Most overdose deaths in King County don't involve illegal drugs
While prescription drugs or alcohol have largely eclipsed illegal drugs as the leading cause of overdose deaths in King County, illegal drugs such as cocaine still cause many fatal overdoses, according to a new University of Washington study.
Seattle Times health reporter
Over the past 14 years, the number of people dying from prescription pain drugs has risen rapidly in King County, but last year — for the first time in a decade — that number took a sharp drop.
Caleb Banta-Green, a research scientist at the University of Washington's Alcohol and Drug Abuse Institute, presented the statistics to a national drug-abuse work group, which began a three-day meeting in Seattle on Wednesday.
Even with the one-year drop, over the past 14 years prescription drugs have largely displaced illegal drugs when it comes to overdose deaths.
In 1997, Banta-Green said, the vast majority of King County's drug-caused deaths involved at least one illegal drug.
By last year, though, the majority of such deaths did not involve illegal drugs. Most — 62 percent — involved only legal substances such as alcohol or prescription drugs, whether legally obtained or not.
Of the 240 drug-caused deaths in King County last year, 130 involved prescription-type opiates such as methadone, oxycodone, hydrocodone, fentanyl or morphine.
Methadone, which is often prescribed for pain and is also used as an opiate-substitute medication in treatment programs, was the prescription drug most often implicated in the deaths, said Banta-Green, who analyzed statistics from the King County Medical Examiner's Office. Other work has found that only a small percentage of those who died were enrolled in methadone drug-treatment programs.
About 85 percent of deaths involving prescription opiates in King County, Banta-Green noted, involve more than one drug — often a benzodiazepine sedative such as Valium (generic name diazepam) or Xanax (generic name alprazolam), alcohol, heroin or cocaine.
But illegal drugs still play a major role in drug deaths, with cocaine continuing to be a major drug of abuse and contributor to deaths (46 in 2010), Banta-Green said. A potentially deadly contaminant known as Levamisole was present in two-thirds of the cocaine seized by police in King County in 2010.
Banta-Green said the data revealed other troubling issues, among them the number of young adults using prescription opiates and heroin.
"Those people are very likely to continue to use and abuse," Banta-Green said. "I'm very concerned about what this means in the near future for overdoses." The number of young adults 18 to 29 in treatment programs for heroin rose 74 percent from 1999 to 2010, Banta-Green noted.
While fatal heroin overdoses dropped to 50 last year — from a high of 144 in 1998 — that may be a result of heroin purity now being low, Banta-Green said.
Alcohol, involved in 62 drug-caused deaths in King County in 2010, came close to the numbers involving methadone (65), while benzodiazepines were involved in 57 deaths and oxycodone (including OxyContin, the long-lasting version, and Percocet) in 33.
Prescription sales data from the federal Drug Enforcement Administration (DEA) show hydrocodone (for example, Vicodin or Lortab) has long topped the list of opiates sold in Washington. About 45 million doses were sold in 2010, with no apparent slowdown. "It's interesting that Vicodin just keeps on going," he said.
Hydrocodone is a moderate, short-acting pain drug often prescribed for such injuries as ankle pain or dental work. Pressure on prescribers not to prescribe the more powerful drugs such as OxyContin, Banta-Green speculated, may have pushed some to prescribe hydrocodone instead.
Sales of oxycodone and morphine drugs have leveled off in the past three years, Banta-Green noted.
Approximately 12,230 people are in treatment for opiate addiction in the state using methadone or Suboxone (buprenorphine) as substitute drugs.
Banta-Green said he is cautious about drawing conclusions. For example: The statistics showing that prescriptions for opiates are going down may be good or bad. It would be good if prescribers are making sure patients don't get drugs from multiple sources and are careful not to prescribe to patients who don't need them or might sell or give them to others.
But "if you're tamping down on people who truly need opiates, that's not good," he said, because it may mean pain patients are undermedicated and suffering as a result. .
In the past few years, there has been pressure from a number of sources, including the state workers' compensation program, Labor & Industries, as well as the state's Medicaid program, to stanch the flow of prescription opiates.
A new state law and rules adopted by medical-provider licensing boards will place new requirements on opiate prescribers. Several aspects of the law and rules have been criticized by advocates for pain patients, doctors and the Washington State Medical Association, among others.
Banta-Green is reporting on King County's experience to the National Institute on Drug Abuse's Community Epidemiology Work Group.
In addition to statistics from the King County Medical Examiner's Office, Banta-Green analyzed data from the DEA, the Washington Poison Center, Washington Division of Behavioral Health and Recovery, Public Health — Seattle & King County and the State Patrol crime lab.
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org
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