title: National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009.
abstract: BACKGROUND
  Pharmaceutical opioid related deaths have increased. This study aimed to place pharmaceutical opioid overdose deaths within the context of heroin, cocaine, psychostimulants, and pharmaceutical sedative hypnotics examine demographic trends, and describe common combinations of substances involved in opioid related deaths.
  
  
  METHODS
  We reviewed deaths among 15-64 year olds in the US from 1999-2009 using death certificate data available through the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Database. We identified International Classification of Disease-10 codes describing accidental overdose deaths, including poisonings related to stimulants, pharmaceutical drugs, and heroin. We used crude and age adjusted death rates (deaths/100,000 person years [p-y] and 95% confidence interval [CI] and multivariable Poisson regression models, yielding incident rate ratios; IRRs), for analysis.
  
  
  RESULTS
  The age adjusted death rate related to pharmaceutical opioids increased almost 4-fold from 1999 to 2009 (1.54/100,000 p-y [95% CI 1.49-1.60] to 6.05/100,000 p-y [95% CI 5.95-6.16; p<0.001). From 1999 to 2009, pharmaceutical opioids were responsible for the highest relative increase in overdose death rates (IRR 4.22, 95% CI 3.03-5.87) followed by sedative hypnotics (IRR 3.53, 95% CI 2.11-5.90). Heroin related overdose death rates increased from 2007 to 2009 (1.05/100,000 persons [95% CI 1.00-1.09] to 1.43/100,000 persons [95% CI 1.38-1.48; p<0.001). From 2005-2009 the combination of pharmaceutical opioids and benzodiazepines was the most common cause of polysubstance overdose deaths (1.27/100,000 p-y (95% CI 1.25-1.30).
  
  
  CONCLUSIONS
  Strategies, such as wider implementation of naloxone, expanded access to treatment, and development of new interventions are needed to curb the pharmaceutical opioid overdose epidemic.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States. Susan.Calcaterra@ucdenver.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Calcaterra
authors.forename: Jason
authors.initials: J
authors.lastname: Glanz
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death / Q000639:trends; D016208:Databases, Factual / Q000639:trends*; D062787:Drug Overdose / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D055553:Prescription Drugs; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D055553:Prescription Drugs; D009270:Naloxone
keywords: Heroin; Mortality; Overdose; Pharmaceutical opioids; Poisoning; Stimulants