In one of the first studies of its kind in an urban area, researchers have found that the overdose death rate from prescription painkillers is seven times higher in New York City than it was in 1990. And the death rate for whites in the city from opioid drugs was three times higher than for blacks.
Researchers at Columbia University’s Mailman School of Public Health looked at data from the city’s Office of the Chief Medical Examiner from 1990 to 2006, focusing on deaths from prescription opioids versus those from heroin.
They found that the increase in drug overdoses was driven entirely by analgesic overdoses, which were 2.7 deaths per 100,000 persons in 2006, or seven times the rate in 1990. Methadone overdoses remained stable, while heroin overdoses declined.
Whites were far more likely to overdose on analgesic painkillers than blacks or Hispanics. In 2006, the fatality rate for white males in New York City was almost two times higher than Latinos and three times higher than blacks.
“A possible reason for the concentration of fatalities among whites is that this group is more likely to have access to a doctor who can write prescriptions,” said lead author Magdalena Cerdá, PhD, assistant professor of epidemiology at Columbia’s Mailman School of Public Health. “However, more often than not, those who get addicted have begun using the drug through illicit channels rather than through a prescription.”
Researchers say the profile of a recreational prescription opioid user is very different from the heroin consumer, with less involvement in street-based drug-trafficking and other drugs such as cocaine. Because of that, they say, different strategies are needed to combat opioid abuse.
“It’s a different type of drug with a different profile, and we need a different type of response to it,” says Cerdá.
New York City’s public hospitals recently adopted new restrictions on prescription painkillers that will make it harder for drug abusers, as well as pain patients, to get access to opioid analgesics.
Under the city’s guidelines, emergency rooms in public hospitals will only prescribe a three-day supply of widely used painkillers such as Vicodin and Percocet. Long-acting painkillers such as methadone and Oxycontin will not be dispensed at all, and the hospitals won’t refill lost or stolen prescriptions.
The move is aimed at curbing what Mayor Michael Bloomberg calls a citywide “epidemic” of prescription drug abuse. Over a quarter of a million New Yorkers over age 12 are abusing prescription painkillers.
Previous studies on recreational opioid use have focused on rural areas, which have been hit hard by the epidemic, but the Columbia University study suggests that urban areas are also experiencing a growing health burden from opioid abuse. The study is being published in the journal Drug and Alcohol Dependence.
Over the last 20 years, prescription drug overdoses have risen dramatically in the U. S. Overdose deaths exceeded the number of suicides in 2006, and by 2009 they exceeded the number of motor vehicle deaths.
Naloxone Rescue Kits Save Lives
Meanwhile, public health officials in Boston are having some success in reducing the number of opioid overdoses.
In a study published in the British Medical Journal, researchers at Boston Medical Center, Boston University and the Massachusetts Department of Public Health reported that overdose education and naloxone distribution programs (OEND) reduced overdose deaths rates by as much as 46 percent.
Naloxone is an opioid antagonist that reverses the effects of an opioid overdose. The drug may be administered by injection or by nasal spray.
The OEND programs provided naloxone rescue kits to families and friends of high-risk patients, who are taught to look for signs of an overdose and to respond quickly by administering inhaled naloxone.
Between 2006 and 2009, OEND programs in Massachusetts trained 2,912 potential bystanders, who reported 327 rescues. Researchers estimate that training reduced overdose deaths in high risk communities between 27 to 46 percent.
“Opioid overdose is a major public health problem for which we have few proven solutions. This study provides observational evidence that OEND can have a population-level dose effect in reducing overdose death rates, where the greater the implementation, the greater the impact,” said Alexander Walley, MD, an attending physician at Boston Medical Center and the study’s lead author. “Together with a recent study, which demonstrated that OEND is highly cost effective, it appears that OEND is a promising, scalable and affordable tool to save lives from opioid overdose.”