An Update on the Decline in Drug Overdose Deaths after State Policy Changes — Florida, 2013

BACKGROUND:   In July 2011 an analysis of the trends in overdose deaths in Florida between 2003 and 2009 was published in MMWR.  Death rates increased for all substances except cocaine and heroin in that span.  The death rate for prescription drugs increased by 84.2%, with oxycodone (264.6%) and alprazolam (233.8%) showing the largest increases.   In July 2014 a follow up analysis was published in MMWR that examined continuing trends through 2012 in light of the numerous changes to legislation, law enforcement, and policy implemented in Florida from 2009 through 2012.  Between 2010 and 2012, the rate of drug overdose deaths decreased 17.7%.  The decline for prescription drugs overall was 23.2%, for oxycodone 52.1% and for alprazolam 35.6%.  This presentation will further examine the overdose death rate trend through 2013.

METHODS:  Florida medical examiners are required to submit a report to the Florida Medical Examiners Commission (FMEC) on each death in which a drug is detected in the decedent.  The report includes information on which of nearly 50 monitored drugs are detected, and whether these drugs are causal in the death or merely present.  FMEC 2013 data was analyzed for this presentation.  Only those drugs deemed causal in the death are included.  In addition to updating the previous MMWR article, geographic differences within Florida are examined.

RESULTS:  Oxycodone-caused deaths decreased by an additional 37.7%, and Alprazolam deaths decreased by an additional 32.4% between 2012 and 2013.  Methadone overdose deaths also decreased 34.1%, compared to a 27.2% decrease from 2010 to 2012.   Hydromorphone deaths, which were one of the few substances that showed an earlier increase, decreased by 15.9% in 2013 to 148.   However, heroin deaths increased 122.4% from 2010 to 2012, and an additional 53.7% in 2013; and morphine deaths increased 56.2% from 2010 to 2012, and an additional 20.5% in 2013.  There was little change in gender, race or age differences in trends from the previous report.  There are some substantial differences by regions within Florida, especially in heroin deaths. 

CONCLUSIONS: The reversal of increasing trends seen between 2003 and 2009 generally continued into 2013.  The exception is the increase in heroin and morphine deaths seen since 2010.  The increase in reported morphine deaths is likely partially due to the metabolism of heroin, since some Florida medical examiners cannot detect other metabolites which would confirm heroin use.  However, Florida’s efforts to fight prescription drug use appear to have been largely successful.