Opioid pain relievers, such as oxycodone and hydrocodone, are the most widely misused drug, and Alaska has shared in this growing national problem. During 2009–2013, the age-adjusted rate of drug overdose deaths in Alaska was 15.3 per 100,000 persons. Most of drug overdoses in Alaska and the U.S. involved opioids; however Alaska’s overdose rate involving opioid analgesics (pain relievers) was twice that of the U.S. (10.5 versus 5.1 per 100,000 persons in 2013, respectively). Illicit drug use is highly associative to self-medicating behaviors, and the resurgence of heroin use and continued opioid pain reliever abuse along with other illicit drugs has impacted public and behavioral health as well as public safety. The Alaska Divisions of Public Health and Behavioral Health have partnered to find solutions to critical surveillance questions and prevention needs related to drug use/abuse and suicide. Data from the Alaska Violent Death Reporting System indicated that nearly two-thirds (62%) of all violent deaths in Alaska were suicides. Only 21% of suicide decedents were tested for substances of abuse during 2009 through 2014. Under the guidance of Alaska’s State Epidemiology Workgroup, the Divisions collaborate in myriad ways to improve the collection, analysis, dissemination, and reporting on patterns of consumption, consequences, and influences associated with suicide and substance abuse.
METHODS:
In 2015, supported by the funds from the Division of Behavioral Health, State Medical Examiner Office began forensic toxicology testing of specimens from all suicide decedents. Analyses included illicit and prescription drugs of abuse. Results were entered into the Division of Public Health’s Alaska Violent Death Reporting System. Descriptive statistics were summarized by counts, percentages, and rates.
RESULTS:
During 2015, specimens collected from 199 suicide decedents were sent to a contract forensic toxicology laboratory for postmortem analyses. Tests included alcohol, amphetamines, antidepressants, cocaine, marijuana, and opiates (including heroin and prescription analgesics). Preliminary findings indicated that alcohol (59%), marijuana (23%), and opiates (19%) were the most frequently identified substances and that more than half of decedents (59%) tested had alcohol and 1 or more drugs present. Frequent characteristics among decedents with positive toxicology results included history of mental health problem, intimate partner problem, and suicide thoughts/ideations.
CONCLUSIONS:
Findings from Alaska’s suicide toxicology project will yield crucial information on the role of substances in the state’s suicide problem, as well as improving our understanding of health issues associated with drug use and assisting healthcare providers to evaluate patients and develop individualized strategies for prevention and care.