A study of 2006 fatalities from drug poisoning in West Virginia shows that, with more powerful opioids in circulation, rural communities have caught up with a big city problem.">
Rural America is drawing even with the big cities in a tragic way: deaths by drug overdose.
Researchers at the Centers for Disease Control (CDC) have found that deaths by unintentional drug poisoning have risen steeply since 1999; further, the national health center has found "larger rate increases occurred in states with mostly rural populations."
In West Virginia, deaths from unintentional drug overdose rose most, up 550% from 1999 to 2004.
Because drug poisoning here has spiked, and because West Virginia's systems for keeping both death records and prescription records is highly centralized and uniform, a team of CDC researchers focused on this state to study the problem. What are the human risk factors involved in overdose? And which substances are most lethal?
The researchers examined all accidental poisonings in West Virginia during 2006: 295 people died of overdose. The majority of these deaths, the researchers found, were "associated with nonmedical use and diversion of pharmaceuticals, primarily opioid analgesics," drugs like Oxycontin and Vicodin, rather than street drugs. (See the full study, as published in the Journal of the American Medical Association.)
The chemistry of Methadone
The CDC study looks back to 1997, when clinical guidelines for the dispensing of pain medications changed. "In subsequent years, experts have continued to advocate for improved pain management, and the Federation of State Medical Boards has encouraged adoption of model policies to promote more compassionate pain management by clinicians." This direction in health policy resulted in huge increases of opioid drug sales — and access. The CDC team writes that since 1997, "per capita retail purchases of methadone, hydrocodone, and oxycodone in the United States increased 13-fold, 4-fold, and 9-fold, respectively."
As so many more powerful analgesic drugs became widely available, so did unsupervised use of these medications. The researchers found that of those who died from accidental prescription drug overdose in West Virginia during 2006, 63% had no record of prescription for these drugs. Of those who died, 25% had been prescribed controlled substances by five or more clinicians in the past year — evidence of "doctor shopping." Very few of the decedents were infants or elderly people who had ingested these drugs by mistake.
The researchers discovered two fairly different populations of drug abusers among those who died. Younger men were more likely to have obtained drugs by "diversion," taking them from a friend or relative, or buying them illegally. "Doctor shopping" for drugs was more prevalent among women and those in the 35-44 age range. There were twice as many men as women among the 295 fatalities. And nearly all the decedents (95%) "had at least 1 indicator of substance abuse."
Psychotherapeutic drugs, like Valium, contributed to nearly half the deaths, "though all but 1 of these deaths (attributed to amitriptyline) involved other contributory substances, primarily opioid analgesics."
The CDC concludes that "risk factors for prescription drug deaths included being male, having less education, and living in the most impoverished counties of the state."
Drug overdose has long been associated with big city junkies and starlets on barbiturates. But looking across West Virginia's casualties, the researchers found no gap between urban and rural: "No significant differences in rates were observed for county population density." Prescription drug abuse has become an equal opportunity killer.