Utah to launch study of prescription drug overdose deaths

From the Salt Lake Tribune:

If your loved one died of a pain pill overdose in late 2008 or early 2009, he or she was probably unemployed and suffering from chronic pain -- and had a lot of life to live.

Three-quarters of those who died were between the ages of 25 and 54. There's a 50-50 chance they had been treated for mental illness or substance abuse.

Those are some of the characteristics described in a first-of-its-kind study for Utah, the results of which were disclosed March 22. Researchers from federal and state health agencies interviewed the families of those who had accidentally died of a prescription opiate overdose over one year, beginning in October 2008.

The hope is that with further research, doctors can screen and help patients using pain pills who have a greater likelihood of dying, although pain specialists say they already screen for substance abuse and mental illness.

"I don't know of anyone who has done a psychiatric autopsy, if you will, to go back and talk to next of kin," said Len Paulozzi, a medical epidemiologist with the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control.

He praised Utah for its investigation. But he added that it is difficult to tease out causes of deaths, even after learning the risk factors. For example, people who have mental health problems are more likely to report pain, and in addition to antidepressants, people who are depressed are more likely to be prescribed
opioids instead of other painkillers, Paulozzi said.

Utah has one of the nation's highest overdose death rates. In response, the state health department interviewed relatives to understand risk factors. There were 432 deaths that met its criteria, including deaths due to painkillers or illegal drugs such as heroin.

Researchers asked 47 questions on topics such as chronic health conditions, religion, sleep patterns, use of alcohol and tobacco and why they took pain pills.

One woman in the study was Shannon Anderson, a 38-year-old mother of two found dead by a friend on May 9 in her Murray apartment.

Anderson's brother, Brandon Bott, said she suffered from ovarian cysts and complained of chronic pain. Her family became concerned she was abusing painkillers; at least twice relatives called for an ambulance after Anderson passed out from her medications, he said.

Bott said a rehabilitation clinic rejected her because she did not meet its criteria. A few weeks before her death, Anderson was laid off from her job as a paralegal.

A medical examiner's report also noted Anderson had a history of depression. There were six prescription or over-the-counter drugs in her system, including hydrocodone, a muscle relaxant and an antidepressant.

"Most people who met her would have seen her as a very regular, very vibrant young woman and probably wouldn't have suspected she was battling a demon," Bott said.

The data show few who take the medications correctly die. Abuse and misuse account for about three-quarters of the deaths.

Derek Barnes was in the seventh grade the first time a friend gave him a Lortab to calm him, said Barnes' mother, Gayle Barnes. At age 16, Derek Barnes began using heroin because it was cheaper, his mother said.

Derek Barnes died June 10 at his home in Roy. He was 21.

"He wanted to get better," Gayle Barnes said. "He wanted to go to the rehab. He really tried."

Other studies have found some of the same risk factors that the Utah study found, including that overdose deaths are more common among people with low income, a history of substance abuse and mental health problems.

Nationally, men are more likely to die. A study of unintentional pharmaceutical overdose deaths in West Virginia found 67 percent were men. The numbers are closer in Utah's study, with men making up 51 percent.

The most common drugs listed by the medical examiner as contributing to the cause of death was oxycodone, methadone and hydrocodone. The drugs are synthetic versions of opium and can suppress breathing if too much is taken.

William Lanier, a U.S. Public Health Service epidemiologist assigned to Utah, said a lack of health care and a job may be contributing factors in the deaths. Many of the deceased had combinations of chronic pain, mental illness and substance abuse, and may not have received adequate treatment.

"They need some complicated care and unfortunately, the way the health system is set up, if you are uninsured it is sometimes tough to get the best care," Lanier said.

Shane Brogan, medical director of the Pain Management Center at the University of Utah, had not seen the study. But he said his clinic screens patients for substance abuse and requires them to pledge in writing to seek prescriptions only from the clinic. His office checks for doctor shopping if abuse is suspected.

He doesn't know of any of center patients who have died from an unintentional overdose. "If we are feeling the patient is misusing their medication, we're quick to confront the patient with that," he said.

St. Mark's Hospital Interventional Pain Center also screens for mental illness and substance abuse. Pain physician David Byrd said doctors need to be more wary of prescribing narcotics.

"Narcotics should not be the first line of treatment for pain," he said. "If anything they should be the last line. They carry such huge burdens."