Risk Factors for Prescription Opioid-Related Death, Utah, 2008–2009


  • Conflict of interest: No competing financial interests exist.
  • Funding sources: None.
  • Human subjects approval statement: This study received approval from the Utah Department of Health's institutional review board and was reviewed by a Human Research Protection Coordinator at the Centers for Disease Control and Prevention.
  • Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
  • Prior presentation: Selected findings of the study reported here were presented in April 2011 in Atlanta, Georgia at the 60th Annual Conference of the Centers for Disease Control's Epidemic Intelligence Service.
  • Authors' Contributions:

    Dr. Lanier had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Study conception and design: Lanier, Johnson, Rolfs.

    Acquisition of data: Lanier, Johnson, Friedrichs, Grey.

    Analysis and interpretation of data: Lanier, Johnson, Rolfs, Friedrichs.

    Drafting of the manuscript: Lanier, Johnson.

    Critical revision of the manuscript for important intellectual content: Lanier, Johnson, Rolfs, Friedrichs, Grey.

    Statistical analysis: Lanier, Rolfs, Friedrichs.

    Administrative, technical, or material support: Johnson, Rolfs, Grey.

    Study supervision: Rolfs.

    Approval of final version to be published: Lanier, Johnson, Rolfs, Friedrichs, Grey.

  • Additional Contributions:

    Kristina Russell, MPH, and Jonathan Anderson, MPH (Utah Department of Health) provided assistance with data collection and writing. Connor McKeown, BA (Utah Department of Health), W. Brandon Callor, BS, and Joshua J. Byrd, BA (Utah Office of the Medical Examiner) provided assistance with data collection. Jacob Crook, BA, (Utah Department of Health) provided assistance with analysis. Betsy L. Cadwell, MSPH (Centers for Disease Control and Prevention) provided assistance with statistical methods. Leonard J. Paulozzi, MD, MPH (Centers for Disease Control and Prevention) provided assistance with manuscript review. None of these individuals received compensation for their contributions.

Reprint requests to: William A. Lanier, DVM, MPH, Food and Drug Administration, 4300 River Road, College Park, MD 20740, USA. Tel: 240-402-2286; Fax: 301-436-3221; E-mail: william.lanier@fda.hhs.gov.



Utah prescription opioid death rates increased nearly fivefold during 2000–2009. Inadequate understanding of risk factors hinders prevention. The goal of this study was to determine risk factors for prescription opioid death in Utah.


Case-control study. Cases were 254 Utah decedents with ≥1 prescription opioid causing death during 2008–2009 with nonintentional manner of death (information obtained via next-of-kin interviews). Controls were 1,308 Utah 2008 Behavioral Risk Factor Surveillance System respondents who reported prescription opioid use during the previous year.

Outcome Measures

Exposure prevalence ratios (EPRs) for selected characteristics and confidence intervals (CIs) were calculated.


Decedents were more likely than the comparison group to have used prescription pain medication more than prescribed (52.9% vs 3.2%; EPR, 16.5; 95% CI, 9.3–23.7), obtained prescription pain medication from nonprescription sources (39.6% vs 8.3%; EPR, 4.8; 95% CI, 3.6–6.0), smoked daily (54.5% vs 9.7%; EPR, 5.6; 95% CI, 4.4–6.9), not graduated high school (18.5% vs 6.2%; EPR, 3.0; 95% CI, 2.0–3.9), and been divorced or separated (34.6% vs 9.4%; EPR, 3.7; 95% CI, 3.0–4.4). Decedents were more likely to have had chronic pain than the comparison group (94.2% vs 31.6%; EPR, 3.0; 95% CI, 2.7–3.3).


Use of pain medication outside prescription bounds was a risk factor for death. However, decedents were more likely to have had chronic pain, and the majority of both groups had obtained pain medication by prescription. Other factors (e.g., smoking status) might also play important roles in prescription opioid-related death. Prescribers should screen chronic pain patients for risk factors.