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BACKGROUND: The increase in deaths due to prescription drug overdoses since the early 2000s is well documented. Numerous researchers have noted that these deaths frequently involve multiple drugs. A more complete examination of multiple-substance caused deaths, including prescription and illicit drugs, will contribute to the substance abuse epidemiology body of knowledge.
METHODS: Florida’s Medical Examiners (ME) are required to report data on all examinations in which one or more of 50 listed substances are found. Each substance identified is listed either as a cause of death or as merely present. A copy of the 2012 raw data file was obtained from the Florida ME Commission and descriptive statistics were computed. Only drugs that were classified as causal were included. Emphasis was placed on multi-substance deaths involving opioid analgesics (OA), benzodiazepines, heroin or cocaine.
RESULTS: Of 8,330 total deaths reported, 2,666 involved at least one of the listed substances as a cause of death. Of these deaths, 56.5% were caused by more than one substance, and 11.4% involved four or more. There was no difference whether the death was unintentional, suicide or undetermined. Ethanol was a secondary cause of death in 29.6% of heroin-caused deaths, but only in 12.9% to 17.8% of the OA, benzodiazepine or cocaine caused deaths. Of those deaths which listed OA as a cause of death 41.1% also reported a benzodiazepine and 26.4% listed another OA. Of those that listed a benzodiazepine as a cause of death 82.3% also reported an OA and 27.5% reported another benzodiazepine. Of those that listed heroin as the cause of death 63.9% also reported OA and 38.9% reported cocaine. Of those that listed cocaine as the cause of death 48.0% also reported OA and 24.7% reported benzodiazepines. Alcohol was listed as a cause of death in 12.9% of OA caused deaths, 16.0% of cocaine caused deaths, 17.8% of benzodiazepine caused deaths, and 29.6% of heroin caused deaths. Among deaths caused by OA, benzodiazepines or cocaine, the most frequent co-occurring causal substances are OA and benzodiazepines. Among heroin deaths the most common other causal drugs were OA and cocaine.
CONCLUSIONS: Most of Florida’s drug-caused deaths include multiple drugs. Combinations of OA and benzodiazepines account for the majority of these deaths. However there are differences in the pattern of multi-drug deaths, particularly when heroin is involved. Further research may explain this difference and provide data to reduce overdose deaths.