 to 2009, methadone was the leading agent in N.H. drug deaths. In second place, cocaine was supplanted by oxycodone in 2008. The majority of deaths were caused by a combination of agents, plus alcohol, which is involved in 30 to 40 percent of N.H.’s multi-drug deaths.

“Prescription opiates have comprised no less than four and up to seven of the top 10 agents involved in drug deaths,” Andrew says. “Rounding out top 10 are illicits like heroin and cocaine and some of the benzodiazepines [Valium].”

While raw numbers tell one story, population-adjusted data tell another. Maine and Vt., as well as Mass. and R.I., had opioid-related death rates in 2006 significantly higher than the U.S. rate, whereas N.H. did not.

“The populous counties in the southern part of the state generate the numbers, but per capita, the problem is in our rural counties where people don’t have ready access to practitioners who are skilled in the management of chronic pain,” Andrew says.

He says that psychologists must be aware of a patient’s complete drug profile – not just the medications a partner physician prescribed for, say, a mood disorder, but what might have been prescribed for physical ailments and the drugs’ potential interactions.

“Is this going to be the 55-year-old found dead at home, and we come along and find a benzo, an opiate, a sleeper and maybe an antidepressant on board?” Andrew says. “If so, it’s because Peter wasn’t talking to Paul.”

By Nan Shnitzler

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