Drug poisoning in the US

Information on drug poisoning suicide deaths in the US is not available at a very granular level. However, the following table1 does give a breakdown of 2012 suicide drug poisoning deaths:

Method

No.

%

Other and unspecified drugs, medicaments and biological substances

3,632

54.0%

Other gases and vapours

1,003

14.9%

Anti-epileptic, sedative-hypnotic, anti-parkinsonism and psychotropic drugs, not elsewhere classified

969

14.4%

Narcotics and psychodysleptics [hallucinogens], not elsewhere classified

662

9.8%

Non-opioid analgesics, antipyretics and anti-rheumatics

160

2.4%

Organic solvents and halogenated hydrocarbons and their vapours

126

1.9%

Other and unspecified chemicals and noxious substances

78

1.2%

Alcohol

47

0.7%

Other drugs acting on the autonomic nervous system

42

0.6%

Pesticides

10

0.1%

Total

6,729

 

According to the CDC1, 81% of intentional poisoning suicides were caused by drugs - both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications1. Self-harm poisoning was the leading cause of emergency department visits for intentional injury in 20102.

In 2011, it was estimated by SAMHSA3 that attempted suicide led to 228,366 emergency department (ED) visits. Almost all involved a prescription drug or over-the-counter medication. It is worth noting that with only 5,465 actually succeeding in suicide using drugs, it means there were 42 ED visits for every successful suicide. Sobering odds of success, and there are probably lots of attempts that don’t even end up in hospital.

Most patients attempting drug-related suicide had some form of follow-up after their ED visit, with the outcomes of their ED visits as follows:

  • 49% were admitted for inpatient hospital care (18.3% to an intensive or critical care unit [ICU]), 9% to a psychiatric unit, and 22% to other units including combination psychiatric/detox units)
     
  • 25% were transferred to another health care facility for specialist treatment
     
  • 7% were referred to detox/treatment
     
  • 15% treated and discharged to home

Evidence suggests that alcohol had been ingested in around a third of people who died by suicide, and in 29% of those admitted to ED departments. In nearly two thirds of cases more than one drug was involved.

Pain relievers were found to be involved in 38% of drug-related suicide attempts. Narcotic pain relievers were involved in over a third of that number, and cetaminophen products were involved in just under a third.

Benzodiazepines (anti-anxiety drugs) were found to be involved in 29.3% of drug - related suicide attempts. Alprazolam (Xanax) and clonazepam each accounted for about a third.

Antidepressants appeared in 19.6% of visits. About half of those visits involved an SSRI antidepressant such as citalopram, sertraline, or fluoxetine. Trazodone, a SARI antidepressant, was involved in about a quarter.

Antipsychotics, as a whole, appeared in 12.9% of visits, with the vast majority being the newer types of atypical anti-psychotics e.g. Quetiapine.

The American Association of Poison Control Centers (AAPCC)4 publishes data on phone calls they receive into their 55 centers which are designed to track the incidence of poison exposure (both intentional and unintentional) nationally. In 2012 they recorded 2,873 deaths by poisons (itself some way short of the figures provided by US Department of Health and Human Services for suicide alone), and the table below shows the drugs that appeared most frequently as the cause of death by poisoning.

Top 25 substance categories associated with deaths reported by 55 U.S. Poison Centers 2012

Substance

No.

%

Sedative/hypnotics/antipsychotics

377

14.1%

Miscellaneous cardiovascular drugs

350

12.2%

Opioids

255

8.9%

Acetaminophen (paracetamol) in combination

183

6.4%

Miscellaneous stimulants and street drugs

176

6.1%

Acetaminophen (paracetamol) only

159

5.5%

Miscellaneous alcohols

145

5.0%

Miscellaneous antidepressants

126

4.4%

Selective serotonin reuptake inhibitors

89

3.1%

Miscellaneous antihistamines

69

2.4%

Tricyclic antidepressants

69

2.4%

Miscellaneous fumes/gases/vapors

67

2.3%

Acetylsalicylic acid

65

2.3%

Miscellaneous muscle relaxants

57

2.0%

Miscellaneous anticonvulsants

56

1.9%

Oral hypoglycemic

56

1.9%

Non-nonsteroidal anti-inflammatory drugs

50

1.7%

Miscellaneous unknown drug

44

1.5%

Miscellaneous unknown drugs

44

1.5%

Miscellaneous chemicals

33

1.1%

Miscellaneous hormones and hormone antagonists

31

1.1%

Anticonvulsants: gamma aminobutyric acid & analogs

29

1.0%

Miscellaneous anticoagulants

23

0.8%

Miscellaneous diuretics

23

0.8%

Cannabinoids and analogs

20

0.7%

Miscellaneous hydrocarbons

19

0.7%

It should be noted that these percentages from their source do not add up to 100% as they are only the top 25 causes. It should also be noted that the above figures each represent the number of mentions in cause of death, not number of deaths. Any one fatality may have had exposure to more than one substance. Indeed, consistent with data from SAMHSA, the breakdown of drugs shown for many of the fatalities reported by AAPCC showed more than one drug.

Sources

  1. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (WISQARS), fatal injuries report figures (http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html).

  2. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables (10 and 17) (www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf). See also Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (NCIPC), Prescription Drug Overdose in the United States: Fact Sheet www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.

  3. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. Drug Abuse Warning Network (DAWN): National estimates of drug-related emergency department visits for 2011, Table 22 (www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf).

  4. James B Mowry, PHARMD; Daniel A Spyker PHD, MD; Louis R Cantilena  JR, MD, PHD; J Elise Bailey MSPH; and Marsha Ford MD; 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report, Clinical Toxicology vol. 51 Oct 2013 (available from www.aapcc.org/annual-reports).