Accidental deaths from overdoses of pain medication are more likely in economically disadvantaged neighborhoods with high rates of divorce and single parent households, according to researchers at Columbia University’s Mailman School of Public Health.
Their study, which is being published in the American Journal of Public Health, is one of the first to look at the geographical distribution of painkiller overdoses in urban areas. Urban areas have long been associated with elevated risks of substance abuse. From 1997 to 2002, the number of overdose deaths involving opioid analgesics increased 97% in urban areas.
“Given the increasing rates of analgesic overdose fatalities and the systematic distribution of overdose risk across urban neighborhoods, there is a critical need for research that identifies the particular neighborhood mechanisms that may distinguish the risk of analgesic overdose from that of illicit drug overdose,” said Magdalena Cerda, an assistant professor of Epidemiology at Columbia University.
Cerda and her colleagues analyzed data from the Office of the Chief Medical Examiner of New York City, to understand the role of neighborhood characteristics, including income distribution and family fragmentation, in analgesic overdose deaths. Fatalities from analgesic overdoses were compared against heroin overdoses and other accidental deaths.
Researchers found that analgesic overdoses occurred more often in neighborhoods with a higher prevalence of divorced and single-parent households. The highest rates of analgesic fatalities occurred in neighborhoods in northern Manhattan characterized by low median incomes, low-quality buildings, and high levels of family fragmentation.
Cerda believes that in households with fragmented families, there may be a greater opportunity for diversion and trafficking of pain medication obtained from legitimate prescription users. Several studies have found that a key source of illicit analgesics is the diversion of prescriptions legitimately filled by parents, relatives, friends, or acquaintances.
“Neighborhoods where fragmented families are common may have lower levels of collective social control and oversight of delinquent activity, and thus a larger pool of one’s peers are involved in delinquent activities such as use of recreational analgesic opiates,” she said.
When researchers compared analgesic overdoses to heroin overdoses, they found that accidental deaths from painkillers were nearly one and a half times more likely to occur in higher-income neighborhoods than deaths from heroin overdose.
“The concentration of analgesic overdoses in higher-income, less fragmented neighborhoods may be attributable to several factors. First, higher-income neighborhoods offer a formal supply of analgesics, through pharmacies and physicians, that is not present in highly disadvantaged, primarily minority neighborhoods where heroin may be the drug of choice,” said Cerda.
Researchers found that the victims of analgesic overdoses were more likely to be white and female, have higher median incomes, and to come with neighborhoods with cleaner sidewalks and fewer dilapidated buildings.