Cocaine- and opiate-related fatal overdose in New York City, 1990-2000

Abstract

Background: In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990-2000.

Methods: Data were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990-2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression.

Results: Overall, among decedents ages 15-64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62-0.82), Black (OR = 4.73, 95% CI 4.08-5.49) or Hispanic (OR = 1.51, 95% CI 1.29-1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06-1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44-0.56) and older age (55-64) (OR = 2.53 95% CI 1.70-3.75)).

Conclusion: As interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical.

Figure 1

Overdose death attributed to only cocaine-only and opiate only among 15–64 year olds in NYC, 1990–2000 (N = 8,774). Cocaine only overdose deaths were decedents in which cocaine (not in the presence of opiates) was the cause of death; other drugs (except opiates) may also have been contributors of cause of death; Opiate only overdose deaths were decedents in which opiates (without the presence of cocaine) were the cause of death; other drugs (except cocaine) may also have been contributors of cause of death. Cocaine and opiate overdose deaths refers to overdose deaths in which both cocaine and opiates were the cause of death; other drugs may also have been contributors of cause of death.

Figure 2

Percentage of drug overdose death attributed to cocaine only and opiates-only among 15–64 year olds in NYC, 1990–2000 (N = 8,774). Cocaine only overdose deaths were decedents in which cocaine (not in the presence of opiates) was the cause of death; other drugs (except opiates) may also have been contributors of cause of death; Opiate only overdose deaths were decedents in which opiates (without the presence of cocaine) were the cause of death; other drugs (except cocaine) may also have been contributors of cause of death. Cocaine and opiate overdose deaths refers to overdose deaths in which both cocaine and opiates were the cause of death; other drugs may also have been contributors of cause of death.