Preventable death: accidental drug overdose in Rhode Island.

rhode islaNd is iN The midsT of a drug poisoNiNg epidemiC. Since 2005, the number of drug poisoning deaths has exceeded the number of motor vehicle accidents, falls, firearms, and fire death among adults <85 years of age. However, Rhode Island is not alone: 20 states now report similar statistics where drug poisonings dominate adult injury deaths. National survey data find that Rhode Island has the nation’s highest rate of past month illicit drug use , and nonmedical use of prescription pain pills ranks 3 in the country, behind Oklahoma and Oregon. The mechanism of death from overdose is respiratory depression, which deprives the victim’s brain of oxygen, causing death over a period of one to three hours. Proximal causal mechanisms and risk factors for accidental overdose include: (a) change in tolerance (i.e. due to voluntary or forced abstinence such as hospitalization, imprisonment, detoxification, selfimposed abstinence); (b) mixing opioids with other substances, especially central nervous system depressants like alcohol or benzodiazepines which worsen respiratory depression; (c) presence of illness, especially diseases that may affect drug metabolism such as hepatitis C or HIV, and breathing conditions like pneumonia or sleep apnea; and (d) using opioids alone, in the absence of others who may recognize a victim’s symptoms and act to intervene. Like all injuries, the majority of drug poisoning deaths are preventable. This surveillance brief provides an overview of state-level statistics describing the extent and nature of the drug poisoning epidemic in Rhode Island and will conclude with a summary of the local prevention initiatives being undertaken or considered.