drug overdose deaths in kentucky, 2000 - 2013 · 2015. 10. 30. · 2. the 2013 kentucky resident...

Drug Overdose Deaths

in Kentucky,

2000 - 2013

Kentucky Injury Prevention and Research Center

Drug Overdose Deaths

in Kentucky, 2000-2013 March 6, 2015

Prepared by

Svetla Slavova, PhD Terry L. Bunn, PhD

Wei Gao, MS

Released by Kentucky Injury Prevention and Research Center (KIPRC)

333 Waller Avenue, Suite 242 Lexington, Kentucky 40504

For more information contact Svetla Slavova

E-mail: [email protected]

This project was supported by Grant No. 2014-PM-BX-0010 (Data-Driven Multidisciplinary Approaches to Reducing Prescription Abuse in Kentucky) awarded by the Bureau of Justice Assistance (BJA). BJA is a component of the Department of Justice’s Office of Justice Program, which includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office of Victims Crime, and the SMART Office. Points of view or opinions in this document are

those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice.

Executive Summary

1. In 2013, there were 1,019 Kentucky resident drug overdose deaths. This is a 9% decrease from the

1,078 drug overdose deaths registered in 2012. For the first time in six years, the drug overdose deaths

in the state showed a decline.

2. The 2013 Kentucky resident age-adjusted drug overdose death rate was 23.7/100,000, down from

25.0/100,000 in 2012. The U.S. age-adjusted drug overdose mortality rate actually increased from 2012

(13.1/100,000) to 2013 (13.8/100,000).

3. In 2013, Kentucky still had the 2nd highest age-adjusted drug overdose death rate in the United States,

23.7 deaths per 100,000 population. The corresponding U.S. rate was 13.8/100,000.

4. Pharmaceutical opioids remained the primary cause of Kentucky resident drug overdose deaths in

2013. Pharmaceutical opioids were involved in 438 drug overdose deaths in 2013, a 10% decrease

from the 488 pharmaceutical opioid overdose deaths in 2012. The rate of overdose deaths involving

pharmaceutical opioids in Kentucky declined from 11.2/100,000 in 2012 to 10.1/100,000 in 2013, a

10% decline. At the same time, the level of involvement of pharmaceutical opioids in overdose deaths

remained unchanged at the national level, 5.1/100,000 in 2012 as well as in 2013.

5. The involvement of pharmaceutical opioids in Kentucky resident overdose deaths could be underesti-

mated because about one third of the Kentucky death certificates do not list information on specific

drugs involved in the overdose. For example, in 2013 pharmaceutical opioids were listed in 438 of the

1,019 overdose deaths (43%). However, only 761 of the 1,019 deaths listed specific drugs. Therefore,

pharmaceutical opioids were involved in 58% (438 out of 761) of the deaths with involved drugs listed

on the death certificate.

6. Heroin contributed to 215 Kentucky resident drug overdose deaths in 2013, a 50% increase from the

143 heroin-involved deaths recorded in 2012. There was a 50% increase in the Kentucky rate of over-

dose deaths involving heroin, from 3.4/100,000 in 2012 to 5.1/100,000 in 2013. A similar percentage

increase (42%) was observed at the national level , from 1.9/100,000 in 2012 to 2.7/100,000 in 2013.

7. Males remained at higher risk for drug overdose deaths (29.9 deaths per 100,000 population) com-

pared with females (17.5/100,000) in 2013.

8. Of the 1,019 overdose deaths, 882 (87%) were declared unintentional/accidental deaths.

9. Adults, ages 35-44 years old, were at highest risk for overdose deaths (49/100,000) in 2013, followed

by 45-54 year olds (44.6/100,000), and 25-34 year olds (37.8/100,000).

10. Over the last three years, 2011-2013, the following counties experienced the highest number of over-dose

deaths involving pharmaceutical opioids per 100,000 county residents: Bell County (annual age-adjusted

rate of 55.4 deaths involving pharmaceutical opioids per 100,000 residents), Clay County (54.6/100,000),

Floyd County (53.3/100,000), Johnson County (46.3/100,000), and Knox County (40.2/100,000).

11. From 2011 to 2013, the residents of the following counties were at highest risk for overdose deaths involv-

ing heroin: Campbell County (rate of 21.4 heroin overdose deaths per 100,000 county population), Kenton

County (13.4/100,000), Boone County (11.3/100,000), Fayette County (5.2/100,000), and Jefferson County

(4.8/100,000).

2

241

345

426

560 526

638

728 708 764 769

1,0071,058 1,078

1,019

0

200

400

600

800

1000

1200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Tota

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er

Kentucky Resident Drug Overdose Deaths, 2000-2013

Produced by the Kentucky Injury Prevention and Research Center, February 2015. Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015.

5.9

8.4

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13.612.8

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Kentucky Resident Age-Adjusted Drug Overdose Mortality Rates, 2000-2013


3

Top Ten States with the Highest Age-Adjusted Drug Overdose Mortality Rates, 2013

Age-Adjusted Drug Overdose Death Rate by State, 2013

Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2013

on CDC WONDER Online Database, released 2015. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Feb 25, 2015.

States Number of drug over-dose deaths

Age-adjusted drug overdose death rate per 100,000

population

1 West Virginia 570 32.2

2 Kentucky 1,019 23.7

3 New Mexico 458 22.6

4 Rhode Island 241 22.4

5 Utah 594 22.1

6 Nevada 614 21.1

7 Ohio 2,347 20.8

8 Oklahoma 790 20.6

9 Pennsylvania 2,426 19.4

10 Arizona 1,222 18.7

The United States 43,982 13.8

5

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560

526

638

728

708

764

769

1,007

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1,019

147

214

248

324

308

380

448

421

467

505

685

740

771

761

75

129

158

213

206

266

310

322

344

388

532

560

488

438

29

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74

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Total Number

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100

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Kentucky Resident Drug Overdose Deaths by Gender, 2000-2013

Male

Female


7.8

10

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13

.5

16

.2

15

.7

20

.1 21

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21

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

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Kentucky Resident Age-Adjusted Drug Overdose Mortality Rates by Gender, 2000-2013

Male

Female


8

Age Groups

Year 15-24 25-34 35-44 45-54 55+

2000 33 53 83 49 22

2001 35 77 132 71 28

2002 43 102 157 82 41

2003 69 109 185 138 57

2004 63 120 165 129 45

2005 72 151 188 173 52

2006 79 193 201 166 87

2007 75 186 183 179 83

2008 61 175 207 235 85

2009 55 158 213 247 96

2010 66 227 278 297 134

2011 68 229 319 307 130

2012 74 230 269 334 169

2013 74 213 277 276 179

Age Groups

Year 15-24 25-34 35-44 45-54 55+

2000 5.8 9.3 12.9 8.8 2.5

2001 6 13.8 20.7 12.3 3.1

2002 7.4 18.5 25 14 4.5

2003 11.8 19.8 29.8 23.2 6.1

2004 10.7 21.7 26.8 21.4 4.7

2005 12.3 27.2 30.9 28.2 5.3

2006 13.6 34.8 33.1 26.6 8.6

2007 12.8 33.3 30.4 28.4 8

2008 10.4 31.3 34.8 36.8 7.9

2009 9.4 28 36.5 38.5 8.8

2010 11.2 40.1 48.2 46.2 12

2011 11.5 40.2 56 48.2 11.3

2012 12.5 40.5 47.5 53.3 14.4

2013 12.4 37.8 49 44.6 14.8

Kentucky Resident Drug Overdose Deaths by Age Group, 2000-2013

Kentucky Resident Drug Overdose Mortality Rates by Age Group, 2000-2013 (Rate per 100,000 population in the corresponding age group)

10

County (FIPS code) Total number of drug overdose deaths, 2009-

2013

Annual rate per 100,000 population

1 Adair County, KY (21001) 14 Unreliable

2 Allen County, KY (21003) 20 19.9

3 Anderson County, KY (21005) 19 Unreliable

4 Ballard County, KY (21007) Suppressed Suppressed

5 Barren County, KY (21009) 25 11.8

6 Bath County, KY (21011) 18 Unreliable

7 Bell County, KY (21013) 90 63.3

8 Boone County, KY (21015) 146 24.1

9 Bourbon County, KY (21017) 23 23

10 Boyd County, KY (21019) 65 26.4

11 Boyle County, KY (21021) 17 Unreliable

12 Bracken County, KY (21023) Suppressed Suppressed

13 Breathitt County, KY (21025) 31 45

14 Breckinridge County, KY (21027) 12 Unreliable

15 Bullitt County, KY (21029) 63 16.8

16 Butler County, KY (21031) 15 Unreliable

17 Caldwell County, KY (21033) 12 Unreliable

18 Calloway County, KY (21035) 27 14.4

19 Campbell County, KY (21037) 168 37.1

20 Carlisle County, KY (21039) Suppressed Suppressed

21 Carroll County, KY (21041) 16 Unreliable

22 Carter County, KY (21043) 39 28.3

23 Casey County, KY (21045) 12 Unreliable

24 Christian County, KY (21047) 40 10.8

25 Clark County, KY (21049) 65 36.5

26 Clay County, KY (21051) 61 56.3

27 Clinton County, KY (21053) 29 56.7

28 Crittenden County, KY (21055) Suppressed Suppressed

29 Cumberland County, KY (21057) 10 Unreliable

30 Daviess County, KY (21059) 74 15.2

31 Edmonson County, KY (21061) 12 Unreliable

32 Elliott County, KY (21063) Suppressed Suppressed

33 Estill County, KY (21065) 32 43.8

34 Fayette County, KY (21067) 268 17.8

35 Fleming County, KY (21069) 16 Unreliable

36 Floyd County, KY (21071) 136 69.4

37 Franklin County, KY (21073) 39 15.8

38 Fulton County, KY (21075) Suppressed Suppressed

39 Gallatin County, KY (21077) 15 Unreliable

40 Garrard County, KY (21079) 19 Unreliable

Drug Overdose Deaths, by County, 2009-2013a

11


2013


41 Grant County, KY (21081) 39 31.6

42 Graves County, KY (21083) 23 12.3

43 Grayson County, KY (21085) 35 27.1

44 Green County, KY (21087) Suppressed Suppressed

45 Greenup County, KY (21089) 48 26.1

46 Hancock County, KY (21091) Suppressed Suppressed

47 Hardin County, KY (21093) 68 12.8

48 Harlan County, KY (21095) 62 42.8

49 Harrison County, KY (21097) 15 Unreliable

50 Hart County, KY (21099) 10 Unreliable

51 Henderson County, KY (21101) 29 12.5

52 Henry County, KY (21103) Suppressed Suppressed

53 Hickman County, KY (21105) Suppressed Suppressed

54 Hopkins County, KY (21107) 45 19.2

55 Jackson County, KY (21109) Suppressed Suppressed

56 Jefferson County, KY (21111) 705 18.9

57 Jessamine County, KY (21113) 47 19.1

58 Johnson County, KY (21115) 68 58.2

59 Kenton County, KY (21117) 296 36.8

60 Knott County, KY (21119) 45 55.4

61 Knox County, KY (21121) 69 43.3

62 Larue County, KY (21123) Suppressed Suppressed

63 Laurel County, KY (21125) 66 22.3

64 Lawrence County, KY (21127) 24 30.2

65 Lee County, KY (21129) 18 Unreliable

66 Leslie County, KY (21131) 28 49.9

67 Letcher County, KY (21133) 61 50.5

68 Lewis County, KY (21135) 11 Unreliable

69 Lincoln County, KY (21137) 31 25.2

70 Livingston County, KY (21139) 12 Unreliable

71 Logan County, KY (21141) 17 Unreliable

72 Lyon County, KY (21143) Suppressed Suppressed

73 McCracken County, KY (21145) 71 21.6

74 McCreary County, KY (21147) 10 Unreliable

75 McLean County, KY (21149) Suppressed Suppressed

76 Madison County, KY (21151) 85 20.2

77 Magoffin County, KY (21153) 27 41

78 Marion County, KY (21155) 19 Unreliable

79 Marshall County, KY (21157) 37 23.6

80 Martin County, KY (21159) 35 54.6

12


2013


81 Mason County, KY (21161) 13 Unreliable

82 Meade County, KY (21163) 10 Unreliable

83 Menifee County, KY (21165) 11 Unreliable

84 Mercer County, KY (21167) 12 Unreliable

85 Metcalfe County, KY (21169) Suppressed Suppressed

86 Monroe County, KY (21171) 18 Unreliable

87 Montgomery County, KY (21173) 22 16.4

88 Morgan County, KY (21175) 11 Unreliable

89 Muhlenberg County, KY (21177) 29 18.5

90 Nelson County, KY (21179) 31 14.1

91 Nicholas County, KY (21181) 12 Unreliable

92 Ohio County, KY (21183) 19 Unreliable

93 Oldham County, KY (21185) 25 8.2

94 Owen County, KY (21187) 11 Unreliable

95 Owsley County, KY (21189) Suppressed Suppressed

96 Pendleton County, KY (21191) 20 27.2

97 Perry County, KY (21193) 68 47.7

98 Pike County, KY (21195) 146 45.2

99 Powell County, KY (21197) 41 65.2

100 Pulaski County, KY (21199) 66 20.8

101 Robertson County, KY (21201) Suppressed Suppressed

102 Rockcastle County, KY (21203) 37 43.6

103 Rowan County, KY (21205) 23 19.6

104 Russell County, KY (21207) 36 40.9

105 Scott County, KY (21209) 31 12.9

106 Shelby County, KY (21211) 11 Unreliable

107 Simpson County, KY (21213) 12 Unreliable

108 Spencer County, KY (21215) 12 Unreliable

109 Taylor County, KY (21217) 39 31.7

110 Todd County, KY (21219) 12 Unreliable

111 Trigg County, KY (21221) Suppressed Suppressed

112 Trimble County, KY (21223) Suppressed Suppressed

113 Union County, KY (21225) 28 37.4

114 Warren County, KY (21227) 69 12

115 Washington County, KY (21229) Suppressed Suppressed

116 Wayne County, KY (21231) 15 Unreliable

117 Webster County, KY (21233) Suppressed Suppressed

118 Whitley County, KY (21235) 87 48.7

119 Wolfe County, KY (21237) 17 Unreliable

120 Woodford County, KY (21239) 25 20

aData are “Suppressed” when the counts represent zero to nine (0-9) persons, in order to protect personal privacy (http://wonder.cdc.gov/wonder/help/mcd.html#Assurance of Confidentiality). Death rates are flagged as “Unreliable” when the rate is calculated with a numerator of 20 or less (http://wonder.cdc.gov/wonder/help/mcd.html#Unreliable)

13

Total Number of Drug Overdose Deaths, 2009-2013 Combined*

*Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Feb 25, 2015. Data are “Suppressed” when the counts represent zero to nine (0-9) persons, in order to protect personal privacy (http://wonder.cdc.gov/wonder/help/mcd.html#Assurance of Confidentiality). Death rates are flagged as “Unreliable” when the rate is calculated with a numerator of 20 or less (http://wonder.cdc.gov/wonder/help/mcd.html#Unreliable)

Annual Age-Adjusted Rate of Drug Overdose Deaths, 2009-2013*

Rate represents average annual number of overdose deaths per 100,000 county population.

14

Top 5 counties by number of drug overdose deaths involving pharmaceutical opioids, 2011-2013

County (FIPS code) Total number of drug

overdose deaths involving

pharmaceutical opioids,

2011-2013

Annual age-

adjusted rate per

100,000 population



3 Floyd County, KY (21071) 59 53.3

4 Pike County, KY (21117) 55 29.2

5 Kenton County, KY (21195) 54 11.2

Top 5 counties by rate of drug overdose deaths involving pharmaceutical opioids, 2011-2013



pharmaceutical opioids,

2011-2013

Annual age-

adjusted rate per

100,000 population

1 Bell County, KY (21013) 48 55.4

2 Clay County, KY (21051) 36 54.6

3 Floyd County, KY (21071) 59 53.3

4 Johnson County, KY (21115) 30 46.3

5 Knox County, KY (21197) 35 40.2

Top 5 counties by number of drug overdose deaths involving heroin, 2011-2013



heroin, 2011-2013

Annual age-

adjusted rate per

100,000 population


2 Kenton County, KY (21117) 65 13.4

3 Campbell County, KY (21037) 56 21.4


5 Boone County, KY (21015) 41 11.3

Note: a drug overdose death involving heroin and pharmaceutical opioids is counted under both categories.

15

Annual Age-Adjusted Rate of Drug Overdose Deaths Involving Pharmaceutical Opioids,

2011-2013*

The 3 counties with highest age-adjusted rate of heroin overdose deaths were in Northern Kentucky, on the border with Cincin-

nati area: Campbell County (21.4/100,000), Kenton County (13.4/100,000), and Boon County (11.3/100,000). The next two coun-

ties with highest risk for heroin overdose death were Fayette County/Lexington (5.2/100,000) and Jefferson County /Louisville

*Data source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Feb 25, 2015. Data are “Suppressed” when the counts represent zero to nine (0-9) persons, in order to protect personal privacy (http://wonder.cdc.gov/wonder/help/mcd.html#Assurance of Confidentiality). Death rates are flagged as “Unreliable” when the rate is calculated with a numerator of 20 or less (http://wonder.cdc.gov/wonder/help/mcd.html#Unreliable)

Annual Age-Adjusted Rate of Drug Overdose Deaths Involving Heroin, 2011-2013*

The top 5 counties at highest risk for overdose deaths involving pharmaceutical opioids were Bell County (average age-adjusted annual rate of 55.4 overdose deaths per 100,000 population, 2011-2013), Clay County (54.6/100,000), Floyd County (53.3/100,00), Johnson County (46.3/100,00), Knox County (40.2/100,000). These counties are all located in the Appalachian

16

About This Report

This report presents drug overdose mortality data for Kentucky residents. The data source for the

report is the U.S. Multiple Cause of Death files, 1999-2013, accessible through the CDC WONDER online que-

ry system http://wonder.cdc.gov/mcd-icd10.html. The Multiple Cause of Death database contains mortality

and population counts for all U.S. counties. Data are based on death certificates for U.S. residents.

Typically, when a drug overdose death occurs, the coroner completes a death certificate and lists the

causes of death and information on how the death occurred. This information/text is then transferred in an

electronic record that is sent to the National Center for Health Statistics (NCHS) at the Centers for Disease

Control and Prevention (CDC ) to be coded according to the guidelines of the Tenth Revision of the Interna-

tional Classification of Diseases (ICD-10) [www.who.int/classifications/icd10/] to allow standardized classifi-

cation of the causes of death. Each death certificate is assigned a single underlying cause of death and up to

twenty additional multiple causes of death. The underlying cause of death is defined as the reason that initi-

ated the chain of events leading directly to death.

For example, the death described below is coded with an underlying cause of death being uninten-

tional drug overdose (X42 Accidental poisoning and exposure to narcotics and psychodysleptics). The follow-

ing additional multiple causes of death were assigned based on the information listed on the death certifi-

cate: T40.3 Methadone, G93.1 Anoxic brain damage, T50.9 Other and unspecified drugs.

http://www.who.int/classifications/icd10/

17

When the information on the death certificate is not specific enough and there is no mention of a

particular drug contributing to the death, the death cannot be associated with a drug/drug class. For exam-

ple, about one third of the death certificates for drug overdose cases in Kentucky list only “drug overdose”,

“drug toxicity”, “acute drug intoxication”, or “polypharmacy intoxication”, with no mention of particular

drugs involved. Therefore, the involvement of pharmaceutical opioids or heroin in Kentucky resident over-

dose deaths could be underestimated as about one third of the overdose deaths are not associated with

specific drugs. When an overdose death involves multiple drugs from different classes (for example heroin

and methadone), each drug will receive appropriate ICD-10-coded cause of death (T40.1 for heroin, T40. 3

for methadone) and the death will be counted under both categories of drugs (heroin-associated deaths and

pharmaceutical opioid-associated deaths). If an overdose death involves multiple drugs from the same drug

class, only one multiple cause of death ICD-10 code will be assigned. For example, if oxycodone and hydro-

codone are both listed on a death certificate, their involvement will be coded with one ICD-10 code (T40.2)

that represents the involvement of natural or semi-synthetic opioids.

Definition: Drug overdose deaths were identified as deaths with an underlying cause of death in the follow-

ing ICD-10 code range: X40-X44(accidental/unintentional drug poisoning), X60-X64(suicide by drug poison-

ing), X85(homicide by drug poisoning), and Y10-Y14 (drug poisoning with undetermined intent).

X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics)

X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified)

X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified)

X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system)

X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances)

X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics)

X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified)

X62 (Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified)

X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system)

X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances)

X85 (Assault by drugs, medicaments and biological substances)

Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent)

Y11 (Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent)

Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent)

Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent)

Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent)

The types of drugs contributing to drug overdose deaths can be identified using ICD-10 codes T36-

T50.9 listed in any of the multiple causes of death fields. In this report we included statistics on drug over-

dose deaths involving heroin (T40.1), pharmaceutical opioids (T40.2, T40.3, or T40.4), cocaine ( T40.5), or

benzodiazepines (T42.4).

Age-adjusted morbidity and mortality rates were based on 2000 U.S. standard population data.

Previous reports (http://www.mc.uky.edu/kiprc/projects/kdodhedv/index.html) on Kentucky resi-

dent drug overdose deaths were based on data from the state Office of Vital Statistics and therefore the

numbers do not necessary match with the numbers presented in this report.

drug overdose deaths in kentucky, 2000 - 2013 · 2015. 10. 30. · 2. the 2013 kentucky resident...

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