In a new report, David L. Nordstrom, an epidemiologist and associate professor at the University of Wisconsin-Whitewater, reveals striking data about drug poisonings in the state.
"We're not just talking about stereotypical addicts," Nordstrom said. "The people who die are typically working-age people. They are family members, neighbors and co-workers."
Nordstrom and his colleagues analyzed Wisconsin certificates of death from 1999-2008. Of the nearly 450,000 deaths during those years, 4,828 deaths were certified as drug-related by a coroner or medical examiner. Over 90 percent of these deaths were accidents or suicides, and the causes included both prescription and non-prescription drug use.
During the decade studied, Nordstrom observed that the causes of death included:
Deaths from methadone, a long-acting synthetic opioid used to treat pain and heroin addiction, increased 1,080 percent, from 10 in 1999 to 118 in 2008, and deaths from benzodiazepines increased 361 percent, from 23 in 1999 to 106 in 2008, according to the report.
"The evidence shows a shift," Nordstrom said. "In the past, deaths caused by illegal drugs were greater than those caused by legal drugs. Now, it may have flipped. During the 10-year study period, codeine, morphine and other prescription opioid drugs surpassed cocaine and heroin as the most frequent causes of fatal poisoning."
The study showed that men in their 40s died from drug use more often than women or people of other ages did. Drug deaths increased throughout the period in both urban and rural areas.
"Dr. Nordstrom and his colleagues mine further into the complexity of drug-related deaths in the United States. In Wisconsin, opioid analgesic poisoning is now the most frequent cause of drug-related poisoning," said James F. Cleary, associate professor of medicine and pain specialist at UW-Madison.
"In the 10-year period there has been a ten-fold increase in methadone deaths, even though the Centers for Disease Control and Prevention have suggested this represents only three percent of opioids prescribed for pain control," Cleary said. "The authors challenge us to really get a better understanding of this public health issue in order to address this at local, state and national levels."
Drug abuse is not a reportable disease, and that's part of the problem. Nordstrom said establishing a statewide prescription drug monitoring program in Wisconsin, authorized in 2010 but not yet operating, may help to combat some of the drug problem.
"It would enable pharmacists and doctors to look up patients' records to spot possible inappropriate use of some prescription medications," he said. Other states have such systems.
Drug abuse is a complex problem without a simple solution. Substance abuse treatment spending in the United States, of which nearly 80 percent comes from public payers, totals $22 billion a year, according to the latest data available from the U.S. Department of Health and Human Services.
That figure doesn't take into account other costs such as lost earnings and productivity from drug-related illness and premature death.
"The number of drug-related deaths continues to rise, and the problem is not going away unless we address it," Nordstrom said. "We need to find ways to intervene."
The full report, co-authored by Mieko Yokoi-Shelton, a recent graduate of UW-Whitewater, and Amy Zosel, an emergency medicine physician at the Medical College of Wisconsin, has been accepted for publication this month by the Journal of Public Health Management and Practice.
David L. Nordstrom is associate professor of occupational and environmental safety and health at UW-Whitewater.