Abstract
BackgroundDrug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates.MethodsReported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities.ResultsAdjusted involvement rates of opioid analgesic mentions in 2012 were 54.3 % (95 % confidence interval [CI]: 53.6 %–55 %), 40.8 % higher than the reported 38.6 % rate. Adjusted rates for all narcotics, other narcotics, sedatives, or psychotropics, and multiple drug use were 81.5 % (95 % CI: 80.9 %–82.2 %), 38.4 % (95 % CI: 37.8 %–39 %), 30 % (95 % CI: 29.4 %–30.7 %), 26 % (95 % CI: 25.4 %–26.6 %) and 42.8 % (95 % CI: 42.1 %–43.5 %) in 2012, compared to reported proportions of 60.7, 27.9, 18.7, 18 and 26.9 %. The adjustments typically had similar or slightly smaller effects on the estimates in 1999, and larger impacts on subcategories of drug types such benzodiazepines and antipsychotic medications. Based on the adjusted proportions, 22,534, 15,933, 12,457, 10,798, and 17,670 drug deaths in 2012 were estimated to involve opioid analgesics, other narcotics, sedatives, psychotropic medications, and drug combinations, compared to death certificate reports of 16,007, 11,567, 7,754, 7,467, and 11,176.ConclusionsDeath certificates substantially understate the involvement of opioid analgesics, sedatives, psychotropics, and drug combinations in fatal drug poisonings. Adjustment procedures that account for cases where only unspecified drugs are reported on death certificates provide more accurate information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0071-7) contains supplementary material, which is available to authorized users.
Highlights
Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates
Drug poisonings are not limited to opioids – sedatives and psychotropic drugs are frequently identified on death certificates, and combination drug use is common [8, 9]
This study provides a more accurate understanding of the nature of drug poisoning deaths by using statistical methods that account for cases where no specific drug is identified on death certificates, to estimate the proportions of specific drug mentions and combination drug use for all types of drug poisoning mortality, as well as separately by manner of death and for two age groups (15–59 and ≥60 year olds)
Summary
Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates. The poisoning mortality rate roughly tripled over the last three decades, with about 90 % of these fatalities caused by drugs [1]. Increased rates of poisoning deaths are the most important reason for the striking result that the all-cause mortality rates of 45–54 year old non-Hispanic whites rose by around 0.5 % per year between 1999 and 2013 [3]. Drug poisonings are not limited to opioids – sedatives and psychotropic drugs are frequently identified on death certificates, and combination drug use is common [8, 9]. Perhaps most important is that we do not currently have reliable information on the specific drugs involved in fatal drug poisonings because no specific drug is identified on almost one-quarter of death certificates. Rates of involvement for specific legal and illegal drugs
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