Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997-2007.
BACKGROUND
The leading cause of injury death among adults in Connecticut (CT), USA is drug poisonings. We analyzed the epidemiology and geographic distribution of opioid-involved accidental drug-involved intoxication deaths ("overdoses") in CT over an 11-year period.


METHODS
We reviewed data from 1997 to 2007 on all adult accidental/undetermined drug intoxication deaths in CT that were referred to the Office of the Chief Medical Examiner (OCME). Regression analyses were conducted to uncover risk factors for fatal opioid-involved intoxications and to compare heroin- to prescription opioid- and methadone-involved deaths. Death locations were mapped to visualize differences in the geographic patterns of overdose by opioid type.


RESULTS
Of the 2900 qualifying deaths, 2231 (77%) involved opioids. Trends over time revealed increases in total opioid-related deaths although heroin-related deaths remained constant. Methadone, oxycodone and fentanyl, the most frequently cited prescription opioids, exhibited significant increases in opioid deaths. Prescription opioid-only deaths were more likely to involve other medications (e.g., benzodiazepines) and to have occurred among residents of a suburban or small town location, compared to heroin-involved or methadone-involved deaths. Heroin-only deaths tended to occur among non-Whites, were more likely to involve alcohol or cocaine and to occur in public locations and large cities.


CONCLUSIONS
The epidemiology of fatal opioid overdose in CT exhibits distinct longitudinal, risk factor, and geographic differences by opioid type. Each of these trends has implications for public health and prevention efforts.
Warren Alpert Medical School of Brown University, Providence, RI 02912, USA. traci.c.green@brown.edu
Traci C
TC
Green
Lauretta E
LE
Grau
H Wayne
HW
Carver
Mark
M
Kinzly
Robert
R
Heimer
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000378:metabolism / Q000506:poisoning*; D002423:Cause of Death / Q000639:trends; D003237:Connecticut / Q000453:epidemiology; D062787:Drug Overdose / Q000378:metabolism / Q000401:mortality*; D005260:Female; D003932:Heroin / Q000378:metabolism / Q000506:poisoning; D006801:Humans; D008297:Male; D008691:Methadone / Q000378:metabolism / Q000506:poisoning; D008875:Middle Aged; D009294:Narcotics / Q000378:metabolism / Q000506:poisoning*; D009293:Opioid-Related Disorders / Q000378:metabolism / Q000401:mortality*; D055553:Prescription Drugs / Q000378:metabolism / Q000506:poisoning; D055815:Young Adult
D000701:Analgesics, Opioid; D009294:Narcotics; D055553:Prescription Drugs; D003932:Heroin; D008691:Methadone