Increasing deaths from opioid analgesics in the United States: An evaluation in an interventional pain management practice

Kavita n. Manchikanti, BA; Laxmaiah Manchikanti, MD; Kimberly S. Damron, RN; Vidyasagar Pampati, MSc; Bert Fellows, MA

doi:10.5055/jom.2008.0031

Authors

Kavita n. Manchikanti, BA
Laxmaiah Manchikanti, MD
Kimberly S. Damron, RN
Vidyasagar Pampati, MSc
Bert Fellows, MA

DOI:

https://doi.org/10.5055/jom.2008.0031

Keywords:

drug poisoning deaths, opioids, benzodiazepines, nonmedical use of prescription drugs, psychotherapeutic drugs, hydrocodone, methadone

Abstract

Objective: To assess the prevalence of opioid-related deaths in patients in an interventional pain management tertiary referral center.
Methods: Patient deaths from March 2003 to February 2007 were evaluated.
Results: From March 2003 to February 2007, 2,179 patients were receiving opioids in 2003, 2,445 in 2004, 2,804 in 2005, and 2,965 in 2006, respectively. Overall, 86 percent of the patients were referred by a physician and 90 percent of patients received interventional techniques. There were a total of 91 deaths, of which 60 were categorized as natural deaths, 25 were characterized as accidental deaths, and 6 were characterized as suicidal. Of the 18 drug poisoning deaths, 5 deaths were positively related to prescription drugs, 7 deaths were probably related to prescription drugs, and 6 deaths had no relation to the prescription drugs provided. Total opioidrelated deaths were 12 over this 4-year period with 0.46 in 2003, 2.04 in 2004, 2.85 in 2005, and 1.35 in 2006 per 1,000 population. In contrast, deaths definitely related to prescription opioids were 5 (0.92 per 1,000) over a period of 4 years. In the suicidal group, there were a significantly higher proportion of patients with generalized anxiety disorder.
Conclusions: In an interventional pain management practice (a tertiary referral center), the total prevalence of opioid-related deaths varied from 0.46 to 1.78 per 1,000 from 2003 to 2006 with a total of 12 deaths over a period of 4 years. The deaths definitely related to opioid prescriptions were 5 with a rate of 0 to 1.43 per 1,000 over a period of 4 years.

Author Biographies

Kavita n. Manchikanti, BA

Research Assistant, Pain Management Center of Paducah, Paducah, Kentucky; Medical Student, University of Kentucky, Lexington, Kentucky.

Laxmaiah Manchikanti, MD

Medical Director, Pain Management Center of Paducah, Paducah, Kentucky; Associate Clinical Professor of Anesthesiology and Perioperative Medicine, University of Louisville, Kentucky.

Kimberly S. Damron, RN

Assistant Nursing Administrator, Pain Management Center of Paducah, Paducah, Kentucky.

Vidyasagar Pampati, MSc

Statistician, Pain Management Center of Paducah, Paducah, Kentucky.

Bert Fellows, MA

Director Emeritus of Psychological Services, Pain Management Center of Paducah, Paducah, Kentucky.

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