Guest blogger – Len Paulozzi, MD, MPH
Heath Ledger. Anna Nicole Smith. I’m sure you saw the news stories when these celebrities died unexpectedly. Did you also hear about Shannon Anderson? Or Derek Barnes? Probably not. Yet they—and thousands more—share a significant connection to the celebrities. They all died of unintentional drug poisoning.
Unintentional drug poisoning includes drug overdoses resulting from drug misuse, drug abuse, and taking too much of a drug for medical reasons. While we may associate these overdose deaths with celebrities, this public health concern is not a distant “Hollywood” problem. More than ever before, stories of drug overdose deaths are part of your local news—especially in rural areas of the United States that traditionally have not been affected by drug problems.
Nationally, deaths from drug overdose were second only to motor vehicle crashes among leading causes of unintentional injury death in 2007. Drug overdose death rates in the United States have risen steadily since 1970, and we should all be alarmed by how quickly the numbers have increased. Death rates more than doubled between 1999 and 2007, when more than 28,000 deaths from unintentional drug poisoning occurred; that’s more than 75 deaths per day.
Among deaths attributed to drugs, the most common drug categories are cocaine, heroin, and a type of prescription drug called opioid painkillers. These painkillers have the ability to reduce pain but, when taken in excess, also can suppress breathing to a fatal degree. Our data suggest that the increase in drug overdose death rates is largely related to prescription opioid painkillers, such as oxycodone (OxyContin®), hydrocodone (Vicodin®) and methadone. There has been at least a 10-fold increase in the medical use of opioid painkillers since 1995, resulting from a movement toward more aggressive management of pain. By 2006, opioid painkillers were involved in more overdose deaths than heroin and cocaine combined due in part to legal prescriptions being used illicitly. And rural America is particularly at risk, with states in the Appalachian region and the Southwest having the highest death rates.
A recent study on prescription drug use by the Utah Department of Health found that medical providers commonly prescribe more doses of painkillers than patients use and that patients generally don’t dispose of leftover medications. Utah issued guidelines focused on reducing the number of leftover medications and informing patients about disposing of unused medications properly.
These are positive steps. Yet we know that this approach, which asks patients to manage their drug use and limit leftover drugs in their households, won’t solve the problem by itself. Studies show that those who overdose on prescription drugs generally have had a pattern of abuse. We must address this public health crisis with additional public health resources and proven interventions.
The Injury Center has developed recommendations based on promising interventions and expert opinion. In part, we encourage health care providers to use opioid medications only after determining that alternative therapies do not work. If opioids are prescribed, patients should be monitored closely for signs of inappropriate use. Insurance providers, pharmacies, and pharmacy benefit managers also have responsibilities, as they can help identify patients who have prescriptions for the same drug from multiple providers and limit that access. State and federal agencies, to the extent provided by law, should consider more robust monitoring for inappropriate use of controlled substances and work to improve the availability of substance abuse treatment services. We know that treatment works, yet only a fraction of those who need treatment for drug abuse receive it.
We must try to prevent unintentional drug overdoses through education and enforcement—working with all public health entities and other relevant stakeholders. Now is the time to address this public health crisis and help communities change the local news about unintentional drug overdoses. It’s up to all of us, working together, to make a difference.
Dr. Len Paulozzi is a medical epidemiologist for the Division of Unintentional Injury Prevention at the CDC National Center for Injury Prevention and Control.
Learn More about this Public Health Threat
- MMWR – Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs United States, 2004–2008
- CDC Press Release: Study Shows 111 Percent Increase in Emergency Department Visits Involving Nonmedical Use of Prescription Opioid Pain Relievers in Five-Year Period
- CDC Issue Brief – Unintentional Drug Poisoning in the United States
- Poisoning in the United States
Overview of poisoning in the U.S, including occurrence, costs and risk factors.
- Poison Prevention Tips
Suggestions to keep you, your family and your friends safe from poisonings.
- NCHS Data Brief: Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999-2006
Summary of trends in fatal opioid analgesic-related poisonings from the years 1999-2006.
- The DAWN Report: Trends in Emergency Department Visits Involving Nonmedical Use of Narcotic Pain Relievers (SAMHSA)
- CDC Statement Regarding the Misuse of Prescription Drugs
Listen to Podcasts
Unintentional Poisoning Deaths
Summary of a study on unintentional poisoning deaths, which indicated that poisoning death rates in the United States increased by 62.5% from 1999–2004. (6:12 mins)
Protecting Yourself and Your Family Against Poisonings
Poisoning prevention tips for audiences of all ages. (2:59 mins)