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Deaths from prescription opioids soar in New York

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f921 (Published 11 February 2013) Cite this as: BMJ 2013;346:f921
  1. Janice Hopkins Tanne
  1. 1New York

The number of people in New York city who died from overdose of prescription opioids such as oxycodone in 2006 was seven times the number in 1990, a study has found. Death from prescription opioid overdose was the only type of overdose death to rise in this period.

The study, published in Drug and Alcohol Dependence, was conducted by researchers at the Mailman School of Public Health at Columbia University and Cornell University Weill School of Medicine in New York and the School of Nursing at the University of California, San Francisco.1 Although much has been written about misuse of prescription drugs in rural areas, the epidemic has also occurred in cities.

Prescription opioids include analgesics (such as oxycodone, codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, and propoxyphene) and methadone, which in addition to treating heroin addiction is used increasingly to treat chronic pain. The number of deaths from overdose of analgesic opioids rose from 0.39 per 100 000 people in New York city in 1990 to 2.7 per 100 000 in 2006. Deaths from overdoses of methadone remained stable over the period, and deaths from heroin overdose fell.

White people were more likely than African Americans or Hispanic people to die from an overdose of analgesic opioids. In 2006 the death rate among white men was almost twice that among Hispanic man and three times that among black men.

The study’s lead author, Magdalena Cerdá, assistant professor of epidemiology at Mailman, said that a possible reason for the higher death rate among white people was that they were more likely to be able to see a doctor and therefore to get a prescription. “However, more often than not, those who get addicted have begun using the drug through illicit channels rather than through a prescription,” she said.

The study reviewed cases of fatal, unintentional poisoning deaths in adults aged 15 to 64 years in New York city from 1990 to 2006. It excluded suicides caused by overdose.

Deaths from prescription drug overdoses have risen dramatically in the United States in the past 20 years. By 2006 they exceeded the number of suicides and by 2009 the number of deaths from motor vehicle crashes.

The Centers for Disease Control and Prevention said that more people in the US die from prescription drug overdose than from cocaine and heroin combined. In 2010 more than 16 000 US deaths involved opioid analgesics.

Federal and state governments, insurers, physicians and other healthcare providers, community organizations, and patients and their families are trying to stop the epidemic. A Food and Drug Administration advisory panel recommended new restrictions on drugs containing oxycodone. Mayor Michael Bloomberg of New York city announced that public hospitals would limit the doses of these drugs that could be prescribed in the emergency room.2

Last month the consumer watchdog group Public Citizen called on federal drug regulators to restrict access to hydrocodone based painkillers. The group said that 99% of all hydrocodone in the world is manufactured and used in the US, whose citizens take more than 2.6 billion doses of the drug each year, an average of eight doses per person.3

This week the FDA held a public hearing on opioid painkillers. Pain experts suggested that labeling should include a recommended upper daily dose and that treatment be limited to 90 days. Patients’ representatives feared that such a move would limit their access to the drugs.4

Notes

Cite this as: BMJ 2013;346:f921

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