“While prescription drug abuse has been a major public health concern for several years, the public health and public safety consequences of prescription drug abuse continue to mount. National data show that in 2009 the 39,147 drug-induced deaths exceeded deaths from motor vehicle crashes (36,216). In 2008, the latest year for which national data are available, there were 20,044 unintentional prescription drug overdose deaths. The problem of prescription drug abuse is particularly acute in the southern United States and the Appalachian region. Prescription drugs caused an average of seven deaths per day in Florida in 2010, according to the Florida Medical Examiners Commission Drug Report.”

Source: http://www.whitehouse.gov/ondcp/2012-national-drug-control-strategy)

While it’s important for all of us to maintain our focus on illicit drugs of abuse, it’s also important to recognize that diverted prescription drugs, principally opioids, are estimated to cause more overdose deaths each year in the US than heroin, cocaine, and methamphetamine – combined! Moreover, the figure of 20,044 “unintentional prescription drug overdose deaths” mentioned in the recent ONDCP Strategy Report (supra) in all likelihood represents an undercount. This death tally is computed by the Centers for Disease Control and Prevention (CDC) from death certificates filed by state medical examiners. Researchers, however, have criticized this dataset for its limitations. Wysowski (2007), for example, conducted a surveillance study of 25,031 deaths attributed to prescription drugs in 2003 and compared this with a total of 16,135 similar deaths reported for 1999. She used the aforementioned CDC data base that transfers data from death certificates to categories known as the ICD-10 codes, designed in accordance with the International Classification of Diseases (10th revision). Wysowski commented on the limitations of these data:

“Drug names also are absent from death certificates because of certifiers’ under-attribution of drug-related deaths. Certifiers of death may not recognize a drug as a cause or, or as contributing to, a patient’s death, and when they do, they sometimes write ‘adverse drug reaction’ without providing the name of the drug on the death certificate. Furthermore, toxicological data are often unavailable at the time of death certification although death certificates can be amended to include subsequent information.”

Source: (Ref: Wysowski DK. Surveillance of prescription drug-related mortality using death certificate data. Drug Saf. 2007;30(6):533-540