National Center for Health Statistics

Top Ten Drugs Tied to Overdose Deaths

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Deaths from drug overdose in the United States increased by 54% from 2011 to 2016 — with opioids, benzodiazepines (benzos), and stimulants the most commonly used drug classes involved, a new report released today by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), shows.

The report notes that there were 41,340 drug overdose deaths in 2011 vs 63,632 such deaths in 2016.

Although the opioid oxycodone was the most cited drug in overdose death records in 2011, heroin took the top spot from 2012 to 2015.

The story around fentanyl may be even more troubling. The rate of overdose deaths involving it or one of its analogs doubled each year from 2013 through 2016, when it finally took the lead in becoming the most mentioned drug. In 2016, 29% of all overdose deaths involved fentanyl (n = 18,335).

In addition, the stimulant cocaine was the second or third most cited drug in the overdose death records throughout the entire study period.

The CDC’s list of the 10 most frequently mentioned drugs also included the opioids methadone, morphine, and hydrocodone; the benzos alprazolam and diazepam; and the stimulant methamphetamine.

Of all 10 drugs, only methadone was associated with a decreasing overdose death rate from 2011 to 2016.

“While the ranking changed from year to year, the top 10 drugs involved in overdose deaths remained consistent throughout the 6-year period,” note the investigators, led by Holly Hedegaard, MD, NCHS.

“This report identifies patterns in the specific drugs most frequently involved in drug overdose deaths…and highlights the importance of complete and accurate reporting in the literal text on death certificates,” they write.

The data were published online in the December 12 issue of the National Vital Statistics Reports.

Rise in Overdose Death Toll

An NCHS report released last year showed the age-adjusted rate of US drug overdose deaths increased dramatically from 1999 (6.1 per 100,000 population) to 2016 (19.8 per 100,000).

Although several previous studies on drug overdoses have used National Vital Statistics System-Mortality (NVSS-M) information, this data is coded using the International Classification of Diseases, Tenth Revision (ICD-10); and these ICD-10 codes focus on broad drug categories rather than on individual drugs, note the investigators.

In answer to this, the NCHS and the US Food and Drug Administration “collaboratively developed methods to search the literal text from death certificates to identify mentions of specific drugs and other substances, and to search contextual terms to identify involvement of the drug(s) or substance(s) in the death,” the researchers write.

They defined “literal text” as written information from the medical certifier on cause or circumstances related to a death.

For the current report, they examined NVSS-M data from 2011 through 2016. These data were linked to electronic files containing death certificate information.

In addition to the top 10 drugs involved in overdose deaths, drugs that held the number 11 through number 15 ranking throughout the 6-year study period included diphenhydramine, acetaminophen, citalopram, carisoprodol, oxymorphone, tramadol, amitriptyline, clonazepam, gabapentin, and amphetamine.

Threefold Increase in Heroin Deaths

The involvement of heroin in overdose deaths rose threefold from 4571 deaths in 2011 to 15,961 deaths in 2016. This made it the second-most mentioned drug in 2016, behind fentanyl.

Mentions of cocaine increased from 5892 overdose deaths in 2014 to 11,316 deaths in 2016, giving it that year’s number 3 ranking.

The fourth most mentioned drug in overdose deaths in 2016 was methamphetamine. Its 6762 related deaths signified a sharp increase from the 1887 related deaths in 2011.

“An analysis of trends…showed that, for several drugs, the age-adjusted rate of drug overdose deaths increased considerably within a relatively short period,” the investigators write.

Heroin, cocaine, and methamphetamine all showed significant increasing trends for age-adjusted rates of drug overdose deaths between 2011 and 2016 (1.5 vs 5.1 per 100,000 population; 1.6 vs 3.6 per 100,000; and 0.6 vs 2.1 per 100,000, respectively; all, P < .05).

Fentanyl showed a significant increasing trend between 2013 and 2016 (0.6 vs 5.9 per 100,000; P < .05).

The only decrease for a specific drug came from methadone, which was mentioned in 4545 overdose deaths in 2011 vs 3493 deaths in 2016 (1.4 vs 1.1 per 100,000). Still, it was the eighth most mentioned drug in 2016.

For the 2016 top 10 drugs, “the proportion of deaths involving both the referent drug and at least one other concomitant drug ranged from 50% for methamphetamine to 96% for alprazolam or diazepam,” the researchers report.

Finally, drugs most frequently recorded in unintentional overdose deaths in 2016 were fentanyl, heroin, and cocaine. The most frequently cited drugs in suicide by overdose were oxycodone, diphenhydramine, hydrocodone, and alprazolam.

Painkiller Deaths From Prescription Opioids Increased 4-Fold In The Past 10 Years

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Poisoning is considered the leading cause of injury death in the United States; both illicit and pharmaceutical drugs account for 90 percent of poisoning deaths. A National Center for Health Statistics (NCHS) Data Brief released by the Centers for Disease Control and Prevention has revealed that poisoning deaths attributed to prescription opioid painkillers, including hydrocodone, morphine, and oxycodone, have increased from 2,749 deaths in 1999 to 11,693 deaths in 2011.

Drug-Poisoning Deaths

“Although the rate is still increasing, it is not increasing quite as fast as it did between 2000 and 2006,” Dr. Holly Hedegaard, an epidemiologist at the CDC’s NCHS, told HealthDay. “From 1999 to 2006, the rate of deaths increased about 18 percent per year, but since 2006 it’s only increasing about 3 percent per year.”

Researchers from the CDC defined drug-poisoning deaths as loss of life caused by unintentional or intentional overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug inadvertently. Data was obtained using multiple cause of death morality files from the National Vital Statistics System. Among all drug-poisoning deaths in 2011, 80 percent were unintentional, 13 percent were intentional, seven percent were undetermined, and less than one percent were homicides.

While natural and semisynthetic opioid painkillers, such as hydrocodone, morphine, and oxycodone, were involved in 70 percent of drug-poisoning deaths, deaths caused by synthetic opioid analgesics, like fentanyl, meperidine, and propoxyphene, also saw a sharp increase from 730 deaths in 1999 to 2,666 deaths in 2011. The percentage of deaths attributed to benzodiazepines (drugs prescribed for anti-anxiety and muscle relaxant) also increased from 13 percent of opioid-analgesic poisoning deaths to 31 percent in 2011.

In the past 10 years, adults between the ages of 55 and 64 experienced the most significant increase in drug-poisoning deaths. The number of deaths attributed to opioid-analgesic drugs in this age group jumped from one out of every 100,000 people in 1999 to 6.3 out of every 100,000 people in 2011. However, people 25-34, 35-44, and 45-54 still account for the highest rates of opioid-analgesic poisoning deaths. In terms of racial and ethnic backgrounds, drug poisoning death rates more than quadrupled among non-Hispanic white people and doubled among non-Hispanic black people in the last decade.

Source: Chen L, Warner M, Hedegaard H. Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999–2011. NCHS Data Brief. 2014.

Suicidal? These 5 Types Of People Are At Increased Risk Of Considering Suicide.

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While Robin Williams’ suicide came as an unfortunate surprise for family, friends, and members of the general public, certain aspects of Williams’ personality may have served as the writing on the wall for his untimely death. Aside from his history ofdepression and addiction, some experts agree that Williams’ comedic abilities were tell-tale signs of depression and bipolar behaviors, keeping up with the “sad clown” façade. There are some other personality traits people exhibit that can indicate their risk for attempting suicide.

Suicide

1. Smokers

It seems as though smoking cannot only deteriorate our physical health, but also ourmental health. Researchers from the Washington University School of Medicine noticed that a rise in cigarette taxes coincided with a drop in suicide rates, so they decided to examine the possible relation to these statistics. Using data from the National Center for Health Statistics, the research team first decided how many suicides were committed by people who identified as smokers. The second part of their analysis focused on the number of suicides in states with aggressive anti-smoking policies. For each dollar increase on cigarette taxes each year, the suicide rate for that state dropped by 10 percent.

“We really need to look more closely at the effects of smoking and nicotine, not only on physical health but on mental health, too,” said lead researcher Dr. Richard A. Grucza. “It could be that [smoking] affects depression or increases addiction to other substances. We don’t know how smoking exerts these effects, but the numbers show it clearly does something. Nicotine is a plausible candidate for explaining the link between smoking and suicide risk. As with other drugs … chronic use can contribute to depression or anxiety, and that could help to explain the link to suicide.”

2. Teens Who Suffer A Concussion

Suffering a traumatic brain injury (TBI) can damage a teenager’s neurological health as they grow up, but could that also relate to a weakened psychological and emotional state? A recent study conducted at St. Michael’s Hospital in Ontario found that teenagers who experience a TBI such as a concussion are at an increased risk to premature death, most notably due to suicide. Teens who suffered a concussion were three times more likely to attempt suicide, twice as likely to be bullied at school, and more likely to call a crisis help-line or to be prescribed drugs to treat anxiety/depression compared to those who did not suffer a concussion.

“These results show that preventable brain injuries and mental health and behavioural problems among teens continue to remain a blind spot in our culture,” said lead author of the study Dr. Gabriela Ilie. “These kids are falling through the cracks.”

3. Musicians

Kurt Cobain’s personal history of drug abuse and family history of suicide were both indicated as risk factors for his eventual suicide, but not many psychology experts were quick to suggest his career as a musician was a red flag. Steve Sack, director of the Center for Suicide Research and a professor at Wayne State University,explains that suicide rates among musicians are three times higher than the current national average. While many studies on suicide agree that other artistic professionals such as writers, actors, and painters are prone to depression and suicidal thoughts, musicians tend to go unnoticed. Yet their work is of a similar nature.

4. Adults With Asperger’s

Falling under the umbrella of autism spectrum disorders (ASD), Asperger’s syndrome is a condition that causes people to suffer from social impairment, communication difficulties, and restrictive/repetitive behaviors. The recent study of the UK population revealed that people with Asperger’s are nine times more likely to have suicidal thoughts and many even attempt suicide at some point in their life. The inability to socialize or connect with other people exhibited by those with Asperger’s was deemed a contributing factor to suicidal thoughts.

“Adults with Asperger Syndrome often suffer with secondary depression due to social isolation, loneliness, social exclusion, lack of community services, under-achievement, and unemployment. Their depression and risk of suicide are preventable with the appropriate support,” Simon Baron-Cohen, professor from the Autism Researcher Center at Cambridge University, and the CLASS clinic in the Cambridgeshire, said in a statement. “This study should be a wake-up call for the urgent need for high quality services, to prevent the tragic waste of even a single life.”

5. Adopted Teens

As a result of detachment and placement in an institutional setting at an early age, many adopted teens can display signs of various psychiatric disorders as well as substance abuse. A recent study including over 1,200 teens living in Minnesota revealed that 47 out of the 56 suicidal attempts were carried out by those who were adopted. Sixteen of the adopted teens who attempted suicide were boys and 31 were girls. Among the 692 adopted teens included in the study, the majority suffered from a range of behavioral issues such as a family discord, academic disengagement, externalizing behavior, and a negative mood. Surprisingly, the research team associated suicidal thoughts with psychological traits inherited form their biological parents, including psychiatric disorders and substance abuse rather than problems with their adopted home.

“Adolescence, in general, is a period of higher risk [for suicide attempt],” Dr. Victor Fornari, director of child and adolescent psychiatry at North Shore-LIJ Health System, told HealthDay. “And now there’s evidence that the risk may be relatively higher for adopted adolescents.”