Bringing Back the Overdose Dead

Heath Ledger, Anna Nicole Smith and Brad Renfro have put famous faces on fatal prescription painkiller overdoses, but celebrities aren't the only victims. In fact, drug overdose is the second leading cause of death by unintentional injury in the U.S.—and the overdose death rate rose by nearly two-thirds between 1999 and 2004.

"Overdose passed homicide some time ago," says Leonard Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, noting that some 22,000 people died of overdose in 2005, while there were 17,000 homicides. In some regions, more people die from overdoses than from car accidents.

But can these deaths be prevented? Overdose fatalities usually involve an opioid drug like heroin, Vicodin or Oxycontin that is taken for non-medical purposes in combination with alcohol or other drugs. With that in mind, some hard-hit states and cities are taking action, providing an opioid antidote to addicts—and even piloting its distribution to patients who are prescribed painkillers.

Although the approach is opposed by the Office of National Drug Control Policy—the "Drug Czar's" office— researchers who study addiction think it is well worth investigating.

Deadly cocktails

Most overdose fatalities result from mixing drugs, and the most dangerous kind of drug to include in the mix is an opioid. Mixing "downs" or "depressant drugs"—the class that includes alcohol, opioids, and tranquilizers like Valium and Ambien—is what killed Ledger, and is, according to Frank Vocci, director of the Division of Pharmacotherapy for the National Institute on Drug Abuse (NIDA), "unquestionably" the deadliest combination. Seventy-five percent of overdoses involve drug mixtures.

Taking stimulants like cocaine or methamphetamine with alcohol or opioids can also kill, of course—but because the drugs have effects that, to some degree, oppose each other, this is less risky than using similar drugs together. "Any mixing is dangerous," says Sandro Galea, associate professor of epidemiology at the University of Michigan, "but if you mix depressants, it is more dangerous."