. 2015 Nov;105(11):e29–e49. doi: 10.2105/AJPH.2015.302843

TABLE 2—

Studies Reporting Trends Across Time in Unintentional Overdose Worldwide, 1980–2013

Reference	Type of Drug^a	Location and Time Period	Sample or Source	Measure	Trend or Change
CDC⁷¹	All substances	United States, 1990–2001	CDC, National Center for Injury Prevention and Control	Overdose death rate	56% increase
		11 US states,^b 1990–2001			145% average increase (range = 28%–325% [FL = 325%])
White et al.¹¹	All substances	United States, 1999–2008	Nationwide inpatient sample^c	Hospitalization rates	55% increase
Paulozzi et al.⁷²	All substances	United States, 1990–2003	National Center for Health Statistics: Whites	Drug-induced death rate	189% increase
			National Center for Health Statistics: African Americans		64% increase
Paulozzi et al.⁷³	All substances	United States, 1999–2004	NVSS	Unintentional and undetermined drug poisoning mortality rates	62.0% increase
			NVSS, metropolitan counties only		51.0% increase
			NVSS, nonmetropolitan counties only		159% increase
Degenhardt et al.⁷⁴	All substances	New South Wales, Australia, 2001	Multiple^d	Drug-related deaths that appeared to be driven by the reduction in heroin supply	43% decrease
		Victoria, Australia, 2001			85% decrease
Edwards et al.⁷⁵	All substances	Vermont, 2006–2009	Medical Examiner’s Office	Drug-induced death rate	27.4% increase
		Vermont, 2009–2010			16.0% decrease
Wunsch et al.⁷⁶	All substances	Western Virginia, 1997–2003	Retrospective, population-based review of medical examiner cases	Deaths with a direct or contributing cause of drugs	300% increase
Hammersley et al.⁷⁷	All substances	Glasgow, Scotland, 1991–1992	The Department of Forensic Medicine and Science Laboratory	Drug-induced death rate	400% increase
Shah et al.⁷⁸; Mueller et al.⁷⁹	All substances	New Mexico, 1990–2005	New Mexico Office of the Medical Investigator	Unintentional drug overdose death numbers and rates	176.8% increase
Paulozzi et al.⁸⁰	All substances	United States, 1979–1990	NCHS	Unintentional drug poisoning mortality rates	5.3% increase (average per year)
		United States, 1990–2002			18.1% increase (average per year); 217.6% total
	Opioid analgesics without heroin and cocaine	United States, 1999–2002		Number of poisonings on death certificates	129.2% increase
	Heroin				12.4% increase
	Cocaine				22.8% increase
Fingerhut et al.⁸¹	All substances	United States, 1999–2005	NVSS	Number of poisoning deaths	65.6% increase
	Methadone				467.7% increase
	Heroin				2.4% increase
	Other opioids				110% increase
	Cocaine				62.5% increase
	Cannabis				202.7% increase
CDC⁸²	All substances	Florida, 2003–2009	Florida Medical Examiners Commission	Overdose death rate	47.5% increase
	Prescription drugs				84.2% increase
	Illicit drugs				21.4% decrease
Madden and Shapiro⁸³	All substances	Vermont, 2001–2006	Retrospective review of the Vermont Office of the Chief Medical Examiner	Overdose deaths	400% increase
	Methadone			Proportion of overall deaths that include methadone	300% increase
Socie et al.⁸⁴	All substances	United States, 1996–2006	CDC WISQARS Fatal Injury Reports” (WISQARS = Web-Based Injury Statistics Query and Reporting System)	Poisoning death rate	74% increase
		Ohio, 1996–2006			178% increase
		Ohio, 1999–2008			325% increase
Wells et al.⁸⁵	All substances	England and Wales, 2007–2008	National Statistics database	Drug poisoning deaths, men	8% increase
				Drug poisoning deaths, women	17% increase
	Heroin and morphine			Drug poisoning deaths, women	8% increase
	Cocaine			Drug poisoning deaths, women	20% increase
CDC⁶	All substances	United States, 1999–2010	CDC	Drug poisoning deaths, women	151% increase
				Drug poisoning deaths, men	85% increase
	Opioids			Drug poisoning deaths, women	500% increase
Wisniewksi et al.⁸⁶	Oxycodone	United States, 1995–2002	Consolidated from the Drug Abuse Warning Network database^e	Emergency department visits	560% increase
	Morphine				116% increase
	Hydrocodone				160% increase
Cerdà et al.²	Prescription analgesics	New York, NY, 1990–2006	Office of the Chief Medical Examiner of NYC	Overdose death rate	700% increase
CDC⁸⁷	Methadone	United States, 1999–2009	NVSS	Overdose death rate	550% increase
Hawton et al.⁸⁸	Coproxamol	England and Wales, 1998–2010	Office for National Statistics	Number of overdose deaths after withdrawal of coproxamol	62% decrease (after intervention)
The DAWN Report⁸⁹	Prescription drugs	United States, 2004–2011	Drug Abuse Warning Network database	Emergency department visits	232.5% increase
Green et al.⁹⁰	Opioids	Connecticut, 1997–2007	Connecticut Office of the Chief Medical Examiner	Absolute number of overdose deaths	44% increase
				Overdose deaths with toxicological data	80% increase
	Methadone			Overdose deaths	379% increase
Degenhardt et al.⁹¹	Opiods	New South Wales, Australia, 1999–2001	Australian Bureau of Statistics, et al.^f	Opioid deaths	60% decrease
		2000–2002		Presentations of opioid overdose to emergency departments	45% decrease
Calcaterra et al.⁹²	Pharmaceutical opioids	United States, 1999–2009	CDC WONDER Database; 15- to 64-year-old patients	Age-adjusted death rate	292.9% increase
Cochella et al.⁹³; Johnson et al.⁹⁴	Prescription opioids	Utah, 2007–2008	Intervention^g	Medication-related overdose deaths following program implementation	14.0% decrease (after intervention)
Scott et al.⁹⁵	Illicit opioids	Chicago, IL, 2000–2003	Death certificates^h	Incidence of fatal overdose	34% decrease
Marshall et al.⁹⁶; Wood et al.⁹⁷	Injection drugs	Vancouver, BC, 2001–2005	British Columbia Coroners Service	Overdose death rates after opening of first medically supervised safe-injection facility	35% decrease (after intervention)
Friedman⁹⁸	Heroin and fentanyl	Illinois, 2006–2005	Poison Control data	Heroin-related calls	63.6% increase
Schwartz et al.⁹⁹	Heroin	Baltimore, MD, 1995–2002 vs 2003–2009	Baltimore City Health Department	Average annual heroin overdose deaths (after buprenorphine became available)	37% decrease
Maxwell et al.¹⁰⁰	Heroin	Chicago, IL, 1996–2000	The Chicago Recovery Alliance, The Medical Examiner of Cook County	Opioid overdose deaths	400% increase
		Chicago, IL, 2000–2001		After prevention program started providing naloxone	20% decrease (after intervention)
Neeleman and Farrell¹⁰¹	Heroin alone	England and Wales, 1974–1992	Office of Population Censuses and Surveys tabulations	Lethal self-poisonings (including accidental, suicidal, and unknown)	1186% increase
	Methadone with or without heroin		Office of Population Censuses		823% increase

Note. CDC = Centers for Disease Control and Prevention; NCHS = National Center for Health Statistics; NVSS = National Vital Statistics System; NYC = New York City; WONDER = Wide-Ranging Online Data for Epidemiologic Research.

^{^a}

All substances = opioid and nonopioid substances, both pharmaceutical and illicit, including alcohol.

^{^b}

Colorado, Delaware, Kentucky, New Mexico, Florida, Massachusetts, North Carolina, Oregon, Washington, Utah, Wisconsin.

^{^c}

Designed to approximate a 20% sample of US community hospitals as defined by the American Hospital Association. Poisoning and nondependent abuse of alcohol and drugs in patients aged 18–24 years.

^{^d}

Hospital emergency departments, ambulance services, and coroner’s systems; treatment entries for heroin dependence compiled by state health departments; numbers of needles and syringes distributed to drug users; and data on arrests for heroin-related incidents and property-related crime incidents compiled by State Police Services.

^{^e}

Medical record and toxicology screening data from a nationally representative hospital sample.

^{^f}

Australian Bureau of Statistics and the Division of Analytical Laboratories, Institute of Clinical Pathology and Medical Research, Western Sydney Area Health Service, the Ambulance Service of New South Wales Case Sheet Database, and other emergency department data.

^{^g}

“Presentations highlighting six recommended prescribing practices were developed and presented to health care workers. Participants were encouraged to utilize the state prescription database and to complete a series of surveys assessing confidence and behavior changes at 0, 1, and 6 months post-presentation. Continuing medical education credits incentivized participation.”⁹³^(pS73)

^{^h}

Manually screened death certificates from the Illinois Department of Public Health master death files, 1999–2003, and the Chicago Real Time Death Surveillance System, 2003.