Search

AIMS: Accidental drug overdose contributes substantially to mortality among drug users. Multi-drug use has been documented as a key risk factor in overdose and overdose mortality in several studies. This study investigated the contribution of multiple drug combinations to overdose mortality trends. DESIGN: We collected data on all overdose deaths in New York City between 1990 and 1998 using records from the Office of the Chief Medical Examiner (OCME). We standardized yearly overdose death rates by age, sex and race to the 1990 census population for NYC to enable comparability between years relevant to this analysis. FINDINGS: Opiates, cocaine and alcohol were the three drugs most commonly attributed as the cause of accidental overdose death by the OCME, accounting for 97.6% of all deaths; 57.8% of those deaths were attributed to two or more of these three drugs in combination. Accidental overdose deaths increased in 1990-93 and subsequently declined slightly in 1993-98. Changes in the rate of multi-drug combination deaths accounted for most of the change in overdose death rates, whereas single drug overdose death rates remained relatively stable. Trends in accidental overdose death rates within gender and racial/ethnic strata varied by drug combination suggesting different patterns of multi-drug use among different subpopulations. CONCLUSIONS: These data suggest that interventions to prevent accidental overdose mortality should address the use of drugs such as heroin, cocaine and alcohol in combination. [ABSTRACT FROM AUTHOR]

Presents a study in which the authors sought to determine the prevalence of cocaine metabolites detected at autopsy in persons who committed suicide in New York City during this one year period. Method; Results; Conclusions.

We determined the prevalence of recent cocaine and alcohol use among motor vehicle fatalities occurring in New York, NY, from 1984 through 1987. Recent cocaine use was detected at autopsy in 18.2% of the sample and no significant difference between drivers (20.0%) and passengers (13.9%) was found. Both alcohol and cocaine metabolites were found in 10.0% of cases tested. The prevalence of cocaine metabolites or alcohol detected in driver fatalities aged 16 through 45 years did not change significantly when the period prior to the widespread availability of "crack" cocaine (1984 through 1985) was compared with the period immediately following the introduction of crack cocaine (1986 through 1987). Additional studies are needed both to elucidate the association between cocaine use and these fatalities and to determine the value of screening persons seriously injured in traffic accidents in areas where such drug use is endemic. [ABSTRACT FROM AUTHOR]

Context: Hot weather taxes cardiovascular function and is associated with increased deaths from heart disease. Cocaine can cause hypertension, tachycardia, coronary vasospasm, arrhythmias, and increased core temperature.Objective: To determine the association between mortality from cocaine overdose and hot weather.Setting: New York, NY.Design: Retrospective review of medical examiner cases from 1990 through 1995.Subjects: All fatal unintentional cocaine overdoses from 1990 through 1992 (n = 1382) and all hyperthermia deaths of cocaine users (n = 10) were used to identify a maximum daily temperature threshold above which mortality from cocaine intoxication increased. The study population consisted of all fatal unintentional cocaine overdoses from 1993 through 1995 (n = 2008) and 4 contemporaneous comparison groups that included fatal unintentional opiate overdoses (n = 793), all other fatal unintentional overdoses (n = 85), and a subset of homicides (n = 4638) and fatalities from motor vehicle crashes (n = 815).Main Outcome Measures: The number of overdose deaths and the proportion of homicides and traffic fatalities with a positive cocaine toxicology test result on days with a maximum temperature above or below the temperature threshold.Results: A threshold temperature of 31.1 degrees C (88 degrees F) was identified, above which the mean daily number of fatal cocaine overdoses increased steadily. On days with a maximum daily temperature of 31.1 degrees C (88 degrees F) or higher ("hot days"), the mean daily number of cocaine overdose deaths was 2.34 (SD = 1.68), which was 33% higher than the mean on days with a maximum temperature of less than 31.1 degrees C (88 degrees F) (mean = 1.76 [SD=1.37] (P<.001). In contrast, the mean number of opiate overdose deaths per day was 0.81 (SD = 0.94) on hot days and 0.71 (SD = 0.86) on other days (P=.28). For other drug overdose deaths, the mean number of deaths per day was 0.08 (SD = 0.28) on hot days and 0.08 (SD = 0.28) on other days (P=.69). Among homicides, the proportion with a positive cocaine toxicology test result was 18.9% on hot days and 19.5% on other days (P=.69), and among traffic fatalities, the proportions with positive cocaine toxicology test results were 9.5% on hot days and 10.3% on other days (P=.91).Conclusions: High ambient temperature is associated with a significant increase in mortality from cocaine overdose. Based on our comparison groups, the increase is not explained by changes in cocaine use among the general population. Although cocaine use is dangerous on all days, it appears to be even more dangerous on hot days. [ABSTRACT FROM AUTHOR]

This study reconstructs and analyzes pathways of help-seeking traveled by severely disabled mental patients in the community. Ethnicity is a prime factor in differentiating patterns of help-seeking in that Chinese patients are kept for prolonged periods of time within their families in the beginning of pathways, while Anglo-Saxons and Middle Europeans are referred by their families or themselves to multiple social and mental health agencies. Native Indians are referred by persons other than family members or themselves between social and legal agencies in the community. Eventually all of these pathways lead to psychiatric inpatient intervention. There are major impediments to treatment in these patterns, most notably isolation and deterioration of patients within confines of families or lack of coordination of agencies in the community. Recommendations aimed at the improvement of treatment in the community are presented in light of these findings. [ABSTRACT FROM AUTHOR]

Examines the association between recent cocaine use and risk taking, particularly in the form of playing Russian roulette, a paradigm for extreme risk-taking behavior. Conclusion that in some populations, cocaine may be associated with life-threatening risk-behaviors. Study methods and results; Relationship of cocaine use with fatal accidents, suicides and homicides; More.

Abstract Background In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990–2000. Methods Data were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990–2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression. Results Overall, among decedents ages 15–64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62–0.82), Black (OR = 4.73, 95% CI 4.08–5.49) or Hispanic (OR = 1.51, 95% CI 1.29–1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06–1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44–0.56) and older age (55–64) (OR = 2.53 95% CI 1.70–3.75)). Conclusion As interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical.

Accidental drug overdose is a substantial cause of mortality for drug users. Neighborhood-level factors, such as income distribution, may be important determinants of overdose death independent of individual-level factors. We used data from the Office of the Chief Medical Examiner to identify all cases of accidental deaths in New York City (NYC) in 1996 and individual-level covariates. We used 1990 US Census data to calculate the neighborhood-level income distribution. This multi-level case-control study included 725 accidental overdose deaths (cases) and 453 accidental deaths due to other causes (controls) in 59 neighborhoods in NYC. Overdose deaths were more likely in neighborhoods with higher levels of drug use and with more unequal income distribution. In multi-level models, income maldistribution was significantly associated with risk of overdose independent of individual-level variables (age, race, and sex) and neighborhood-level variables (income, drug use, and racial composition). The odds of death due to drug overdose were 1.63-1.88 in neighborhoods in the least equitable decile compared with neighborhoods in the most equitable decile. Disinvestment in social and economic resources in unequal neighborhoods may explain this association. Public health interventions related to overdose risk should pay particular attention to highly unequal neighborhoods. [ABSTRACT FROM AUTHOR]