Citation

Turner C, Chandrakumar D, Rowe C, Santos GM, Riley ED, Coffin PO. Drug Alcohol Depend. 2018; 185: 305-312.

Affiliation

San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, United States; Department of Medicine, Division of HIV, Infectious Disease and Global Health, University of California, San Francisco, CA, United States.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2017.12.030

PMID

29486419

Abstract

BACKGROUND: Opioids and stimulants (e.g., cocaine or methamphetamine/amphetamine [MAMP]) are major contributors to acute substance toxicity deaths. Causes of stimulant death have received little attention. We sought to characterize and compare causes of death and significant contributing conditions among persons who died from acute opioid, cocaine, or MAMP toxicity.

METHODS: We identified all opioid, cocaine, or MAMP deaths in San Francisco from 2005 to 2015 through the California Electronic Death Reporting System. Multivariable logistic regression analyses were used to estimate associations between acute substance toxicity deaths (opioid versus stimulant; cocaine versus MAMP), additional reported causes of death, and significant contributing conditions most often linked to opioid and stimulant use.

RESULTS: From 2005-2015, there were 1252 opioid deaths and 749 stimulant deaths. Cocaine accounted for most stimulant deaths. Decedents with cardiac or cerebral hemorrhage deaths had higher adjusted odds of death due to acute stimulant toxicity versus acute opioid toxicity (aOR = 4.79, 95%CI = 2.88-7.96, p < 0.01; aOR = 58.58, 95%CI = 21.06-162.91, p < 0.01, respectively); no statistically significant associations were found for cocaine compared to MAMP deaths. Significant contributing cardiac conditions were associated with higher adjusted odds of stimulant compared to opioid (aOR = 1.46, 95%CI = 1.19-1.79, p < 0.01) and cocaine compared to MAMP death (aOR = 1.66, 95%CI = 1.13-2.45, p = .01).

CONCLUSIONS: Stimulant compared to opioid deaths tended to involve cardiac or cerebrovascular causes of death, and cocaine deaths were more likely than MAMP deaths to involve significant contributing cardiac conditions. Mounting evidence suggests that stimulant use be considered a cardio/cerebrovascular risk factor and clinical care be adjusted to address this heightened risk.

Copyright © 2018 Elsevier B.V. All rights reserved.

Language: en

Keywords

Acute substance toxicity deaths; Cocaine mortality; Methamphetamine/amphetamine mortality; Multiple causes of death; Opioid mortality; Stimulant mortality