Issue 19, 2006
Opiate-Related Drug Misuse Deaths
in Six States: 2003
T
he misuse of prescription pain medications,
especially those containing natural or syn-
thetic opiates, is a problem attracting na-
tionwide attention. According to the 2004 National
Survey on Drug Use and Health, an estimated 4.4
In Brief
According to the Drug Abuse Warning
Network (DAWN):
■ In the six States that participate in the
mortality component of the Drug Abuse
Warning Network (DAWN)—Maine, New
Hampshire, Vermont, Maryland, Utah,
and New Mexico—the rates of opiate-
related drug misuse deaths in 2003
ranged from 7.2 per 100,000 population
in New Hampshire to 11.6 per 100,000
population in New Mexico.
■ In each of these six States, most opiate-
related drug misuse deaths involved
multiple drugs.
■ In five of the six States, adults aged 35
to 54 had the highest rates of opiate
misuse deaths. In the remaining State
(Maine), the highest rate was for adults
aged 21 to 34.
The DAWN Report is published periodically by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration
(SAMHSA). This issue was written by Elizabeth Crane (SAMHSA/OAS) and Scott Novak (RTI International, a trade name of Research Triangle
Institute). All material in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the
source is appreciated.
million persons aged 12 or older had used opiate
pain medications nonmedically in the past month.1
The consequences of this can be severe: in 2004,
opiate pain medications were involved in an esti-
mated 158,281 emergency department (ED) visits
attributed to drug misuse/abuse.2
This report examines the involvement of opiates
in deaths related to drug misuse in Maine, New
Hampshire, Vermont, Maryland, Utah, and New
Mexico. These States were selected because they
participated in the Drug Abuse Warning Network
(DAWN) in 2003. DAWN is a public health surveil-
lance system that monitors drug-related morbidity
and mortality.3 Although DAWN is best known for
estimates of drug-related ED visits for the Nation,
DAWN also provides valuable information about
drug-related deaths because of the participation of
medical examiners and coroners in selected metro-
politan areas and States. By analyzing States, deaths
in rural as well as urban areas are included, and the
State’s population can be used to calculate rates.
DAWN collects data on all deaths where drugs
played a role, either directly (such as an overdose)
or indirectly (such as a fatal car crash where drugs
were involved). A drug misuse death is defined as a
drug-related death caused by homicide by drugs,
overmedication, all other accidental causes, and
where the cause could not be determined. This
report includes all deaths related to drug misuse
where an opiate (including natural and synthetic
opiates) contributed to the death. Opiates include
The DAWN Report — Opiate-Related Drug Misuse Deaths in Six States: 2003 Issue 19, 2006

prescription pain medications as well as heroin, which

Figure 1. State population and opiate-related is included because its metabolite cannot always be
drug misuse deaths: 2003 distinguished from the metabolites of other opiates. The
drugs acquired through legitimate prescriptions cannot
a) State population, in millions: 2003 be differentiated from diverted prescription medications
or illicit drugs because information on the source is not
6
5.5 available.
5
Opiate-related misuse deaths in the six
4 participating States
3 The six States vary considerably in size and in the
2.4
number of opiate-related fatalities. Maryland, the larg-
1.9
2 est participating State, had a population of 5.5 million
1.3 1.3 and 595 drug misuse deaths involving opiates in 2003
1 0.6 (Figure 1, Table 1). In comparison, Vermont, the small-
est state, had a population of only 619,000 and 54 opi-
0 ate-related drug misuse deaths. When population size is
ME NH VT MD UT NM taken into account, however, it becomes clear that these
b) Opiate-related drug misuse deaths per 100,000 States face problems of similar magnitude. Although the
population: 2003 smaller New England States had lower rates of opiate-
14
related misuse deaths than the three other States, the
difference between Vermont and Maryland was only
11.5 11.6 two deaths per 100,000 population.
12
10.8
Because its data are from medical examiner records,
10
8.7 DAWN is able to capture very specific information
7.8 about drugs. The involvement of three opiate pain
8 7.2
medications—oxycodone, hydrocodone, and metha-
6 done—is of particular interest (Table 1). Oxycodone
was involved in 30 percent of the opiate-related misuse
4
deaths in Vermont, but was relatively uncommon in
2 Maryland (14%) and New Mexico (13%). The involve-
ment of hydrocodone ranged from 3 percent in Mary-
0 land to 17 percent in Utah.
ME NH VT MD UT NM
In five of the six States, methadone outnumbered
Source: a) U.S. Census Bureau; b) Office of Applied Studies, SAMHSA, Drug
oxycodone or hydrocodone in opiate-related misuse
Abuse Warning Network, 2003 (September 2004 update). deaths (the exception was Vermont). Nearly half (46%)

Table 1. Involvement of oxycodone, hydrocodone, and methadone in opiate misuse deaths: 2003
Oxycodone Hydrocodone Methadone Total Opiate
State
Deaths Percent Deaths Percent Deaths Percent Misuse Deaths

Maine 24 24% 7 7% 47 46% 102

New Hampshire 19 20% 7 8% 34 37% 93
Vermont 16 30% 8 15% 12 22% 54
Maryland 86 14% 15 3% 142 24% 595
Utah 72 27% 47 17% 93 34% 270
New Mexico 29 13% 22 10% 36 17% 218
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2003 (September 2004 update).
Issue 19, 2006 The DAWN Report — Opiate-Related Drug Misuse Deaths in Six States: 2003

of Maine’s and more than one third of opiate-related

misuse deaths in New Hampshire and Utah (37% and Figure 2. Polydrug involvement in opiate-
34%, respectively) involved methadone. In comparison, related misuse deaths: 2003
methadone was implicated in only 17 percent of the
opiate-related misuse deaths in New Mexico. Metha- ME 65.7 34.3
done is used to treat addiction to heroin and other
opiates and also can be used to treat chronic pain. As NH 80.6 19.4
discussed above, DAWN cannot identify which type of
methadone was involved in these deaths. Also, DAWN VT 77.8 22.2
cannot distinguish the persons who misused methadone
MD 90.4 9.6
from the persons who were in methadone treatment
and misusing other drugs at the same time.
UT 93.0 7.0
In each of the six States, most of the opiate-related
misuse deaths involved more than one drug (Figure 2). NM 78.0 22.0
Utah had the highest percentage of polydrug deaths
(93%), while Maine had the lowest (66%). 0 20 40 60 80 100
Percent
Polydrug Single drug
Demographic characteristics
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2003
(September 2004 update).
In each participating State, more men than women
died from opiate-related drug misuse in 2003. The
proportion of males ranged from 58 percent in Utah to Notes
78 percent in Vermont.
1. Office of Applied Studies. (2005). Results from the 2004 National Survey
In the six participating States, opiate-related misuse on Drug Use and Health: National Findings (DHHS Publication No. SMA
deaths were not evenly distributed across age groups. 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and
Mental Health Services Administration. [Available http://www.oas.samhsa.
In all of these States, the lowest rates were among the gov/nsduh/2k4nsduh/2k4Results/2k4Results.htm#fig2.2]
youngest and oldest age groups (under age 21 and 55 2. Office of Applied Studies. (in press). Drug Abuse Warning Network, 2004:
years or older) (Figure 3). In five of the six States, adults National Estimates of Drug-Related Emergency Department Visits. Rockville,
MD: Substance Abuse and Mental Health Services Administration. [To be
aged 35 to 54 had the highest fatality rates from opiate- available at http://dawninfo.samhsa.gov/pubs/edpubs/default.asp]
related drug misuse. However, in Maine, young adults 3. Information about DAWN is available in the “About DAWN” box in this publica-
aged 21 to 34 had the highest rate. tion, and on the Internet at http://dawninfo.samhsa.gov/.

Figure 3. Opiate-related drug misuse deaths by age group, per 100,000 population: 2003

30
Under 21 21–34 35–54 55+
25.7 26.3
25
22.4

20 18.1 17.9
17.6
Percent

13.7 14.4 13.9 13.7

15
12.0 12.2

10

5.3
5 4.0
2.6 3.0
1.1 1.9 1.5 1.4 1.4 1.1
0.5 0.6
0
ME NH VT MD UT NM

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2003 (September 2004 update).
 list please e-mail: shortreports@samhsa.hhs.gov
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The DAWN Report — Opiate-Related Drug Misuse Deaths in Six States: 2003

In Brief The Drug Abuse Warning Network (DAWN) is a public health

According to the Drug Abuse Warning Network
(DAWN):
■ In the six States that participate in the mortal-
ity component of the Drug Abuse Warning
surveillance system that monitors drug-related morbidity and
mortality. DAWN uses a probability sample of hospitals to
produce estimates of drug-related emergency department (ED)
visits for the United States and selected metropolitan areas
annually. DAWN also produces annual profiles of drug-related
deaths reviewed by medical examiners or coroners in selected
metropolitan areas and States.

Network (DAWN)—Maine, New Hampshire,
Vermont, Maryland, Utah, and New Mexico—
the rates of opiate-related drug misuse deaths
in 2003 ranged from 7.2 per 100,000 popula-
tion in New Hampshire to 11.6 per 100,000
population in New Mexico.
■ In each of these six States, most opiate-
related drug misuse deaths involved multiple
drugs.
■ In five of the six States, adults aged 35 to 54
had the highest rates of opiate misuse deaths.
In the remaining State (Maine), the highest
rate was for adults aged 21 to 34.
Any ED visit or death related to recent drug use is included in
DAWN. All types of drugs—licit and illicit—are covered. Alcohol
is included for adults when it occurs with another drug. Alcohol is
always included for minors. DAWN’s method of classifying drugs
was derived from the Multum Lexicon, Copyright © 2005, Multum
Information Services, Inc. The Multum Licensing Agreement can
be found in DAWN annual publications and at
http://www.multum.com/license.htm.
DAWN is one of three major surveys conducted by the Substance
Abuse and Mental Health Services Administration’s Office of
Applied Studies (SAMHSA/OAS). For information on other
OAS surveys, go to http://www.oas.samhsa.gov. SAMHSA has
contracts with Westat (Rockville, MD) and RTI International
(Research Triangle Park, NC) to operate the DAWN system and
produce publications.
For publications and additional information about DAWN, go to
http://DAWNinfo.samhsa.gov.