# Presentation: 102558

## Recent findings from NCHS: Methadone deaths, 1999-2004 

- Lois A. Fingerhut, MA
- Office of Analysis and Epidemiology
- National Center for Health Statistics
- SAMHSA, CSAT, July 2007

## Presentation Overview

- Poisoning mortality in perspective
- Review of NCHS published findings on methadone deaths
- Other insights from national mortality data for methadone
- Role of collaborative efforts

## Trends in leading mechanisms of injury death: 1968-2004

**Notes:**
In 2004, the number of deaths due to poisoning (30,308) exceeded the number of firearm deaths by 739. Firearms and motor vehicle traffic deaths have been the 2 leading causes of injury death. The age-adjusted poisoning death rate increased 45% from 1999 to 2004 reaching 10.3 per 100,000 as compared with the 3% decline in the age adjusted firearm death rate to 10.0 per 100,000 in 2004. There was no change in the rate for motor vehicle traffic deaths (14.7 per 100,000)

## Published findings to date

## Age-specific methadone death rates: 1999-2004

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
Published in Health E-Stat; available on NCHS website
www.cdc.gov/nchs/injury.htm
Rates highest for 35-54 ; it should not go unnoticed however that the 2004 rate for those 55-64 (despite it being low)_ was 7 times the rate in 1999 and rate for 15-24 year olds was 11 times what it was in 1999  while rates in other age groups increased less than that 

## Methadone deaths by underlying mechanism and intent: 1999-2004

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
Overall, the number of poisoning deaths mentioning methadone  increased nearly 400% growing from 4% of all poisoning deaths to 13% of all in 2004.
Unintentional poisoning mentioning meth increased 414%

## Percent distribution of methadone deaths by cause and intent: 1999-2004

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
1999-2004  3⁄4 to nearly 80% coded to unintentional poisoning
Undetermined—11-13%
Suicide by poisoning 7 down to 5 %
Noninjury deaths-6 down to 4%

## Other insights from national mortality data for methadone

## Methadone deathsby age and sex: 2004

- All methadone
- deaths

- Female

- Male

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
Female injury - 34% of deaths
Male injury 63%--
4% of meth deaths were not injuries
Female meth deaths peak in their 40’s while among makes there is a less obvious pattern to the number of deaths

## Methadone death ratesby age and sex: 2003-04

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
Meth death rates among males tend to be twice the rates for females across this part of the age span where the rates are highest

## Methadone-related unintentional poisoning death rates  in 2003 and 2004, for states with highest rates in 2004

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
By State- these are crude death rates ranked by rates in 2004.
W VA’s rate in 04 was “nearly” higher than that in Maine- z=1.94;
In both states the rates increased nearly 50% from 2003 to 2004.

## Most common ICD-10 code combinations with T40.3 (methadone): 2004

| Leading drug code
combinations | # of deaths | Percent |
| --- | --- | --- |
| T40.3 only |       1,304  | 32.3 |
| 
T40.3_T50.9_ |            576 | 14.3 |
| T40.3_T40.5_ |            201  | 5.0 |
| T40.3_T42.4_T50.9_ |            171  | 4.2 |
| T40.3_T42.4_ |            166  | 4.1 |
| T40.3_T40.5_T50.9_ |            107  | 2.7 |
| T40.3_T40.2_ |            105  | 2.6 |
| T40.3_T40.2_T50.9_ |              93  | 2.3 |
| Subtotal | 2723         | 67.6 |
| All Methadone deaths |         4,031  | 100.0 |

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**

Here are some new data from a file only recently created at NCHS. We looked at all causes of death (not just poisoning or other injury) and found that in 1304 instances T40.3 was the only substance mentioned (all pois and txeff codes). That is a conservative number because the next leading combination of codes includes T50.9 and in some portion of those 576 deaths, meth was the only drug mentioned. So at least a third and as many as 40 some odd % of meth deaths only mention methadone. 

## Other drugs mentionedwith methadone

- T50.9     Other and unspecified drugs, 			medicaments and biological 				substances
- T40.5	Cocaine
- T42.4	Benzodiazepines
- T40.2 	Other opioids

## Age-specific death rates for methadone-only deaths: 1999-2004

**Source: NCHS, data from the National Vital Statistics System**

**Notes:**
Increases since 1999

472% 25-34
256%	35-44
495%	 45-54

About a third of all meth deaths

## Death certificate literals tell us...

- What is written on each line sequencing the cause of death; and
- If death is from an injury, what is written in the “describe how injury occurred” box.
- ----
- This is the first file of literals
- Probably to be housed in the Research Data Center at NCHS.
- Need to examine closely for confidential information and coding quality

## What we gain from the literals

- Lines 1-4 from Part 1 of the death certificate
- Contain what the physician wrote about the sequencing patterns of causes.
- Line 5 from Part 2 of the death certificate
- Includes other important diseases or conditions existing at the time of death that may have contributed to death but were not part of the sequence in Part I.
- How injury occurred
- If present, generally determines underlying external cause of death.

## Example: Male 14 years

- Underlying cause- Y12 Undetermined drug poisoning
- Other codes T40.3, T50.9 (?)
- Line 1- Methadone poisoning
- How injury occurred: “Consumed a prescription medication that was not prescribed to him.”
- Place of death: unspecified

## Example: Female under 1 year

- Underlying cause: X85 Homicide by poisoning
- Other codes: T40.3
- Line 1: Methadone intoxication
- How injury occurred: “Fed methadone”
- Place of injury: home

## Example: Male 25 years

- Underlying cause: K85
- Other codes: T40.3, T50.9, X42
- Line 1: Acute hemorrhagic pancreatitis
- Line 5: Acute methadone intoxication
- How injury occurred: Drug overdose
- Place: Home

##  Female 14 years

- Underlying cause: X42 Unintentional drug poisoning
- Other codes: J18.9, T40.3
- Line 1: Toxic effects of methadone
- Line 5-part 2: Acute pneumonia
- How injury occurred: Found unresponsive at home
- Place: home

## Example: Male 25 years

- Underlying cause: X62 Suicide by poisoning
- Other codes R29.8, T40.3, T50.9
- Line 1: Central nervous system depression
- Line 2: Acute methadone intoxication
- How injury occurred: Apparent intentional drug overdose
- Place: home

## Role of Collaborations

## Key organizations and people

- DEA
- SAMSHA
- Medical examiners

## Issues to address

- Need for continued surveillance of narcotic drug use
- Lack of current information from death certificates
- Linking data across sources through systems like NVDRS

## Thank you

- Lois A. Fingerhut
- Special Assistant for Injury Epidemiology, Office of Analysis and Epidemiology
- National Center for Health Statistics
- _[LFingerhut@cdc.gov](mailto:LFingerhut@cdc.gov)_
- Special thanks to my colleagues
- Li-Hui Chen and Margaret Warner for programming assistance with the new file of death certificate “literals.”

**For more information on injury data and resources from NCHS, see:**
**www.cdc.gov/nchs/injury.htm.**

## A new drug to be tracking

## Death rates for methadone and fentanyl (T40.4) by age and sex: 2004

**Source: NCHS, data from the National Vital Statistics System**