Opioids are main contributor to fatal overdoses

The number of deaths from drug overdoses in the United States in 2010 rose for the 11th consecutive year, show data from the National Center for Health Statistics.

The majority of these deaths involved pharmaceuticals, particularly opioid analgesics and benzodiazepines; worryingly, most deaths were unintended.

"Tools such as prescription drug monitoring programs and electronic health records can help clinicians to identify risky medication use and inform treatment decisions, especially for opioids and benzodiazepines," suggest Christopher Jones (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and co-authors.

The study, presented in a Research Letter in JAMA, used the National Vital Statistics System multiple cause-of-death file, which is based on death certificates submitted by medical examiners or coroners.

During 2010 there were a total of 38,329 deaths due to drug overdoses. Most (57.7%) were due to prescription drugs, 24.6% involved unspecified drugs, and the remainder involved illicit and/or over-the-counter drugs in combination with prescription or unspecified drugs.

Of the 22,134 pharmaceutical-related overdose deaths, 74.3% were unintentional, 17.1% were suicides, and 8.4% were of undetermined intent.

The pharmaceutical drugs most frequently involved in these deaths, either alone or in combination, were opioids (75.2%), benzodiazepines (29.4%), antidepressants (17.6%), and antiepileptic and antiparkinsonism drugs (7.8%).

Opioids were frequently implicated in overdose deaths involving other pharmaceuticals, note Jones and co-authors. Indeed, opioids were involved in 77.2% of deaths involving benzodiazepines, 65.5% of deaths involving antiepileptic and antiparkinsonism drugs, and in more than half of all deaths involving antipsychotics, neuroleptics antidepressants, other analgesics, antipyretics, antirheumatics, and other psychotropic drugs.

The researchers say that their figures underestimate the true picture because 25% of death certificates failed to specify the type of drugs involved. Nevertheless, their analysis confirms the "predominant role" played by opioid analgesics in fatal drug overdoses.

The study also highlights the frequent involvement of psychotropic medications in overdose deaths, say Jones et al.

"People with mental health disorders are at increased risk for heavy therapeutic use, nonmedical use, and overdose of opioids," the authors conclude. "Screening, identification, and appropriate management of such disorders is an important part of both behavioral health and chronic pain management."

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