Drug Mortality Research Articles

Geography of poly-substance drug mortality

BackgroundThere has been a rise in drug overdoses and death in recent years. We examine the spatial distribution of drug related deaths in the U.S., by typing places by multiple problem substances and predicting the types with potential covariates. MethodsUnits of analysis are N = 3079 counties in the 48 conterminous United States. Drug death rates by substance are drawn from confidential cause-of-death mortality files from the National Vital Statistics System and independent variables are from several official sources. Latent profile analysis is used to identify drug clusters by classifying counties into profiles based on mortality rates across six drug types in 2017–19 and change from 2000 to 02. A multivariate general linear model is used to explore unconditional mean differences by latent profile across a number of variables. ResultsLPA identified 7 classes. These clusters vary by key covariates, with a cocaine and illicit opioid problem concentrating in relatively affluent urban areas, a methamphetamine problem in rural areas, a prescription drug problem concentrated in a few states, and a syndemic in places that were the origin of the opioid pill epidemic of preceding decades. ConclusionsThere is no longer a single drug crisis in the U.S. Rather, the problem is diverse spatially. A single national drug policy response is unlikely to be equally effective in all parts, but findings speak to responses that have promise in particular contexts.

Drug overdose death rates in different countries: Who should be alarmed?

This study aims to assess how many nations, in addition to the United States and Canada, report alarmingly high drug overdose death rates, and to compare how those rates have changed. Drug overdose death rates exceed four per 100,000 in over 10% of the world's nations, including Libya (where rates are increasing) and in Russia (where rates have fallen). A comparison of data from five well-resourced nations with high drug death rates showed recently accelerated and alarming increases in rates in the United States and Canada (attributed to influx of fentanyl, plus increased stimulant use). A reported recent fall in Canada's drug suicide rate may be attributable to misclassification of some suicides as accidents. There is an urgent need to ensure accuracy and better understanding concerning drug overdose deaths and how to prevent them.

Geographical Aspects of Recent Trends in Drug-Related Deaths, with a Focus on Intra-National Contextual Variation.

Background. Recent worldwide estimates are of 53 million users of opioids annually, and of 585,000 drug-related deaths, of which two thirds are due to opioids. There are considerable international differences in levels of drug death rates and substance abuse. However, there are also considerable variations within countries in drug misuse, overdose rates, and in drug death rates particularly. Wide intra-national variations characterize countries where drug deaths have risen fastest in recent years, such as the US and UK. Drug deaths are an outcome of drug misuse, which can ideally be studied at a relatively low spatial scale (e.g., US counties). The research literature suggests that small area variations in drug deaths to a considerable degree reflect contextual (place-related) factors as well as individual risk factors. Methods. We consider the role of area social status, social cohesion, segregation, urbanicity, and drug supply in an ecological regression analysis of county differences in drug deaths in the US during 2015–2017. Results. The analysis of US small area data highlights a range of factors which are statistically significant in explaining differences in drug deaths, but with no risk factor having a predominant role. Comparisons with other countries where small area drug mortality data have been analyzed show differences between countries in the impact of different contextual factors, but some common themes. Conclusions. Intra-national differences in drug-related deaths are considerable, but there are significant research gaps in the evidence base for small area analysis of such deaths.

Intersections of Firearm Suicide, Drug-Related Mortality, and Economic Dependency in Rural America

BackgroundRural counties in the United States have higher firearm suicide rates and opioid overdoses than urban counties. We sought to determine whether rural counties can be grouped based on these “diseases of despair.” MethodsAge-adjusted firearm suicide death rates per 100,000; drug-related death rates per 100,000; homicide rate per 100,000, opioid prescribing rate, %black, %Native American, and %veteran population, median home price, violent crime rates per 100,000, primary economic dependency (nonspecialized, farming, mining, manufacturing, government, and recreation), and economic variables (low education, low employment, retirement destination, persistent poverty, and persistent child poverty) were obtained for all rural counties and evaluated with hierarchical clustering using complete linkage. ResultsWe identified five distinct rural county clusters. The firearm suicide rates in the clusters were 5.9, 6.8, 6.4, 8.5, and 3.8 per 100,000, respectively. The counties in cluster 1 were poor, mining dependent, with population loss, cluster 2 were nonspecialized economies, with high opioid prescription rates, cluster 3 were manufacturing and government economies with moderate unemployment, cluster 4 were recreational economies with substantial veterans and Native American populations, high median home price, drug death rates, opioid prescribing, and violent crime, and cluster 5 were farming economies, with high population loss, low median home price, low rates of drug mortality, opioid prescribing, and violent crime. Cluster 4 counties were spatially adjacent to urban counties. ConclusionsMore than 300 counties currently face a disproportionate burden of diseases of despair. Interventions to reduce firearm suicides should be community-based and include programs to reduce other diseases of despair.

Opioid Deaths and Local Healthcare Intensity: A Longitudinal Analysis of the U.S. Population, 2003–2014

This study examines the association between local healthcare intensity and drug death rates. County-level drug death rates were computed for 2003-2014 using vital statistics data adjusted for incomplete reporting of drug involvement. A county-level healthcare intensity index was constructed using Dartmouth Atlas of Health Care data. Linear regression and dose-response models were estimated for all residents and for population subgroups to analyze the relationship between healthcare intensity and drug death rates, as well as for 7 indicators of healthcare quality. Data collection and analysis were conducted in 2018 and 2019. Linear estimates indicated a positive correlation between healthcare intensity and opioid-involved drug death rates. Dose-response models revealed that the association was especially pronounced for the 2 highest healthcare intensity quintiles. Moving from the lowest to the highest healthcare intensity quintile was associated with a 2.14 (95% CI=1.56, 2.72) per 100,000 rise in opioid-involved drug death rates and a 25.1% (95% CI=18.3%, 31.9%) increase from the base rate of 8.54 per 100,000. Corresponding associations were larger in absolute terms for individuals who were male, white, aged 20-44 years, and not college educated than for their counterparts, but similar in percentages, except for 2 minority racial groups and seniors. Non-opioid drug death rates were unrelated to healthcare intensity. High healthcare intensity was associated with worse healthcare quality for 6 of 7 indicators. In the U.S., between 2003 and 2014, high medical care intensity was associated with elevated opioid death rates and lower healthcare quality.

De-unionization and Drug Death Rates

Drug death rates in the United States have risen dramatically in recent years, sparking urgent discussions about causes. Most of these discussions have centered on supply-side issues, such as doctors overprescribing pain killers. However, there is increasing recognition of the need to go beyond proximate causes and to consider larger social forces that bear on the demand for pain-relieving drugs. Informed by sociological research linking labor unions to community health, we empirically examined the relationship between union density and drug death rates for the years 1999 to 2016. We found that states experiencing greater declines in unionization also tended to experience greater increases in drug deaths. Estimates from our fixed-effects models suggested that a one standard deviation decrease in union density was associated with a 42 percent increase in drug death rates over the period. Although the incorporation of a variety of statistical controls reduced this association, it remained negative and significant. Beyond variation in the availability of substances to misuse, our findings underscore the importance of considering institutional decline and broader social conditions as deeply relevant for contemporary drug death trends.

Using multiple cause-of-death data to improve surveillance of drug-related mortality.

Many states and local areas are affected by the national epidemic of drug-related mortality, which recently has shown signs of a rising "licit-to-illicit drug" death ratio. Appropriate local public health surveillance can help monitor and control this epidemic. Using our state as an example, we sought to illustrate how to describe the changes in drug death rates, causes, and circumstances. In contrast to most other surveillance reports, our approach includes both drug-induced and drug-related deaths as well as both demographic and socioeconomic characteristics of decedents. Cross-sectional study. All residents of the state of Wisconsin. Decedents from 1999 to 2008. Annual numbers and population-based rates of deaths due to drugs, including both identified and unidentified drugs. Information was obtained from death certificates with any of approximately 270 underlying, immediate, or contributing cause-of-death codes from the International Classification of Diseases, 10th Revision. Drug-related death rates increased during much of the 10-year study period, and the male-to-female death ratio rose. The median age at death from drug-related causes was 43 years. Opioid analgesic poisoning surpassed cocaine and heroin poisoning as the most frequent type of fatal drug poisoning. Of all 4828 deaths from drug-related causes--virtually all of which were certified by a county medical examiner or coroner--3410 (71%) were unintentional and 1053 (22%) were suicides. The unintentional-to-suicide death rate ratio grew from 1.6 to 3.5 during the study period. Methadone-related deaths increased from 10 in 1999 to 118 in 2008 (1080%), while benzodiazepine-related deaths rose from 23 to 106 (361%). Although premature deaths from drug use and abuse continue to rise, even surpassing deaths due to motor vehicle crash in some states, "multiple causes of death" information from death certificates is available to monitor their occurrence and nature and to inform selection of prevention strategies.

Doctor and Pharmacy Shopping for Controlled Substances

Prescription drug abuse is a major health concern nationwide, with West Virginia having one of the highest prescription drug death rates in the United States. Studies are lacking that compare living subjects with persons who died from drug overdose for evidence of doctor and pharmacy shopping for controlled substances. The study objectives were to compare deceased and living subjects in West Virginia for evidence of prior doctor and pharmacy shopping for controlled substances and to identify factors associated with drug-related death. A secondary data study was conducted using controlled substance, Schedule II-IV, prescription data from the West Virginia Controlled Substance Monitoring Program and drug-related death data compiled by the Forensic Drug Database between July 2005 and December 2007. A case-control design compared deceased subjects 18 years and older whose death was drug related with living subjects for prior doctor and pharmacy shopping. Logistic regression identified factors related to the odds of drug-related death. A significantly greater proportion of deceased subjects were doctor shoppers (25.21% vs. 3.58%) and pharmacy shoppers (17.48% vs. 1.30%) than living subjects. Approximately 20.23% of doctor shoppers were also pharmacy shoppers, and 55.60% of pharmacy shoppers were doctor shoppers. Younger age, greater number of prescriptions dispensed, exposure to opioids and benzodiazepines, and doctor and pharmacy shopping were factors with greater odds of drug-related death. Doctor and pharmacy shopping involving controlled substances were identified, and shopping behavior was associated with drug-related death. Prescription monitoring programs may be useful in identifying potential shoppers at the point of care.

Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

Increasing socio‐economic inequalities in drug‐induced deaths in Australia: 1981 – 2002

Since the 1990s illicit drug use death rates in Australia have increased markedly. There is a notable gap in knowledge about changing socio-economic inequalities in drug use death rates. Some limited Australian and overseas data point to higher rates of drug death in the lowest socio-economic groups, but the paucity of available studies and their sometimes conflicting findings need to be addressed. This paper uses data obtained from the Australian Bureau of Statistics (ABS) to examine changes in age-standardised drug-induced mortality rates for Australian males over the period 1981-2002. Socio-economic status was categorised as manual or non-manual work status. With the rapid increase in drug-induced mortality rates in the 1990s, there was a parallel increase in socio-economic inequalities in drug-induced deaths. The decline in drug death rates from 2000 onwards was associated with a decline in socio-economic inequalities. By 2002, manual workers had drug death rates well over twice the rate of non-manual workers. Three factors are identified which contribute to these socio-economic inequalities in mortality. First, there has been an age shift in deaths evident only for manual workers. Secondly, there has been an increase in availability until 1999 and a relative decline in the cost of the drug, which most often leads to drug death (heroin). Thirdly, there has been a shift to amphetamine use which may lead to significant levels of morbidity, but few deaths.