title: Prescription drug fatalities among women in rural Virginia: a study of medical examiner cases.
abstract: OBJECTIVE
  To evaluate female drug overdose deaths from the Office of the Chief Medical Examiner, Western Virginia (1997-2003) for demographics, medical history, toxicology results, and prescribed medications.
  
  
  METHODS
  Autopsy reports, death investigations, and hospital/physician notes were reviewed for 330 fatal drug poisonings among women. Data were evaluated with both qualitative and quantitative methods.
  
  
  RESULTS
  Most decedents were Caucasian (95 percent), their average age was 42.8 years, and the predominant manner and cause of death was accidental and polydrug toxicity, respectively. Drugs were identified on toxicology or assigned as a cause of death in all 330 cases. The three most common drug classes detected on toxicology were opioids (n = 239; 72.4 percent), antidepressants (n = 201; 60.9 percent), and sedative/anxiolytic/muscle relaxant (SAMR) (n = 161; 48.8 percent) with all three drug classes detected in 89 (27 percent) cases. Illicit drugs identified included cocaine (n = 33; 10 percent) and heroin (n = 3; 0.9 percent). Prescriptions for opioids, SAMR, and antidepressants were found in decedent name in 48 percent, 67.1 percent, and 58 percent of cases, respectively, and 46.1 percent of cases were prescribed at least one medication from each of those three drug classes.
  
  
  CONCLUSIONS
  Although many decedents held prescriptions, and often for multiple drugs, toxicological findings indicate the frequent presence of other therapeutic drugs in the absence of a prescription. Moreover, many of these cases held simultaneous prescriptions for which there are known drug interactions. It is likely that misuse, fatal medication errors, abuse, and addiction were factors in the increased numbers of these deaths. Interventions to prevent prescription overdose deaths must involve education of both physicians and patients.
authors.affiliation: Department of Behavioral Sciences, Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Wunsch
authors.forename: Kent
authors.initials: K
authors.lastname: Nakamoto
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nuzzo
authors.forename: George
authors.initials: G
authors.lastname: Behonick
authors.forename: William
authors.initials: W
authors.lastname: Massello
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D003334:Coroners and Medical Examiners; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D055553:Prescription Drugs / Q000506:poisoning*; D014768:Virginia / Q000453:epidemiology
chemical_list: D055553:Prescription Drugs