Prescription opioid mortality trends in New York City, 1990-2006: examining the emergence of an epidemic

Abstract

Background: The drug overdose mortality rate tripled between 1990 and 2006; prescription opioids have driven this epidemic. We examined the period 1990-2006 to inform our understanding of how the current prescription opioid overdose epidemic emerged in urban areas.

Methods: We used data from the Office of the Chief Medical Examiner to examine changes in demographic and spatial patterns in overdose fatalities induced by prescription opioids (i.e., analgesics and methadone) in New York City (NYC) in 1990-2006, and what factors were associated with death from prescription opioids vs. heroin, historically the most prevalent form of opioid overdose in urban areas.

Results: Analgesic-induced overdose fatalities were the only types of overdose fatalities to increase in 1990-2006 in NYC; the fatality rate increased sevenfold from 0.39 in 1990 to 2.7 per 100,000 persons in 2006. Whites and Latinos were the only racial/ethnic groups to exhibit an increase in overdose-related mortality. Relative to heroin overdose decedents, analgesic and methadone overdose decedents were more likely to be female and to concurrently use psychotherapeutic drugs, but less likely to concurrently use alcohol or cocaine. Analgesic overdose decedents were less likely to be Black or Hispanic, while methadone overdose decedents were more likely to be Black or Hispanic in contrast to heroin overdose decedents.

Conclusions: The distinct epidemiologic profiles exhibited by analgesic and methadone overdose fatalities highlight the need to define drug-specific public health prevention efforts.

Keywords: Epidemiology; Methadone; Mortality; Opioid analgesics; Overdose; Prescription drugs; Urban health.

Fig. 1

Standardized overdose death rates by type of drug, New York City, 1990–2006.

Fig. 2

(a) Analgesic-induced death rates by race/ethnicity and sex, New York City, 1990–2006. (b) Methadone-induced death rates by race/ethnicity and sex, New York City, 1990–2006.

Fig. 3

(a) Proportion of analgesic-induced overdose deaths with other drugs detected, by type of drug. (b) Proportion of methadone-induced overdose deaths with other drugs detected, by type of drug.

Fig. 4

Age-adjusted analgesic- and methadone-induced overdose death rates by community district, New York City. Maps are presented in three panels (from left to right) for the periods of 1990–1995, 1996–2000, and 2001–2006. Analgesic overdose fatalities are presented in the upper row, and methadone overdose fatalities are presented in the lower row.