A survey of 756 accidental drug intoxication cases over a period from 1998 to 2017 showed that most deaths were the result of poly drug abuse (50-80%). Ethanol (2-7%), cocaine (2-8%), methadone (0-10%), morphine/codeine (1-3%), heroin (0-3%) and fentanyl (1-23%) were the next most frequent causes. Oxycodone, hydrocodone, oxymorphone and hydromorphone were then evaluated as being either causative or only contributory to such deaths. Being causative or the sole cause of death, the drugs ranked very low like oxycodone (<1-2%), hydrocodone (0%), oxymorphone (0%) and hydromorphone (0-1%) and when mentioned were often found together with ethanol or cocaine. In contrast, they were often mentioned as contributory factors like oxycodone (14-64%), hydrocodone (9-13%), oxymorphone (0-21%) and hydromorphone (2-11%) but their contributions to such deaths are unclear and perhaps minimal since they were mostly found together with a fair number of other drugs. This study seems to suggest that the role of these drugs in accidental overdose cases is much less than generally assumed and that the overwhelming majority of these 4 narcotics detected in toxicological screens do not or do only contribute in combination with other drugs to the fatal outcomes. This might imply that physicians can prescribe these drugs to their pain patients with confidence in that most patients will use the drugs as directed and the chance of overdose deaths is minimal if it exists at all.
Wolfgang H Vogel