Death from analgesic overdose, including the painkillers oxycodone and codeine, is more concentrated in economically disadvantaged neighborhoods with a prevalence of high divorce, single-parent homes than deaths from unintentional causes, according to research conducted at Columbia University's Mailman School of Public Health. Yet, compared to heroin overdose deaths, analgesic overdoses were found to occur in higher-income neighborhoods. This study is among the first to provide a framework that helps explain the geographical distribution of analgesic overdose in urban areas.
Findings are highlighted online in the October 17th American Journal of Public Health.
Rates of fatal overdoses caused by analgesic opioids have increased dramatically in the United States over the past 5 years. The prevalence of nonmedical analgesic drug abuse is second only to that of marijuana abuse. While research up to now has focused on the role of individual characteristics, scientists are recognizing that the environment increasingly plays a joint role to influence the risk of substance abuse including neighborhood characteristics and family fragmentation.
In the case-control study, researchers led by Magdalena Cerda, DrPH, assistant professor of Epidemiology, analyzed data from the Office of the Chief Medical Examiner of New York City, to determine the role of neighborhood characteristics, including income distribution, quality of built environment and family fragmentation, in analgesic overdose deaths. They compared 447 unintentional analgesic opioid overdose fatalities with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities occurring in 59 New York City neighborhoods between 2000 and 2006. The non-overdose accidental deaths included instances like drownings, poisonings, falls and other accidents.
Results from the study showed that while analgesic overdose deaths were almost one and a quarter times less likely to occur in higher-income neighborhoods compared to non-overdose accidental deaths, they were nearly one and a half times more likely to occur in higher-income neighborhoods than deaths from heroin overdose. Analgesic overdose deaths also occur in neighborhoods with a higher prevalence of divorced and single-parent homes than non-overdose fatalities, but they occur in neighborhoods with less divorce and single-parent homes than heroin fatalities. In neighborhoods with a higher concentration of fragmented families, there may be greater opportunity for diversion and trafficking of analgesics obtained from legitimate prescription users, noted Dr. Cerda.
"Given the increasing rates of analgesic overdose fatalities and the systematic distribution of overdose risk across urban neighborhoods, there is a critical need for research that identifies the particular neighborhood mechanisms that may distinguish the risk of analgesic overdose from that of illicit drug overdose," said Dr. Cerda.