Methadone-related overdose deaths in rural Virginia: 1997 to 2003.

AIM: Nonmedical use of prescription drugs and poisoning overdose deaths related to prescription drugs are increasing. This article presents an in-depth description of decedents from rural southwestern Virginia, where methadone was identified on toxicology. METHODS: Cases for this study were derived from a population-based review of 893 drug-related deaths occurring from 1997 to 2003 in the Office of the Medical Examiner, Western District of Virginia. RESULTS: Deaths in which methadone was identified on toxicology in rural southwestern Virginia increased rapidly over the 7-year study period. In the majority of cases, the cause of death was polydrug toxicity, and the manner of death was classified as accident. A majority of decedents did not have prescriptions for drugs identified on toxicology. The mean concentration of methadone for all cases was 495 mg/L, and there was no significant difference between concentrations where methadone was found alone or in combination with other drugs. There was a significant difference in methadone concentrations for those with prescriptions (645 mg/L vs 449 mg/L) when compared with those without. CONCLUSIONS: Cases where methadone was identified on toxicology increased significantly over the time studied. Efforts to prevent these deaths include the use of State Prescription Monitoring Programs, Universal Precautions, and Guidelines from the Federation of State Medical Boards.

Prescription drug fatalities among women in rural Virginia: a study of medical examiner cases.

OBJECTIVE: To evaluate female drug overdose deaths from the Office of the Chief Medical Examiner, Western Virginia (1997-2003) for demographics, medical history, toxicology results, and prescribed medications. DESIGN: Autopsy reports, death investigations, and hospital/physician notes were reviewed for 330 fatal drug poisonings among women. Data were evaluated with both qualitative and quantitative methods. RESULTS: Most decedents were Caucasian (95 percent), their average age was 42.8 years, and the predominant manner and cause of death was accidental and polydrug toxicity, respectively. Drugs were identified on toxicology or assigned as a cause of death in all 330 cases. The three most common drug classes detected on toxicology were opioids (n = 239; 72.4 percent), antidepressants (n = 201; 60.9 percent), and sedative/anxiolytic/muscle relaxant (SAMR) (n = 161; 48.8 percent) with all three drug classes detected in 89 (27 percent) cases. Illicit drugs identified included cocaine (n = 33; 10 percent) and heroin (n = 3; 0.9 percent). Prescriptions for opioids, SAMR, and antidepressants were found in decedent name in 48 percent, 67.1 percent, and 58 percent of cases, respectively, and 46.1 percent of cases were prescribed at least one medication from each of those three drug classes. CONCLUSION: Although many decedents held prescriptions, and often for multiple drugs, toxicological findings indicate the frequent presence of other therapeutic drugs in the absence of a prescription. Moreover, many of these cases held simultaneous prescriptions for which there are known drug interactions. It is likely that misuse, fatal medication errors, abuse, and addiction were factors in the increased numbers of these deaths. Interventions to prevent prescription overdose deaths must involve education of both physicians and patients.

Opioid deaths in rural Virginia: a description of the high prevalence of accidental fatalities involving prescribed medications.

In rural Virginia, drug overdose deaths increased 300% from 1997 to 2003. Polydrug deaths predominate (57.9%) in this review of 893 medical examiner cases. Prescription opioids (74.0%), antidepressants (49.0%), and benzodiazepines (39.3%) were more prevalent than illicit drugs. Two-thirds of decedents were 35-54 years old; 37% were female. When compared to western Virginia metropolitan cases, polydrug abuse was more common, specific medication combinations were found, the death rate per population was higher, and fewer illicit drugs were detected. These rural prescription overdose deaths differ from urban illicit drug deaths, suggesting the need for different strategies in prevention, treatment, and intervention by clinicians and policymakers.