Open AccessPrescription Histories and Dose Strengths Associated with Overdose Deaths
Author(s) -
Hirsch Anne,
Proescholdbell Scott K.,
Bronson William,
Dasgupta Nabarun
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12391
Subject(s) - oxycodone , medicine , medical examiner , hydrocodone , drug overdose , medical prescription , population , emergency medicine , opioid overdose , opioid , methadone , anesthesia , poison control , injury prevention , (+) naloxone , pharmacology , environmental health , receptor
Objective Misuse, abuse, and diversion of prescription drugs are large and growing public health problems that have resulted in an overdose epidemic. We investigated whether short‐acting or extended‐release opioids were more frequently prescribed to those who died of an overdose and whether there was a linear relationship between dose strength and associated overdose deaths. Methods The study population was N orth C arolina residents in 2010. We conducted a retrospective, population‐based, descriptive study of medication histories of overdose decedents using data from vital statistics, medical examiner records, and a prescription drug monitoring program. Results Unintentional or undetermined drug overdoses were responsible for 892 deaths. Out of 191 deaths involving methadone, only two were patients in opioid treatment programs. Immediate‐release oxycodone was involved in the greatest number of opioid‐related deaths. Out of 221 oxycodone deaths, 134 (61%) of the decedents filled a prescription for oxycodone in the 60 days prior to death. The most common strength dispensed within 60 days to a decedent who died of an oxycodone overdose was 10 mg for immediate‐release (72 prescriptions). Immediate‐release oxycodone products (rho = 1.00, P < 0.01) and extended‐release fentanyl products (rho = 1.00, P < 0.01) showed strong increasing linear trends between dose strength and proportion of prescriptions dispensed to decedents. Conclusions A significant proportion of overdose decedents had been prescribed the same type of drugs that contributed to their death, especially for decedents who died from overdoses involving oxycodone, hydrocodone, and alprazolam. Higher dose strengths for certain opioids had higher associated mortality, and certain immediate‐release opioids may be considered for public health prevention efforts.