Sunday, September 18, 2011

News: Overdose Trends in the USA: More Deaths by Overdose than Traffic Accidents?

The Los Angeles Times has a story up that looks at recent data on overdose deaths in the United States and concludes, among other things, that there are now more fatalities from overdose than form traffic accidents. The basic idea - that there are lots and lots of people dying from overdose and that prescription opioids are responsible for a lot of those deaths - is correct.

Some other aspects of the piece deserve to be read with with a few grains of salt. It's a little unclear how the Times used "preliminary data" from the U.S. Centers for Disease Control and Prevention (CDC) to come up with a purported 37% increase in overdose deaths between 2007 (the year for which CDC most recently reported, at 27,658 deaths) and 2010 (for which the Times estimates 37,485 deaths). Yes the trend has been upward, but I'm going to go out on a limb and say that the figure produced in the article sounds a little wrong.  The article also tends to lean too heavily on scary quotes from law enforcement warning of dire consequences from our "insatiable appetite" for Vicodin and so on, and misses some very interesting data showing major regional differences in overdose mortality. Still, not a terrible article and there's some important information in there.

For a more dispassionate take on recent trends in U.S. drug overdose, it's worth looking at CDC's 2010 issue briefing on "Unintentional Drug Poisoning in the United States." The whole thing is worth reading (and it's only 4 pages), but there are a couple nuggets that strike me as especially interesting. 

One is that while prescription drugs (largely opioids and benzodiazepines, but also other medications used in psychiatry) are now involved in about half of deaths, among illegal drugs cocaine was involved in more than twice as many deaths as heroin, and cocaine deaths have trended upward for the last 10 years. So where's the media attention to cocaine? More importantly, where are good cocaine overdose prevention programs?  Stay tuned, because we'll be looking more into that issue in an upcoming two-part series from the Harm Reduction Coalition's Eliza Wheeler, who runs the DOPE Project in San Francisco. 

Second, there's wide variation among the states. Part of that is due to some big differences in prescribing, but one of the most interesting things is where we see the lowest overdose mortality. For example, in New York and California we see about half the death rate of the states with the highest rates. These also happen to be places that have invested in harm reduction programming, including overdose prevention programs and drug treatment with methadone and buprenorphine. Coincidence? It's probably related to a lot of things, but there sure are a lot of these kinds of coincidences around overdose prevention. 


  1. While I'd love to attribute regional differences to programming, few programs have directed efforts at opioid analgesics, so I don't think we can yet claim credit.

  2. This article by Maia Szalavitz in Time came out yesterday. It mentions naloxone at the end:

  3. A letter to the editor by HRC's Hilary McQuie in response to the LA Times piece:,0,2919199.story?page=2

    Traffic fatalities have gone down because of protective measures that have been implemented. With opiate overdose, there is also a very significant protective measure: take-home naloxone.

    Naloxone can be used by laypersons on someone experiencing overdose, has few harmful side effects and has saved thousands of lives.

    Currently, naloxone is distributed by trained health workers in more than 200 sites in the U.S., primarily to drug injectors. In North Carolina, the state medical association has recommended it also be given out with prescription opiates to combat its overdose epidemic. We should be doing the same in California.

    What has been done for injectors can also be done for pill users.

    Hilary McQuie


    The writer is California director of the Harm Reduction Coalition.

  4. Also, a response from DPA's Meghan Ralston:

    Drug overdose deaths: Common-sense solutions [Blowback]
    September 30, 2011 | 1:19 pm

    Meghan Ralston, harm reduction coordinator for the Drug Policy Alliance, responds to The Times' Sept. 17 article, "Drug deaths now outnumber traffic fatalities in the U.S., data show."