Prescription History and Drug Overdose Death

Wednesday, June 22, 2016: 10:30 AM
Tikahtnu C&F, Dena'ina Convention Center
James W Davis , New Mexico Department of Health, Santa Fe, NM
BACKGROUND:  Drug overdose death has become the largest category of unintentional injury death, exceeding traffic crashes and falls for a number of years.  In New Mexico, prescription drugs were involved in 66.5% of all overdose deaths in 2010-2014.  Diversion of these drugs is a major problem: the National Survey on Drug Use and Health (NSDUH) shows that two thirds of non-medical users of prescription pain relievers obtained those drugs from friends or family in 2013-2014. 

METHODS:  Overdose deaths reported by the Office of the Medical Investigator (OMI) for 2007-2014 were linked to PMP prescription records for 2007-2014 by name and date of birth using The Link King.  Prescription controlled substances (CS) indicated on the OMI record were matched with prescribed CS by drug name.  Two year aggregate prescription histories were created for each person with matched prescriptions, looking back two years from the date of injury.

RESULTS:  There were 1,325 overdose deaths of NM residents in 2012-2014 reported in the OMI data with specific drugs listed, which were 93.3% of all overdose deaths reported by OMI.  Of the 716 overdose deaths (50.5%) that involved CS, 63.7% had not filled prescriptions for all of the CS involved that ended no more than 30 days prior to the date of injury, and 36.2% had filled no prescriptions in the past 2 years for the CS involved.  However, 52.9% of those deaths with no prescriptions for the CS involved had filled prescriptions for opioids or benzodiazepines in the last two years and 30.2% had filled a prescription for those drugs within the last month.  Among those overdose deaths that did not involve CS, 60.1% had filled prescriptions for opioids or benzodiazepines in the prior 2 years and 25.5% had a prescription for those drugs in the last month.  In fact, only 27.1% of overdose decedents did not fill prescriptions for opioids or benzodiazepines in the two years prior to death.

CONCLUSIONS:  Diversion of CS is a major issue, with only 36% of all overdose deaths that involved CS having recent prescriptions for all of the CS involved but the majority of overdose deaths have prior exposure to prescription CS.  Past prescriptions for opioids and benzodiazepines were very common among other overdose deaths, including that that did not involve prescription CS.  Reducing excess prescribing will reduce the social sources of supply and limit prior exposure.