Risk Factors for Prescription Opioid-Related Death, Utah, 2008–2009

Objective Utah prescription opioid death rates increased nearly fivefold during 2000–2009. Inadequate understanding of risk factors hinders prevention. The goal of this study was to determine risk factors for prescription opioid death in Utah. Design Case-control study. Cases were 254 Utah decedents with ≥1 prescription opioid causing death during 2008–2009 with nonintentional manner of death (information obtained via next-of-kin interviews). Controls were 1,308 Utah 2008 Behavioral Risk Factor Surveillance System respondents who reported prescription opioid use during the previous year. Outcome Measures Exposure prevalence ratios (EPRs) for selected characteristics and confidence intervals (CIs) were calculated. Results Decedents were more likely than the comparison group to have used prescription pain medication more than prescribed (52.9% vs 3.2%; EPR, 16.5; 95% CI, 9.3–23.7), obtained prescription pain medication from nonprescription sources (39.6% vs 8.3%; EPR, 4.8; 95% CI, 3.6–6.0), smoked daily (54.5% vs 9.7%; EPR, 5.6; 95% CI, 4.4–6.9), not graduated high school (18.5% vs 6.2%; EPR, 3.0; 95% CI, 2.0–3.9), and been divorced or separated (34.6% vs 9.4%; EPR, 3.7; 95% CI, 3.0–4.4). Decedents were more likely to have had chronic pain than the comparison group (94.2% vs 31.6%; EPR, 3.0; 95% CI, 2.7–3.3). Conclusions Use of pain medication outside prescription bounds was a risk factor for death. However, decedents were more likely to have had chronic pain, and the majority of both groups had obtained pain medication by prescription. Other factors (e.g., smoking status) might also play important roles in prescription opioid-related death. Prescribers should screen chronic pain patients for risk factors.