Utah deaths each year from drug poisoning have increased nearly five-fold since 1991, with by far the largest increase coming from unintentional deaths involving prescription drugs, according to a study published Thursday by the Centers for Disease Control and Prevention.
"Society believes that drug-overdose deaths happen to people using illegal drugs," said Christy Porucznik, a CDC epidemiologist assigned to the Utah Department of Health, who led the study. "In Utah, the reality is that the typical person dying of drug poisoning is a young- to middle-aged, overweight adult who was using drugs that can be obtained by prescription."
In 1991, there were 79 drug deaths, including both illegal and legal substances. In 2003, the last year studied, there were 391. Of those, deaths from illegal drugs such as heroin and cocaine increased from 19 in 1991 to 120 in 1999, then dropped to 92 in 2003.
With legal drugs, the story was very different.
From 1999 to 2003, the increase was in death from drugs obtainable by prescription, most commonly oxycodone, hydrocodone and methadone.
Each of the deaths that were counted were classified as either unintentional or that the intent couldn't be determined. Those thought to be suicides were not included in the count.
The study found a four-fold increase, from 45 deaths in 1999 to 181 in 2003. Every year, prescription drugs outnumbered illegal drugs as a cause of death.
"Prescription narcotics can benefit many, but they're also dangerous, so you need to be careful using them safely and appropriately. The message is also for doctors," Porucznik said. "They need to be sure to talk with the patient to make sure the patient understands that medicines can kill if you take too much."
She said that, unlike in suicide cases, gender made no difference. Neither did whether one lived in an urban center or a rural community.
The study was prompted by the state medical examiner's office, which noted an increase in the number of drug deaths it was seeing — many of them involving legal drugs.
Most of those who died were 25 to 54 years old.
"We consider these to be preventable deaths," Porucznik said. "We are trying to find ways to reduce the number of drug-poisoning deaths in Utah."
But Porucznik said the study also yielded as many questions as answers. For instance, it's not known at this time how many of the people who died from using legal drugs were actually using them legally. The study didn't differentiate who had the prescription for the narcotic — whether, for instance, it had been stolen or "borrowed" from a friend who no longer needed it. And it didn't differentiate whether someone who died followed label directions, took too much or perhaps had a serious reaction. What, if any, role addiction played was also not clear.
"The study is ongoing. At this point we've determined that yes, this is a real problem," she said.
State Epidemiologist Dr. Robert Rolfs said the Utah Department of Health is looking for ways to reduce the number of drug-poisoning deaths in the state. Future studies will focus on identifying risk characteristics that might predict which people are most at risk of dying from a drug overdose, and that could guide interventions to reduce the risk.
Porucznik noted that the methadone deaths don't indicate an increase from drug treatment programs, since the medication is also used for pain control. "It's inexpensive, very effective and lasts a long time. But the way it works in the body is very different than hydrocodone. So people need to be aware of how it will affect them. It is easy to take too much.
"We reviewed some of the methadone deaths and found a fair number of those people were taking methadone for the first time. It wasn't addiction; they had no time to be addicted yet.
"It's very scary and sad," Porucznik said of the findings. "Most of the time, these people are really in pain. It's good to take away their pain, but we want to try to take it away safely."
The CDC published the findings in its Morbidity Mortality Weekly Report.