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

TABLE 3—

Studies Reporting Mortality Rates of Unintentional Drug Overdoses Worldwide, 1980–2013

Reference Type of Druga Location and Time Period Sample or Source Mortality Rate per 100 000 Person-Years, Crude Unless Noted
Duncan102 All substances United States, 1981 Division of Vital Statistics et al.b 3.1 (age-adjusted)
United States, 1982 3.1 (age-adjusted)
United States, 1983 3.1 (age-adjusted)
United States, 1984 3.2 (age-adjusted)
United States, 1985 3.5 (age-adjusted)
United States, 1986 4.0 (age-adjusted)
United States, 1987 3.8 (age-adjusted)
United States, 1988 4.2 (age-adjusted)
United States, 1989 4.1 (age-adjusted)
United States, 1990 3.6 (age-adjusted)
United States, 1991 3.8 (age-adjusted)
CDC71 All substances United States, 2001 CDC, National Center for Injury Prevention and Control 7.8
Paulozzi et al.73 All substances United States, 2004 NVSS 7.8
Warner et al.103 All substances United States, 2008 NVSS 9.2 (age-adjusted)
CDC6 All substances United States, 2010 CDC; female rate 9.8
Merrall et al.104 All substances Scotland, 1996–2000 Scottish Drug Misuse Database cohortc 498 (95% CI = 454, 545)
Scotland, 2001–2005 357 (95% CI = 334, 381)
Shah et al.78; Mueller et al.79 All substances New Mexico, 1990–2005 New Mexico Office of the Medical Investigator 10.4 (age-adjusted)
Shah et al.105 All substances New Mexico, 2005–2009 New Mexico Office of the Medical Investigator 17.6 (95% CI = 16.8, 18.5; age-adjusted)
Socie et al.84 All substances Ohio, 2008 CDC WISQARS Fatal Injury Reports; Ohio Department of Vital Statistics 13.7
Wunsch et al.76 All substances Metropolitan Virginia, 1997–2003 Office of the Medical Examinerd 6.77 (95% CI = 6.12, 7.42)
Micropolitan Virginia, 1997–2003 7.68 (95% CI = 6.16, 9.20)
Rural Virginia, 1997–2003 10.76 (95% CI = 9.67, 11.85)
Farrell and Marsden106 All substances England and Wales, 1998–2003 National sample of prisonerse: men 520 (converted)
National sample of prisonerse: women 590 (converted)
EMCDDA5 All substances European Union, 2010 EMCDDA; population aged 15–64 y 2 (converted)
Marshall et al.107 Illicit drugs British Columbia, 2001–2005 British Columbia Coroners Servicef 4.38 (95% CI = 4.10, 4.67)
Cocaine 2.58
Milloy et al.108 Illicit drugs British Columbia, 2001–2005 British Columbia Coroners Service 4.84 (age-adjusted)
Among those with First Nations identity 13.3 (age-adjusted)
Harlow109 Narcotics (heroin, morphine, dilaudid, etc.) Texas, 1976–1987 Medical examiner or death certificates filed with the Texas Department of Health 0.13–0.92
Cocaine Texas, 1983–1987 0.04–0.09
Galea et al.22; Coffin et al.110 Cocaine, opioids, alcohol New York, NY, 1990–1998 Office of the Chief Medical Examiner of NYCg 7.3–13.3
Torralba et al.111 Cocaine and opioids Barcelona, Spain, 1989–1993 City residents in the age group 15–49 y; used the Forensic Institute, and the Sistema d’Informacio de Drogues de Barcelona 15.3 (95% CI = 14.1, 16.5; age- and sex-adjusted)
Marzuk et al.112 Cocaine and opioids New York, NY, 1990–1992 Office of the Chief Medical Examiner of NYC and Census data 1.27 (Upper East Side; age-adjusted); 38.76 (Central Harlem; age-adjusted)
Tardiff113 Cocaine without opioids New York, NY, 1990–1992 Office of the Chief Medical Examiner of NYC and Census data 2.86
Opioids without cocaine 2.29
Cocaine and opioids 3.42
Cerdà et al.2 Cocaine New York, NY, 1993–1995 Office of the Chief Medical Examiner of NYC 15.5 (age-adjusted)
Heroin 14.1 (age-adjusted)
Prescription analgesics New York, NY, 2006 2.7 (age-adjusted)
Methadone 4.4 (age-adjusted)
Stenbacka et al.114 Illicit drugs Stockholm, Sweden, 1967–2003 Users with substance abuse problems (n = 1705)h 277 (95% CI = 258, 295; converted; all-cause)
Evans et al.56 Injection drugs San Francisco, CA, 1997–2007 UFO (“U Find Out”) Studyi 912 (95% CI = 663, 1253; converted; all-cause)
Vlahov et al.115 Injection drugs 5 US cities,j 1997–2002 Collaborative Injection Drug Users Studyj 7.1
Marshall et al.96 Injection drugs Vancouver, Canada, 2001–2003 British Columbia Coroners Service 253.8 (95% CI = 187.3, 320.3; standardized)
2003–2005 165.1 (108.8, 221.4; standardized)
Hickman et al.116 Injection drugs Bristol, England, 2005–2006 Respondent driven sampling and local Office for National Statistics mortality files; among drug users 400 (converted)
Manfredi et al.117 Injection drugs Bologna, Northeastern Italy, 1977–2002 Open cohort of 1214 IDUs, mostly heroin addicts, referring to a specialized outpatient center 451.8 (converted)
Miller et al.118 Injection drugs Vancouver, BC, 1996–2004 Vancouver Injection Drug User Studyk 1368 (all-cause)
Wang et al.119 Injection drugs Baltimore, MD, 1988–2001 ALIVE cohort study: 1927 actively IDUs HIV seronegative at baseline (308 later HIV seroconverted) 1390 (converted)
ALIVE cohort study, but among seronegative drug users 560 (converted)
Brettle et al.120 Injection drugs Edinburgh, Scotland, 1986–1994 HIV-positive patients from the Edinburgh City Hospital cohort records 1120 (converted)
Calcaterra et al.92 Heroin United States, 2007 CDC WONDER Database; 15- to 64-year-old individuals 1.05 (95% CI = 1.00, 1.09)
United States, 2009 1.43 (95% CI = 1.38, 1.48)
Darke et al.41 Heroin Sydney, Australia, 2001–2009 Australian Treatment Outcome Study cohort of 615 heroin usersl 643 (95% CI = 437, 913; converted)
Davidson et al.121 Heroin San Francisco, CA, 1997–2000 Medical examiner’s case files, Census data 14.29
Ruttenber and Luke122 Heroin District of Columbia, 1981 Deaths associated with injected street preparations of heroin (population-based) 17.4
Calcaterra et al.92 Pharmaceutical opioids United States, 1999 CDC WONDER Database; 15- to 64-year-old patients 1.54 (95% CI = 1.49, 1.60; age-adjusted)
United States, 2009 6.05 (95% CI = 5.95, 6.16; age-adjusted)
CDC7 Opioid painkillers Washington State, 2006 CDC; health and human services agencies in WA 6.4
CDC; health and human services agencies in WA, but among only Medicaid-enrolled population 30.8 (age-adjusted)
Fingerhut et al.81 Methadone United States, 2005 NVSS 1.5
CDC87 Methadone United States, 2007 NVSS 1.8
CDC123 Methadone United States, 2009 NVSS 1.5
Soyka et al.124 Methadone and buprenorphine Munich, Germany 2694 opioid-dependent patients in substitution treatment through the COBRA study 1040 (converted; all-cause)
CDC82 All substances Florida, 2009 Florida Medical Examiners Commission 15.7
Prescription drugs 13.4
Illicit drugs 3.4
Hall et al.125 Prescription drugs West Virginia, 2006 Population-based, observational studym 16.2
Niveau et al.126 Opioids Geneva, Switzerland, 1999 Cantonal Office of Statistics 3.19
Albert et al.127 Opioids Wilkes County, NC, 2009 Before Project Lazarus 46.6
North Carolina, 2009 11.0
Bird128 Opioids European Union,n 1990s Combination of 6 European cohortsn 870 (95% CI = 810, 940; converted)
Bargagli et al.129 Opioids Barcelona, Spain, 1990 Cohorts recruited through EMCDDA protocol 1296 (converted)
Denmark, 1990 707 (converted)
Dublin, Ireland, 1990 309 (converted)
Lisbon, Portugal, 1990 112 (converted)
London, England, 1990 737 (converted)
Rome, Italy, 1990 664 (converted)
Vienna, Austria, 1990 661 (converted)
Clausen et al.130 Opioids Norway, 1997–2003 3789 opioid-dependent userso 2100 (converted) after treatment
Shah et al.131 Opioids England and Wales, 1993–1998 Coroners’ files; men 3.7 (converted)
Coroners’ files; women 0.94 (converted)
Scott et al.95 Illicit opioids Chicago, IL, 2002p Illinois master death files, 1999–2003, and Chicago Real Time Death Surveillance System 2003p 33.0–35.0
Morgan et al.132 Antidepressants England and Wales, 1993 Coroners’ files 0.9 (converted; age-adjusted)
England and Wales, 2002 0.7 (converted; age-adjusted)
Rocchi et al.133 Illicit drugs Italy, 1984–2000 Direzione Centrale per i Servizi Antidroga of the Italian Ministry of the Interior; men aged 15–44 y 6.6 (range = 1.6–11.3) avg per year
Direzione Centrale per i Servizi Antidroga of the Italian Ministry of the Interior; women aged 15–44 y 0.7 (range = 0.3–1.1) avg per year
Fischer et al.134 Fentanyl Ontario, 2009 Provincial coroners’ data (all standardized) 0.44
British Columbia, 2009 0.11
Hydromorphone Ontario, 2009 0.24
British Columbia, 2009 0.45
Morphine Ontario, 2009 0.55
British Columbia, 2009 2.94
Oxycodone Ontario, 2009 1.09
British Columbia, 2009 0.70

Note. ALIVE = AIDS Linked to the Intravenous Experience; CDC = Centers for Disease Control and Prevention; CI = confidence interval; COBRA =  Cost-Benefit and Risk Appraisal of Substitution Treatments study; EMCDDA = European Monitoring Centre for Drugs and Drug Addiction; IDU = injecting drug user; NVSS = National Vital Statistics System; NYC = New York City; WISQARS = Web-Based Injury Statistics Query and Reporting System; WONDER = Wide-Ranging Online Data for Epidemiologic Research.

a

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

b

Division of Vital Statistics of the US Public Health Service, death certificates, and Drug Enforcement Administration’s annual budget.

c

Scottish Drug Misuse Database cohort (treatment sample), matched with General Register Office for Scotland.

d

Retrospective, population-based review of medical examiner cases in the Office of the Medical Examiner.

e

National sample of 48 771 sentenced prisoners released during 1998–2000 with all recorded deaths included to November 2003.

f

All unnatural, unexpected, or unattended deaths in the province (n = 904).

g

All cases of fatal accidental drug overdose occurring in individuals aged 15–64 years.

h

Users were identified through records in Stockholm in 1967; these individuals were followed in registers recording mortality and cause of death and in patient care stays until 2003.

i

UFO (“U Find Out”) Study comprised 644 injection drug users aged < 30 y, recruited by peer outreach workers with study invitation cards and flyers, contacts with youth-friendly neighborhood groups and community providers, and word of mouth; had to have self-reported use of injection drugs in the past 30 days.

j

Collaborative Injection Drug Users Study comprised community-based, recent onset (< 5 y) injection drug users aged 18–35 years (n = 2089) from 5 US cities: Baltimore, MD; Chicago, IL; Los Angeles, CA; New Orleans, LA; and New York, NY.

k

Self-referral and street outreach from the Downtown Eastside, one of Vancouver’s poorest neighborhood: injection drug users aged 14–29 y (n = 572).

l

Australian Treatment Outcome Study cohort consists of entrants to treatment of heroin dependence in opioid maintenance, detoxification, and residential rehabilitation; in addition, a group of heroin users not currently in treatment were recruited from needle and syringe programs in the regional health areas from which treatment entrants were recruited.

m

Population-based (all state residents who died of unintentional pharmaceutical overdoses), observational study using data from medical examiner, prescription drug monitoring program, and opioid treatment program records.

n

Combination of 6 European cohorts who were recruited according to a common EMCDDA protocol from drug treatment agencies in Barcelona, Spain; Denmark; Dublin, Ireland; Lisbon, Portugal; Rome, Italy; and Vienna, Austria.

o

3789 opioid-dependent users who applied for and were accepted for opioid maintenance therapy (cross-linked with the Norwegian death register).

p

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. These communities’ average poverty rate is 43%, 2 times that of the rest of the city.