Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98

TLDR

Accidental drug overdose is a major cause of death among drug users, and multi‑drug use is a key risk factor for overdose mortality. The study examined how combinations of multiple drugs contributed to overdose mortality trends in New York City from 1990 to 1998 using OCME death records. The authors standardized yearly overdose death rates by age, sex, and race to the 1990 NYC census and identified opiates, cocaine, and alcohol as the three most common drugs responsible for 97.6 % of deaths, with 57.8 % involving two or more of these drugs in combination. Overdose deaths rose from 1990–1993 and fell slightly from 1993–1998; the decline was largely due to reduced multi‑drug combination deaths while single‑drug rates stayed stable, and patterns varied across gender and racial/ethnic groups, indicating that interventions should target combined use of heroin, cocaine, and alcohol.

Abstract

Accidental drug overdose contributes substantially to mortality among drug users. Multi-drug use has been documented as a key risk factor in overdose and overdose mortality in several studies. This study investigated the contribution of multiple drug combinations to overdose mortality trends.We collected data on all overdose deaths in New York City between 1990 and 1998 using records from the Office of the Chief Medical Examiner (OCME). We standardized yearly overdose death rates by age, sex and race to the 1990 census population for NYC to enable comparability between years relevant to this analysis.Opiates, cocaine and alcohol were the three drugs most commonly attributed as the cause of accidental overdose death by the OCME, accounting for 97.6% of all deaths; 57.8% of those deaths were attributed to two or more of these three drugs in combination. Accidental overdose deaths increased in 1990-93 and subsequently declined slightly in 1993-98. Changes in the rate of multi-drug combination deaths accounted for most of the change in overdose death rates, whereas single drug overdose death rates remained relatively stable. Trends in accidental overdose death rates within gender and racial/ethnic strata varied by drug combination suggesting different patterns of multi-drug use among different subpopulations.These data suggest that interventions to prevent accidental overdose mortality should address the use of drugs such as heroin, cocaine and alcohol in combination.