Comparing Unintentional OpioidPoisoning Mortality in Metropolitanand Non-Metropolitan Counties,United States, 1999-2003

摘要

Numerous reports have documented the rise in medical and non-medicaluse of opioids in the United States since the early 1990s. Geographic variationsin the medical and non-medical use of opioids have also been documented. Inthis chapter, vital statistics data from 1999 to 2003 were analyzed to describespatial patterns in opioid overdose mortality. Deaths associated with prescriptionopioids, including methadone, showed large increases during the study period inboth metropolitan and non-metropolitan areas. Despite previous research suggest-ing otherwise, metropolitan areas showed higher rates of accidental opioid overdosemortality than non-metropolitan areas. Between 1999 and 2003, the rate of fatalunintentional opioid overdose among 15- to 54-year-old residents of metropolitancounties increased from 3.85 to 5.45 per 100,000 per year, see Table 11.2. Amongresidents of non-metropolitan areas, the increase was from 1.65 to 5.01 per 100,000per year. Cocaine toxicity was much more likely to be mentioned as a contributingcause of death in metropolitan areas, odds ratio (OR) = 2.60 (95% CI: 2.37, 2.84),as was alcohol, OR = 1.34 [95% confidence interval (CI): 1.23, 1.45]. Benzodi-azepine toxicity was more likely in non-metropolitan areas, OR = 1.56 (95% CI:1.44, 1.70), as was toxicity due to anti-depressants, OR = 1.42 (95% CI: 1.28,1.57). Geographic variation in unintentional opioid mortality may be a function ofdrug availability and may be occurring in distinct populations in metropolitan andnon-metropolitan counties. Reasons for these differences are discussed, includingmethodological considerations.