Fact Sheet

Analysis of Controlled Substances Database (CSDB) Combined with Medical Examiner and Death Certificate Data in Utah from1999-2004

  • Total number of drug poisoning deaths: 1,920
  • Total number of non-illicit drug poisoning deaths judged to be of accidental or unknown intent: 734
  • % of opioid deaths with valid opioid prescription within 30 days of death: 47%
  • Average age of decedent: 38.8 years old
  • Higher proportion of non-urban decedents with unknown intent had evidence of a valid prescription than urban decedents of unknown intent
Number of Poisoning Deaths Caused by Prescribable Opioids (with No Illicit Drugs Involved) by Year
1999 39
2000 57
2001 84
2002 119
2003 145
2004 171
2005 265
2006 276
2007 261
Number of Poisoning Deaths Involving Prescribable Opioids (with No Illicit Drugs )
  Year
Month 2005 2006 2007
January 17 22 27
February 29 16 15
March 21 25 20
April 31 33 20
May 14 24 20
June 12 23 28
July 26 17 17
August 16 20 14
September 29 20 26
October 32 24 27
November 22 26 25
December 16 26 22
Background Information

Unintentional fatalities due to prescription medications are an increasing problem in United States and Utah. Over the past few years, the Utah Medical Examiner noted an increase in the number of deaths occurring due to overdose of prescription opioid medications that are typically used for pain management.  Epidemiologic studies of data collected by the Office of the Medical Examiner, as well as from emergency department encounters and controlled substances dispensing confirmed the increases and uncovered an alarming problem.
 
During the years 1997–2004 deaths attributed to poisoning by drugs increased 128% in Utah from 174 to 397.  Deaths of Utah residents from non-illicit drug poisoning (unintentional or intent not determined) have increased from about 50 deaths per year in 1999 to over 250 in 2006.  The increase was mostly due to the higher number of deaths from prescription opiate pain medications, including methadone, oxycodone, hydrocodone, and fentanyl. 

Methadone was the most common drug identified by the Utah medical examiner as causing or contributing to accidental deaths, accounting for a disproportionate number of deaths compared to its frequency of use.  Methadone was the single drug most often associated with overdose death and had the highest prescription adjusted mortality rate (PAMR) with an average of 150 deaths for every 100,000 prescriptions during the study period (range: 89 deaths/100,000 prescriptions in 1998 to 224 deaths/100,000 prescriptions in 2004). From 1997–2004, population-adjusted methadone prescriptions increased 727%.  The rise in the methadone prescription rate was for treatment of pain and not addiction therapy. 

The numbers of prescriptions for four of the primary drugs of concern with respect to fatal drug overdose have increased at a greater rate than the growth of the Utah population.  The population-adjusted relative increase in prescribing for methadone and fentanyl exceeded 700% while oxycodone nearly tripled.

For the years 1999–2003, unintentional deaths due to prescription medications were the fourth-leading cause of death in 25–54 year olds in Utah.  Notably, while deaths of unintentional or undetermined intent caused by prescribable narcotics nearly tripled, cases of self-inflicted harm from narcotics remained stable from 1991–2003.

In 2006, methadone was implicated in 30% of non-illicit drug-related deaths, oxycodone in 21%, hydrocodone in 18%, and fentanyl in 9% of non-illicit drug-related deaths.  The average age at death for deaths due to overdose of non-illicit drugs was 42 years old, with the ages ranging from 16 to 80 years old. Rates of death were slightly higher for males (51.3%) than females. At least one death occurred in 24 out of the 29 counties in Utah, suggesting that the problem spans both the urban and rural population.

Research combining Medical Examiner’s data and data from the CSDB from 1997-2004 found that 50% of individuals who died of an overdose of methadone had a valid prescription at the time of death. This is informative in showing that there are two distinct populations: individuals with a valid prescription and individuals who found prescription opioids from some other source.  To prevent future deaths of individuals with a valid prescription, the approach may be teaching proper use and warning against deviating from the directions given by their doctors, whereas to prevent deaths of individuals who are getting prescription drug from other sources, the approach may be to decrease availability of these drugs (for example, by educating others to lock up or dispose of their leftover medication). 

A national report found that among young adults aged 18 to 25 who used prescription pain relievers non-medically in the past year, over half (53.0 percent) reported that they obtained the medication from a friend or relative for free. (National Survey on Drug Use and Health, 2006, retrieved on October 14, 2007 from http://www.oas.samhsa.gov/2k6/getPain/getPain.htm)

Recreational use of prescription drugs is increasing.  In 2003, approximately 15 million Americans reported using a prescription drug for non-medical reasons at least once during the year. Approximately 6.3 million Americans reported current non-medical use of prescription drugs. (Office of Applied Studies, Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2004)

Abuse of prescription pain killers in the last year now ranks second, following marijuana, as the nation's most prevalent illegal drug problem. Even more foreboding is the fact that the number of new abusers of prescription drugs is equal to the number of new abusers of marijuana. Much of this abuse appears to be fueled by the relative ease of access to prescription drugs. Approximately 60 percent of people who abuse prescription pain killers indicate that they got their prescription drugs from a friend or relative for free. (Office of National Drug Control Policy, 2007, retrieved on October 17, 2007 from http://www.whitehousedrugpolicy.gov/news/press07/022007.html)

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