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BACKGROUND: Drug poisoning death rates in the U.S. have increased five-fold since 1980. During the last decade opioid analgesics have been increasingly involved in drug poisoning deaths. In 1999 in the U.S., while 30% of drug overdose deaths involved an opioid analgesic, by 2010, 60% did. Recent increases in the annual number of persons in the United States who used heroin for the first time have raised concerns about transitioning from opioid analgesics to heroin. This study examines unintentional drug poisoning deaths by opioid type to identify emerging trends.
METHODS: We linked NYC death certificates and death files from the Office of the Chief Medical Examiner to conduct a retrospective review of unintentional opioid poisonings in NYC 2000-2012. Deaths reported here include poisonings from heroin and opioid analgesics. Age-specific and age-adjusted mortality rates were calculated by drug type. Joinpoint regression modeling was used to measure annual percent change and to detect significant linear trends between years.
RESULTS: During 2000–2012, there were 9085 unintentional drug overdose deaths in NYC; 95% involved multiple substances. Seven in ten deaths involved an opioid; of those, 50% involved heroin and 18% involved an opioid analgesic; 7% involved both heroin and opioid analgesics. From 2000–2012, the rate of unintentional drug overdose deaths increased both from 2000–2006 and from 2010–2012 by 2.4% (p=0.08) and 17.4% (p=0.11) respectively; the rate decreased annually by 11% from 2006–2010 (p=0.02). The rate for overdose deaths involving opioids showed similar trends from 2000–2012, with notable decreases from 2006–2010, 9.9% annually, (p<0.05). From 2000–2012 the rate for deaths involving opioid analgesics (without heroin) increased annually by 10% (p<0.05). In contrast, rates for deaths involving heroin (without opioid analgesics) decreased annually by 5.3% (p<0.05) from 2000–2012. The rate for deaths involving both heroin and opioid analgesics increased by 14.2% from 2000–2006 and by 28.9% from 2009–2012 (p<0.05).
CONCLUSIONS: Overall, opioid-involved mortality rates significantly decreased in NYC during 2006–2010. The two most common opioids involved, opioid analgesics and heroin, showed differing trends. Despite decreases in heroin-associated mortality during this time period, rates of opioid analgesic involved deaths steadily trended upwards. In addition, deaths involving both opioids significantly increased. Ongoing surveillance and analysis of trends by demographic and geographic characteristics can inform public health initiatives, such as naloxone distribution and harm reduction education, that can prevent overdose death.