Drug combinations contributing to death according to mental health status

Abstract

In light of rising prescription drug overdose and mental illness rates, this study explores combinations of drugs resulting in death according to mental health status. This retrospective cohort study examined all drug overdose deaths occurring in Utah from 2005 through 2010 (2,843 total). Data were extracted from the records of the Office of the Medical Examiner. Frequencies, percentages, and rates were used to describe the decedents and bivariate analyses were performed and assessed using the chi-square test. Those with both mental and physical health problems were analyzed separately from those with mental health challenges alone in order to account for potential confounding. Half of drug overdose decedents had mental illness, 40% of whom also had physical health challenges. While most deaths overall involved combinations with opiates, only decedents with anxiety were significantly more likely to have had opiates implicated in their death (rate ratio [RR] = 1.60, 1.04–2.47), while those with schizophrenia were significantly less likely (RR = 0.51, 0.29–0.90). Decedents with bipolar disorder, depression, anxiety, or schizophrenia were more likely to have fatally overdosed on drug combinations involving antidepressants and non-prescription medication and those with mental but not physical illness were less likely to have done so with illicit drugs or alcohol. Mentally ill individuals who are currently taking prescription medication should be considered as an at-risk group in planning future drug interventions, as many drug combinations involved in their deaths were positively linked to drugs that are known to alleviate their symptoms and infrequently linked to illicit drugs or alcohol.

Keywords:

• death
• drug overdose
• illegal
• mental illness
• physical illness
• prescription

Acknowledgements

We thank the UDOH VIPP for help with data collection, the Chief Medical Examiner Todd Grey, MD, and the Utah State OME for death investigations and access to their data. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the UDOH. The authors have no conflicts of interest to report.