Cocaine- and opiate-related fatal overdose in New York City, 1990–2000

Kyle T Bernstein,Tinka Markham Piper,Angela Bucciarelli,Sandro Galea,Charles Gross,Ken Tardiff

doi:10.1186/1471-2458-7-31

Abstract

BackgroundIn New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990–2000.MethodsData were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990–2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression.ResultsOverall, among decedents ages 15–64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62–0.82), Black (OR = 4.73, 95% CI 4.08–5.49) or Hispanic (OR = 1.51, 95% CI 1.29–1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06–1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44–0.56) and older age (55–64) (OR = 2.53 95% CI 1.70–3.75)).ConclusionAs interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical.

Highlights

In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths
Of the 8,774 fatal overdoses involving cocaine and/or opiates that occurred in NYC from 1990 to 2000, 79.4% were male, 33.6% were White, 36.9% were Black, and 29.5% were Hispanic
Among the five boroughs of NYC, Manhattan had the largest proportion of accidental overdose deaths with 32.0% occurring in that borough; 27.3% of the total overdose fatalities occurred in Brooklyn, 24.1% in the Bronx, and smaller proportions in Queens (14.6%) and Staten Island (2.0%)

Summary

Introduction

In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990–2000. Illegal drug users experience mortality rates greater than those among the general population[1]. In 2003, non-medically related drug toxicity was the tenth leading cause of mortality in New York City (NYC) [11]. A number of studies have shown that multi-drug use contributes dramatically to overdose death [15,23,24], and in several cities, cocaine is suspected to be a considerable contributor to accidental overdose mortality[9]

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