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BACKGROUND: The World Trade Center (WTC) disaster has been associated with multiple physical and mental health conditions as well as increased prevalence of alcohol and other drug use. A 2011 study from the WTC Health Registry (Registry; n=71,431) found significantly lower than expected standardized mortality ratios (SMR) for all-cause mortality among enrollees; however, the study suggested an elevation in the SMR among rescue and recovery workers for ‘other mental disorders’, which included substance use disorders. We examined drug-related mortality attributed to poisoning (overdose) among Registry enrollees.
METHODS: Deaths occurring from 2004-12 in New York City (NYC) in Registry enrollees were identified via linkage to NYC vital records. Death certificates were reviewed to ascertain if drug use was either the underlying cause of death or a contributing factor using International Classification of Diseases (ICD-10) codes. Charts from the Office of the Chief Medical Examiner of NYC (OCME) were reviewed for a subset of deaths referred for further examination. Deaths were considered an overdose based on the death certificate and/or OCME chart review data. Enrollees included in this study completed the Registry’s initial survey (Wave 1; 2003-04). We defined 9/11-related probable PTSD as a score ≥44 on the PTSD Checklist-Civilian Version (PCL-17).
RESULTS: We identified 34 drug-related overdoses. Multiple drugs (with or without alcohol) were involved in 26 overdoses (76.5%). Substances involved in deaths included opioids (n=19), benzodiazepines (n=15), cocaine (n=13), methadone (n=6) and heroin (n=2). Two deaths were overdoses of acetaminophen, one of which was intentional. Four deaths in total were considered intentional. The largest proportions of overdoses occurred among enrollees who were rescue/recovery workers (64.7%), males (82.4%), whites (61.8%), 18-44 year-olds on 9/11 (58.8%), never married (53.3%), had income < $25,000 (41.7%), were present in the dust cloud on 9/11 (64.7%), or had witnessed at least one horrific event on 9/11 (56.7%). Almost half (46.2%) occurred among enrollees with probable PTSD, and more than half occurred in those who reported new/worsening depression symptoms post-9/11 (60.6%).
CONCLUSIONS: Given the increases in excess alcohol and other drug use associated with the WTC disaster, it is important to characterize overdose deaths attributable to alcohol and drug use in a disaster-exposed population. This information will be useful to programs and providers treating individuals directly exposed to the disaster, particularly those with PTSD or depression or those being treated with opioids and/or benzodiazepines. The Registry will continue its surveillance to monitor drug-related mortality among enrollees.