Lisa Girion's slides from the Center for Health Journalism webinar, "Reporting on America’s Opioid Drug Crisis," 4.11.17 More info: https://www.centerforhealthjournalism.org/content/reporting-americas-opioid-drug-crisis

1. The problem
• Drugs--fueled largely by a surge in
prescription overdoses--kill more people each
year than traffic accidents.
• Prescription drug overdose is one of the few
types of preventable death in the U.S. that are
rising.
• Drugs most commonly involved are opioid
painkillers
• CDC calls it an epidemic

2. Conventional wisdom
• The problem is misuse and abuse from a
number of sources:
• "Diversion," pharmacy robberies, internet
• Teenagers/addicts stealing from Grandma's
medicine cabinet
• Teenagers/addicts stealing from medicine
cabinets at open houses
• Teenagers/addicts following old people home
from pharmacy and stealing from their
medicine cabinets

3. Sources
• News stories
• Medical literature
• Government drug abuse survey
• Mortality studies
• Opioid prescribing guides

4. NSDUH
• National Survey on Drug Use and Health:
widely referenced annual query of 70,000
people nationwide.
• More timely and, in some ways, more granular
than other sources, such as CDC mortality
data.
• Focuses on "misuse" and non-medical use.
• Misses some users; dead people don't
answer surveys.

5. NSDUH: painkillers
• Given by or purchased from friend or relative:
66.4%.
• Took from friend or relative without
asking:4.4%.
• Rx from one doctor: 18.1%
• Rx from more than one doctor:1.9%
• Drug dealer or stranger: 3.9%
• Internet: 0.3%

6. Death study
• 2008 study in JAMA looked at about 300
overdose deaths in West Virginia.
• Reported that 63% involved a "diverted" drug,
i.e. the decedent lacked a prescription for at
least one of the implicated meds.
• Did not report % that involved prescribed
drugs.

7. Our study
• 3,733 accidental deaths involving
prescription medications from 2006
through 2011 in Los Angeles, San Diego,
Orange and Ventura counties.

8. Our findings
• In 1,762 cases--47%--one or more drugs
prescribed for the deceased caused or
contributed to the death

9. The prescribers
• 71 doctors had three or more
patients die of prescription-
involved overdoses.
• All but a handful had clean
records.
• The doctor at the top of the
list had16 patients die of
overdoses.

10. The dead
• 71 doctors had total of 298 patients fatally
overdose
• Age range: 21 to 70; average: 48
• They included cops, nurses, teachers, wives,
husbands, mothers and fathers. They lived on
upscale cul-de-sacs, in rural trailer homes and
urban SROs.
• Some took an extra dose because they were
in pain. Many became dependent or addicted
after treatment for real injuries.

11. The drugs
• Hydrocodone (Vicodin,
Norco): 362
• Oxycodone (OxyContin,
Percocet): 237
• Alprazolam (Xanax): 211
• Methadone: 201
• Morphine: 191
• Diazepam (Valium): 174

12. The sources
• Coroners' reports--including opinion on cause,
investigators' narrative, toxicology results, ID
and demographic info on decedent, prescribed
drugs, prescriber info
• Licensing board records
• National Library of Medicine, U.S. Drug
Enforcement Administration

13. The method
• Collected records on accidental deaths
involving prescription overdose; included a few
suffocations and drownings caused by OD.
• Excluded suicides, traffic accidents and other
trauma-related deaths. Also excluded cases in
which the coroner noted the deceased
overdosed on drugs prescribed for someone
else.
• Cleaned up and organized data; sortable by
key variables, i.e. decedent attributes, cause,
toxicology, prescriber, drugs.