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BACKGROUND: New Mexico has had the highest rate of drug overdose deaths in the nation. During the past decade, prescription-drug overdose deaths and opiate sales have increased dramatically. An investigation of New Mexico prescription-drug overdose deaths was conducted to determine how controlled substances had been accessed.
METHODS: Prescription Monitoring Program data were linked by decedent name and birth date to prescription-drug overdose decedents during 2011, as identified by the Office of the Medical Investigator. Diversion was defined as lacking a current prescription for any controlled substances causing death. For current prescriptions, days of pharmacy-supplied medication overlapped date of death. We compared decedents’ characteristics with and without diversion by demographics, pharmaceutical category, and substance abuse or mental illness history.
RESULTS: Diversion of one or more controlled substances was identified in 67% of 312 decedents and of all controlled substances in 45%. More men (70%) and American Indians (91%) had evidence of diversion, compared with women (63%), Hispanics (55%), and non-Hispanic whites (62%). Diversion was greater among those overdosing on benzodiazepines (73%) and combinations of opiates and sedative hypnotics (71%) than opiates alone (61%). Diversion was common among those who died from prescription-drug and alcohol (78%) or prescription-drug and illicit-drug (71%) combinations or had history of mental illness (63%), overdose (57%), and alcohol (67%), illicit-drug (70%), or prescription-drug (62%) abuse.
CONCLUSIONS: The majority of decedents accessed controlled substances through diversion. Diversion was most evident among men, American Indians, and decedents who had taken benzodiazepines or who had substance abuse or mental illness. Future deaths might be averted through educating these groups about life-threatening risks of taking controlled substances without a prescription or with illicit drugs or alcohol.