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Prescription Histories and Dose Strengths Associated with Overdose Deaths

Authors

  • Anne Hirsch MPH,

    1. CDC/CSTE Applied Epidemiology Fellowship, Injury Epidemiology and Surveillance Unit, N.C. Division of Public Health, Raleigh, North Carolina, USA
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  • Scott K. Proescholdbell MPH,

    Corresponding author
    1. Injury Epidemiology and Surveillance Unit, N.C. Division of Public Health, Raleigh, North Carolina, USA
    • Reprint requests to: Scott K. Proescholdbell, MPH, Injury Epidemiology and Surveillance Unit, N.C. Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA. Tel: 919-707-5442; Fax: 919-870-4803; E-mail: Scott.Proescholdbell@dhhs.nc.gov.

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  • William Bronson BA, CSAC,

    1. Controlled Substances Reporting System, Drug Control Unit, N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Raleigh, North Carolina, USA
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  • Nabarun Dasgupta MPH, PhD

    1. Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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  • The authors declare no conflicts of interest.

Abstract

Objective

Misuse, abuse, and diversion of prescription drugs are large and growing public health problems that have resulted in an overdose epidemic. We investigated whether short-acting or extended-release opioids were more frequently prescribed to those who died of an overdose and whether there was a linear relationship between dose strength and associated overdose deaths.

Methods

The study population was North Carolina residents in 2010. We conducted a retrospective, population-based, descriptive study of medication histories of overdose decedents using data from vital statistics, medical examiner records, and a prescription drug monitoring program.

Results

Unintentional or undetermined drug overdoses were responsible for 892 deaths. Out of 191 deaths involving methadone, only two were patients in opioid treatment programs. Immediate-release oxycodone was involved in the greatest number of opioid-related deaths. Out of 221 oxycodone deaths, 134 (61%) of the decedents filled a prescription for oxycodone in the 60 days prior to death. The most common strength dispensed within 60 days to a decedent who died of an oxycodone overdose was 10 mg for immediate-release (72 prescriptions). Immediate-release oxycodone products (rho = 1.00, P < 0.01) and extended-release fentanyl products (rho = 1.00, P < 0.01) showed strong increasing linear trends between dose strength and proportion of prescriptions dispensed to decedents.

Conclusions

A significant proportion of overdose decedents had been prescribed the same type of drugs that contributed to their death, especially for decedents who died from overdoses involving oxycodone, hydrocodone, and alprazolam. Higher dose strengths for certain opioids had higher associated mortality, and certain immediate-release opioids may be considered for public health prevention efforts.

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