Deaths with drugs as contributing factor are rising dramatically

While many people focus on the role of drugs in overdose deaths, a recent study shows that deaths where drugs were a contributing cause are also on the rise.

In fact, at the same time deaths from many causes are showing a decline in the United States, the proportion of them that involve drugs is often increasing dramatically.

The death rate from accidents and suicides in which drugs played a contributing role increased fivefold between 1999 and 2019, the study found. The death rate from diseases and medical conditions in which drugs played a role increased 2.5 times in that same period.

"That's an incredible and very concerning increase," said Mike Vuolo, co-author of the study and associate professor of sociology at The Ohio State University.

"There's an understandable focus on overdose deaths, but we shouldn't overlook the number of deaths in this country where drugs play a contributing role, even if they aren't listed as the main cause."

Vuolo, who is also a core faculty member of Ohio State's Translational Data Analytics Institute, conducted the study with Brian C. Kelly, professor of sociology at Purdue University, and Laura Frizzell, a graduate student in sociology at Ohio State. Their results appear in the September 2021 issue of the journal Drug and Alcohol Dependence.

The study is based on the fact that when medical examiners and coroners rule on the cause of death they list the "underlying cause"—the main reason the person died—but can also list up to 10 other factors that contributed.

The researchers used the CDC WONDER Multiple Cause of Death database for a 21-year period, 1999 to 2019, which contains every death in the United States.

They examined deaths where the underlying cause was not listed as a drug overdose, but which listed drugs as a contributing cause. That usually means drugs were present in the body at the time of death.

During the time period covered in the study, there were 649,697 deaths with drug overdose listed as the cause. But there were another 51,466 deaths where drugs were a contributing factor.

"Drugs as a contributing cause increases the death toll from drugs nearly 8% beyond overdose deaths alone," Vuolo said.

The most striking statistics were the changes in the proportion of deaths that were related to drugs in some categories, especially among accidents, Vuolo said.

For example, while the number of deaths per year from vehicle-related crashes declined between 1999 and 2019, the proportion that involved the use of drugs rose more than 11 times—from 1 in 901 crashes in 1999 to 1 in 78 crashes in 2019.

Accidental drownings were another example. In 1999, 1 in 104 drownings listed drug use as a contributing factor.

"But drugs contributed to a staggering 1 in 13 drownings in 2019," Vuolo said.

Similar findings were found in many medical conditions. In 1999, about 1 in 1,564 deaths involving diseases of the circulatory system—mostly heart disease—had drugs as a contributing factor. That increased to 1 in 434 in 2019.

"We actually had a decline in the number of people who died of diseases of the circulatory systems in the U.S. between 1999 and 2019, even though our population increased," he said.

"Much of that has to do with advances in medicine and fewer people smoking. But those numbers might be even better if we didn't have an issue with drug use."

While many of the same drugs that are commonly linked to overdose deaths, such as heroin and fentanyl, are also listed as contributing factors, other drugs getting less attention in overdoses also play a role.

In recent years, psychostimulants such as methamphetamine and prescription stimulants have become the predominant drugs listed as contributors to non-overdose deaths in the United States, the findings showed.

Overdose deaths from psychostimulants are getting more attention now, Vuolo said, but these findings show that they are also important as contributing factors in many deaths.

"What our study does is give a broader picture of the drug mortality crisis that is not captured just by looking at overdoses," he said.

"And it means that we can't handle the crisis just by focusing on preventing overdoses. We need a broader policy."