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Findings and Recommendations of the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003

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Findings and Recommendations of the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003 Executive Summary Findings and Recommendations of the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003 Submitted to Carmen Hooker Odom, Secretary, Department of Health and Human Services Roy Cooper, Attorney General, Department of Justice April 2004 N.C. Department of Health and Human Services Division of Public Health Injury and Violence Prevention Branch TABLE OF CONTENTS Acknowledgements............................................................................................................................. i Executive Summary............................................................................................................................ ii Background............................................................................................................ ii The Response........................................................................................................ ii Death Certificate Findings.................................................................................... iii Investigation of Medical Examiner Records......................................................... iii Deaths from Illegal (Illicit) and Legal (Licit) Drugs............................................ iv Deaths from Methadone........................................................................................ v Recommendations from the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina........................................ vi List of Acronyms................................................................................................................................ xiii List of Figures, Tables and Maps...................................................................................................... xiv Chapter 1. The Task Force to Prevent Deaths from Unintentional Drug Overdoses................ 1 1.1 Appointment of the Task Force............................................................................. 1 1.2 Charges to the Task Force..................................................................................... 1 1.3 Task Force Members............................................................................................. 2 1.4 Developing the Recommendations........................................................................ 3 1.5 Voting.................................................................................................................... 4 Chapter 2. Findings........................................................................................................................... 5 2.1 Poisoning Deaths in the United States and North Carolina.................................. 5 2.2 Drugs Associated with Unintentional Poisoning Deaths in North Carolina......... 8 2.3 An Investigation of Deaths from Accidental Drug Overdoses............................. 10 2.3.1 Age............................................................................................... 11 2.3.2 Race............................................................................................. 12 2.3.3 Sex............................................................................................... 12 2.3.4 Health Status Prior to Death...................................................... 12 2.3.5 Geographic Location.................................................................. 13 2.3.6 Cause of Death............................................................................15 2.3.6.1 Single-Drug Deaths.....................................................................17 2.3.6.2 Multiple-Drug Deaths................................................................. 19 2.3.7 Treatment Provided to Victims of Deaths from Unintentional Drug Overdoses...........................................................................20 2.3.8 Source of Licit and Illicit Drugs................................................. 21 2.4 Unintentional Deaths from Overdoses of Methadone........................................... 21 TABLE OF CONTENTS N.C. Drug Overdose Task Force Report, April 2004 2.5 Retailing and Distribution of Controlled Substances in North Carolina.............. 24 2.5.1 Oxycodone...................................................................................25 2.5.2 Methadone...................................................................................26 2.6 Summary................................................................................................................ 28 Chapter 3. Recommendations from the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina................................................................... 30 3.1 Introduction........................................................................................................... 30 3.2 Recommendations................................................................................................. 31 References........................................................................................................................................... 38 Appendices.......................................................................................................................................... 40 I. Voting Status for Recommendations by the Task Force to Prevent Deaths from Unintentional Drug Overdoses. II. DEA lists of controlled substances schedule 1: http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched1.htm schedule 2: http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched2.htm schedule 3: http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched3.htm schedule 4: http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched4.htm schedule 5: http://www.deadiversion.usdoj.gov/schedules/listby_sched/sched5.htm III. Unintentional and Undetermined Poisoning Deaths -- 11 States, 1990-2001. MMWR. March 26, 2004/Vol. 53/No. 11, TABLE: Number and percentage of selected substances identified from International Classification of Disease and Related Health Problems, Tenth Revision (ICD-10) T-codes involved in unintentional or undetermined poisoning deaths, by state - eight states, 1999-2000. IV. Frequency and mortality rates of deaths in N.C., 1997-2001, from unintentional single-drug overdoses. V. Ranking of Single Drugs Causing Deaths from Unintentional Overdoses by N.C. Counties in upper Quartile of All Accidental Drug Related Deaths, 1997-2001. Types of Single-Drugs Identified by Medical Examiner as Responsible for Fatal Drug Overdose: North Carolina, 1997-2001 (Injury Conference Abstract – April 2003). VI. Retailed controlled substances per Registrant, N.C. 2001. ARCOS, Report #1. TABLE OF CONTENTS N.C. Drug Overdose Task Force Report, April 2004 ACKNOWLEDGEMENTS The findings and recommendations in this report would not have been possible without the time and expertise that were generously contributed by the 25 members of the Task Force to Prevent Deaths from Unintentional Drug Overdoses and by the Epidemic Intelligence Services and Public Health Prevention Service officers who were assigned to North Carolina for a three- week period in the summer of 2002 by the Centers for Disease Control and Prevention to investigate an epidemic of fatal unintentional drug-related overdoses. Staff and technical support for the Task Force were provided by Catherine Sanford in the N.C.-DHHS Division of Public Health Injury and Violence Prevention Branch (IVPB). The report reflects the tireless editing of Brenda Motsinger, Head of the IVPB, and the production talent of Cathy Daniels, also from the IVPB. Any errors, however, are the sole responsibility of Ms. Sanford. This report was supported in part by Cooperative Agreement Number U17/CCU419384, Core Capacity Injury Surveillance & Program Development, from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the Center for Disease Control and Prevention. ACKNOWLEDGEMENTS i N.C. Drug Overdose Task Force Report, April 2004 Executive Summary Findings and Recommendations of the Task Force to Prevent Deaths from Unintentional Drug Overdoses in North Carolina, 2003. BACKGROUND. North Carolina is Treatment Program (OTP) clinics is a experiencing an epidemic of poisoning* negligible source of the methadone that has deaths from unintentional drug overdoses. contributed to the dramatic increase in Since 1997, the number of deaths in North unintentional methadone-related deaths in Carolina from unintentional drug overdoses North Carolina. has increased over 100%, and continues to increase annually. Without intervention, THE RESPONSE. In September 2002, the there is no reason to believe this trend will Injury and Violence Prevention Branch in spontaneously reverse. the Division of Public Health of the N.C. Department of Health and Human Services Based on a review of a decade of death (NC-DHHS) released preliminary findings certificates for unintentional drug overdoses documenting the escalating number of (1992-2001) and five years of medical unintentional deaths from drug overdoses in examiner cases (1997-2001), the illicit drugs North Carolina. In November 2002, NC- (i.e., illegal drugs defined by the Drug DHHS Secretary Carmen Hooker Odom Enforcement Agency as drugs with no created the Task Force to Prevent Deaths accepted medicinal value) most responsible from Unintentional Drug Overdoses for these deaths were cocaine and heroin. (henceforth called “the Task
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