METHODS:
The Florida Medical Examiners Commission (FMEC) collects data on each death in which a drug is detected in the decedent, including which of nearly 50 monitored drugs are detected, and whether these drugs are causal in the death or merely present. Deaths in which heroin or any prescription opioid was deemed to be a cause of death in FMEC data from 2006 through 2014 were analyzed.
RESULTS: The rate of death caused by all opiates other than oxycodone was relatively stable for the five years from 2006 to 2010. The rates for methadone ranged from 3.69 – 4.26, hydrocodone from 1.30 – 1.68, and morphine from 1.26 – 1.62 per 100,000. No other specific opiate exceeded a rate of 0.65. Between 2010 and 2014 the rate of deaths caused by any opiate decreased from 13.8 to 10.08. The rate caused by oxycodone decreased 70%, and the rate caused by methadone decreased 57% (from 3.69 to 1.60). Conversely, the rate of deaths caused by morphine increased 159% (1.39 – 3.61), by fentanyl 236% (0.61 -2.04), and by heroin 719% (0.26 – 2.09). Between 2006 and 2010 the portion of heroin caused deaths with no additional opiates reported as causal remained stable at about 75%. However, this decreased consistently to 18% in 2014.
CONCLUSIONS: The overall rate of deaths caused by opiates decreased since major efforts to reduce prescription drug abuse/misuse began in Florida. This is especially true for the drugs with the highest death rates in 2010 – oxycodone and methadone. However, rates of death due to morphine, fentanyl and heroin increased dramatically. This is consistent with recent reports from the NIDA-funded National Drug Early Warning System and others, indicating an increase in fentanyl abuse – as a stand-alone drug or as a heroin adulterant. The increase in morphine deaths is also likely related to heroin due to the rapid conversion of heroin into morphine. The increase in multi-opiate-caused deaths involving heroin may offer clues to the relationship between oxycodone mortality reductions and heroin increases.