Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review.
OBJECTIVE
Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes.


METHODS
In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program.


RESULTS
Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug.


CONCLUSIONS
Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.
Toblin
Robin L
RL
Office of Research and Evaluation, Federal Bureau of Prisons, 320 First St. N.W., Washington, D.C. 20534. rtoblin@bop.gov
Paulozzi
Leonard J
LJ
Logan
Joseph E
JE
Hall
Aron J
AJ
Kaplan
James A
JA
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000506:poisoning; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D002908:Chronic Disease; D003334:Coroners and Medical Examiners; D062787:Drug Overdose / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D055553:Prescription Drugs / Q000009:adverse effects* / Q000506:poisoning; D015995:Prevalence; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011795:Surveys and Questionnaires; D014903:West Virginia / Q000453:epidemiology
D000701:Analgesics, Opioid; D055553:Prescription Drugs; D011619:Psychotropic Drugs; D001569:Benzodiazepines