October 17, 2017
Of the 1,250 drug overdose deaths in North Carolina in 2012, 16.6 percent were self-inflicted, and 81.1 percent were unintentional. The average self-inflicted drug overdose victim was 50 years old, female (64.3 percent) and white (90.3 percent). In contrast, the average unintentional drug overdose victim was a 43-year-old male.
Those are findings by Anna E. Austin, MPH, doctoral student in maternal and child health at the UNC Gillings School of Global Public Health and graduate research assistant at the UNC Injury Prevention Research Center. Her study, “Characteristics of self-inflicted drug overdose deaths in North Carolina,” was published online Oct. 10 in the journal Drug and Alcohol Dependence.
Austin and colleagues linked vital statistics records, data from prescription drug monitoring programs, and toxicology data for self-inflicted and unintentional drug overdose deaths among North Carolina residents in 2012.
The researchers found that more than three-quarters of self-inflicted (79.2 percent) and unintentional (75.6 percent) drug overdose victims had a prescription for a controlled substance within one year prior to death.
Among self-inflicted drug overdose victims, more than half had a prescription for hydrocodone (59.6 percent), about half had a prescription for oxycodone (47 percent) and about one-third had prescriptions for alprazoloam (34.8 percent) and clonazepam (32.9 percent) in the year prior to death.
In contrast, a higher percentage of unintentional drug overdose victims had a prescription for oxycodone (61 percent) and a lower percentage had a prescription for clonazepam (25.8 percent) in the year prior to death.
Antidepressants were involved in a higher percentage of self-inflicted, compared to unintentional, drug overdose deaths (45 percent vs. 8.1 percent). In cases in which commonly prescribed opioids (oxycodone, hydrocondone) or benzodiazepines (alprazolam, clonazepam) contributed to death, a significantly higher percentage of self-inflicted drug overdose victims had a prescription for these substances within 30 days of death compared with unintentional drug overdose victims.
The study provided additional evidence that death by drug overdose, including self-inflicted drug overdose, is an important and continuing public health concern in the U.S.
Study results showed that antidepressants contributed to a higher percentage of self-inflicted, compared to unintentional, drug overdose deaths and that self-inflicted drug overdose victims were more likely to have a prescription for an opioid or benzodiazepine in the weeks prior to death, suggesting that the victims may have interacted with the health-care system.
“Such contact,” the authors write, “offers an opportunity for health-care professionals to identify and intervene on risk factors or signs of distress and potential for self-harm among those receiving prescriptions for controlled substances.”
“We hope,” Austin said, “that this study brings additional attention to the issue of suicide by drug overdose and to the complex associations between opioid use, chronic pain, mental health disorders and suicidal behaviors, issues increasingly referred to by public health professionals as ‘conditions of despair.’”
Austin’s co-authors are from the N.C. Department of Health and Human Services and the Graduate School of Public Health at the University of Pittsburgh.