Injury update : a report to Oklahoma injury surveillance participants

              *The INJURY UPDATE is a publication of the Injury Prevention Service, Oklahoma State Department of Health.
This and other IPS information may be obtained from the Injury Prevention Service, Oklahoma State Department
of Health, 1000 N.E. 10th Street, Oklahoma City, OK 73117, 405-271-3430 or 1-800-522-0204 (in Oklahoma).
IPS publications are also available at http://ips.health.ok.gov
0
50
100
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250
300
350
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450
500
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Number of Deaths
Figure 1. Unintentional Medication Overdose Deaths
by Year and Gender, Oklahoma, 1999-2009
N=3,236 Male Female
October 27, 2011
Unintentional Poisonings Related to Medications, Oklahoma, 2007-2009
Since 2002, unintentional poisoning has been second only to motor vehicle collision as the leading cause of
injury death in the United States. Beginning in 2005, these two causes of death reversed for persons aged 35-
54. Unintentional poisoning is now the leading cause of injury death in this age group, followed by motor
vehicle collision.
In 2007, almost 30,000 individuals died from unintentional poisoning or almost ten individuals per 100,000.
Approximately 90% of unintentional poisoning deaths were due to prescription or illicit drugs. Opioid
analgesics alone were the cause of death in nearly 40% of cases.
However, not every unintentional overdose from prescription drugs results in death. In 2008, nationally, the
number of persons presenting to emergency departments for prescription or over-the-counter drug overdose
equaled the number of persons presenting due to an illicit drug overdose. The three most common causes of
prescription drug overdoses seen in emergency departments were oxycodone, hydrocodone, and
methadone. An estimated 49 million people over age 11 have used prescription medications at some point
in their lifetime for nonmedical reasons.
Over the past decade in Oklahoma, there has been a steady increase in the number of unintentional
medication overdose fatalities (Figure 1; 1999-2006 described in Piercefield, E. et al. Am J Prev Med.
2010;39(4):357-363).To better
understand this problem, a special
study was conducted using data
collected from the Office of the
Chief Medical Examiner. Deaths
that occurred between 2007 and
2009 were included if the decedent
was an Oklahoma resident, the cause
of death involved one or more
prescription or over-the-counter
medications, and the manner of
death was unintentional.
It was found that from 2007-2009,
there were 1,375 unintentional fatal
medication overdoses in Oklahoma,
averaging 458 per year. During the
three-year period, the number of
deaths increased by 4%.
Page 2 Injury Update
Males accounted for the majority of
deaths (57%). Men in the age groups
25-34, 35-44, and 45-54 had the
highest fatality rates (24.6, 26.4, and
27.7 deaths per 100,000 population,
respectively), except for women 45-
54 years, who had a rate of 28.8 per
100,000 population (Figure 2).
Women experienced an 8% increase
over the three-year period in the
mortality rate of medication-related
unintentional poisoning; the rate
among males decreased 12%.
The median age of females who died
was slightly higher than that of
males, 46 years versus 39 years. The youngest person who died was less than 1 year of age and the oldest
person was 94. Children younger than 15 years and persons aged 65 and older had the lowest rates of
unintentional medication overdose deaths (0.18 and 1.9 deaths per 100,000 population, respectively). Rates
increased most among men 55-64 and 65-74 years of age and women aged 45-54 years.
Whites had a rate of unintentional medication-related poisoning death over two times higher than Native
Americans and over 3.5 times higher than blacks (14.4, 6.3, and 4.0 deaths per 100,000 population,
respectively). Whites aged 45-54 years had the highest rate overall (31.8 deaths per 100,000). Rates by race
and gender are illustrated in Figure 3; males had rates 20-40% higher than females across all racial categories.
Over the three-year period, opioid prescription analgesics contributed to 68% of deaths and anti-anxiety
medications contributed to 31%. The five individual substances found most frequently in these unintentional
poisoning deaths included methadone (25%), alprazolam (25%), oxycodone (24%), hydrocodone (23%), and
morphine (14%).
In 18% of the deaths, other
substances were involved in addition
to the medication(s). These
substances included alcohol (10%),
methamphetamine (3%), illicit drugs
(3%), or a combination of alcohol,
methamphetamine, and/or illicit
drugs (2%). Among all decedents,
29% had two medications
contributing to their death; 22% had
three or more medications
contributing. Nearly one in five
decedents was definitely or likely
drinking alcohol prior to their death.
Alcohol use varied by gender (men
were 1.6 times more likely to have
alcohol present), but not by race.
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4
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14
16
18
White Black Native American Other
Rate per 100,000 Population
Race
Figure 3. Unintentional Medication Overdose Death Rates by
Race and Gender, Oklahoma, 2007-2009
Male Female
0
5
10
15
20
25
30
35
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
Rate per 100,000 Population
Age Group (Years)
Figure 2. Unintentional Medication Overdose Death Rates by
Age Group and Gender, Oklahoma, 2007-2009
Male Female
Injury Update Page 3
The state rate of unintentional medication overdose deaths was 12.6 per 100,000 population (Figure 4). More
than half of the counties were below the state rate and seven had no deaths. Pawnee County had the highest
rate of unintentional medication-related poisoning fatalities (28.4 deaths per 100,000 population), followed
by Okfuskee and McCurtain Counties (24.1 and 23.9 deaths per 100,000 population, respectively).
The majority of unintentional medication overdoses occurred in a residence (94%). Of those, 89% were the
decedent’s own home.
CASE BRIEFS
• A young man with a history of seizures advised his family he was not feeling well and took several
Lortab (hydrocodone). Shortly after taking the medication, he began having seizure-type activity and
severe vomiting. The family called 911; emergency medical responders arrived to find the man dead.
• A middle aged man with a history of complex medical needs and chronic back pain was found
unresponsive by his wife after she returned home from church. There was no documented history of
medication overdoses.
• A young man was found unresponsive by his wife. He had a history of prescription pain medication
abuse after sustaining a spinal cord injury in a motor vehicle collision. At the time of his death, he had no
prescriptions for pain medications and was buying them from street dealers.
• A middle aged woman was last known to be alive when she spoke to a friend on the phone. At that time
she mentioned she had been to the doctor’s office for a Demoral shot. She was found deceased by a
neighbor the next day. Two Fentanyl patches were found near the injection site.
Page 4 Injury Update
PREVENTION
For health care providers:
• Complete additional training on identifying prescription drug abuse and addiction in patients.
• Ask about prescription drug use/abuse when taking patient history.
• Check patients’ prescription history using the Oklahoma Prescription Monitoring Program on the
Oklahoma Bureau of Narcotics and Dangerous Drugs’ website:
http://www.ok.gov/obndd/Prescription_Monitoring_Program/index.html.
• Discuss all prescription and over-the-counter medications taken by patients and assess potential
interactions.
• Fully discuss the potential for prescription drug misuse and abuse with patients when prescribing
medications.
• Regularly call or obtain records from other treating physicians before prescribing controlled drugs on a
long-term basis.
For everyone:
• Never drink alcohol while taking medication.
• Never share or sell your prescription drugs.
• Dispose of unused, unneeded, or expired prescription drugs.
• Keep pain medications in a safe place that can only be reached by people who take or give them.
• Keep medicines in their original bottles or containers.
• Read and follow all directions and heed the warnings on the labels of all medications used.
• Monitor the use of medicines prescribed for children and teenagers.
• Consult your heath care provider before taking new medications.
• Put the poison control number, 1-800-222-1222, on or near every home telephone and save it on your cell
phone. The line is open 24 hours a day, 7 days a week.
Prepared by: Liz Langthorn, MPH
Claire Nguyen, MS
Injury Prevention Service