INTRODUCTION & METHODOLOGY By the publisher: The article "Actual Causes of Death in the United States," Journal of the American Medical Association (JAMA), Vol. 270, No. 18, pp. 2207-2212 by McGinnis and Foege (1993) was interesting as it included specific preventable causes of death, as opposed to general statements. I used the deaths reported in that article as the foundation of this compilation to which was added a breakdown of the illicit drug deaths from the Substance Abuse and Mental Health Services Sourcebook, August 1995 edition, as well as its percentage of deaths. Then a subschedule for the illicit use of drugs was compiled using figures from the National Institute on Drug Abuse, Annual Medical Examiner Data, 1990 publication. Table 2.06A of the Annual Medical Examiner Data publication provided a listing of the number of mentions for each drug most frequently mentioned by medical examiners from drug related deaths in 1990. This report was based on a total of 14,081 drug mentions, and a breakdown of individual percentages was tabulated by dividing the number of respective mentions by the total. The estimated number of deaths was then calculated taking the corresponding percentage of the 20,000 deaths attributed to illicit drug use from the McGinnis and Foege article. By Drs. McGinnis & Foege (1993): Actual Causes of Death in the United States, JAMA 270 (18): 2207-2212. This report was a met-analysis1 intended to identify and quantify the major external (non-genetic) factors that contribute to death in the United States. From the "Methods" section of the doctors' article: "This article summarizes published reports that attributed deaths to (preventable contributors) and presents a composite approximation of the totals reported for each. Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained. All relevant analysis were reviewed in full. Those selected for use in developing estimates were those most often cited and those for which the methodological assumptions could be identified. The limitations in the data should be underscored both with respect to deficiencies in the primary databases and to the disparate approaches used in the studies reviewed to arrive at estimates of the contribution of a factor to a particular health outcome. In some cases, assignments were attempted through simple tallies of available information about the presence or absence of a factor in association with a given outcome. In other cases, population attributable risk calculations were used to arrive at estimates based on determinations of the relative risk for a particular health outcome of a population exposed to a specific health risk. Some of the studies presented meta-analyses of reports in the literature on a given topic. Estimates were often limited by the adequacy of information as to disease prevalence, and the nature of the relationship to other contributing risk factors for the disease. Despite their limitations, the results of such studies provide a sense of the relative impact of various factors on health in the Untied States. Derivation of the numbers presented in the Table is explained (in the remaining portion of the article) in the discussion of each category. Where well-established methodologies have been developed for making the estimates, as with tobacco and alcohol, they have been used approximately as reported. For areas of greater uncertainty, such as diet and activity patterns and toxic agents, a sum of the lower boundaries of the estimates for various disease outcomes has been used. Although several of these factors are interrelated in their actions, care has been taken to avoid double counting. Given the fragility of the data base involved and the fact that the studies cited use different approaches to derive estimates, these numbers should be viewed as first approximation." 1 A meta-analysis refers to the analysis of multiple studies using different approaches to derive estimates, ranging from actual counts to population attributable risks.

TOP

CLOSE

Actual Causes of Preventable Deaths in the United States, 19901   Cause of Death Number of Deaths % of Total Preventable Deaths 1. Tobacco 400,000 37.7 2. Diet/Activity Patterns (physical inactivity, obesity) 300,000 28.3 3. Alcohol 100,000 9.4 4. Toxic Agents (occupational hazards, environmental pollutants, contaminants of food and water supplies, and components of commercial products) 90,000 8.5 5. Microbial Agents (unassociated with HIV infection, nor due to use of tobacco, alcohol or drugs) 60,000 5.7 6. Firearms (homicides, suicides, accidental deaths) 35,000 3.3 7. Sexual Behavior (sexually transmitted disease, cervical cancer, abortions) 30,000 2.8 8. Motor Vehicles (passengers and pedestrians, unassociated with alcohol or drugs) 25,000 2.4 9. Illicit Use of Drugs (use of both legal and illegal drugs, including overdoses, drug related HIV infection, drug associated automobile injuries, and hepatitis infections) 20,0002 1.9   A. Cocaine 3,526 .33   B. Alcohol-in-combination 3,272 .31   C. Heroin/Morphine3 2,806 .26   D. Codeine 968 .09   E. Diazepam (Valium) 714 .07   F. Methadone 598 .06   G. Amitriptyline 558 .05   H. Nortriptyline 464 .04   I. D-Propoxyphene 366 .03   J. Diphenhydramine 318 .03   K. Acetaminophen 296 .03   L. Marijuana/Hashish4 296 .03   M. Methamphetamine/Speed 280 .03   N. Remaining 57 drugs most frequently mentioned5 5,316 .52 Total 1,060,000 100.0 1 Data was drawn from selected sources published between 1977 and 1993 and a table quantifying the contributions of each of the leading factors was compiled using actual counts, generally accepted estimates, and correcting to avoid double counting. In the circumstances of uncertainty, a conservative approach was taken. A recompilation of these statistics from the U.S. Department of Health and Human Services, Office of Applied Studies, Substance Abuse and Mental Health Services, SAMHSA Statistics Sourcebook: August 1995, Vol. 9 was also referenced. 2 Figures for sub-scheduling of drugs were taken from the National Institute on Drug Abuse, Annual Medical Examiner Data 1990: Data From the Drugs Abuse Warning Network (DAWN) Series 1, No. 10-B, Washington, D.C.: U.S. Dept. of Health and Human Services; 1990, U.S. Dept. of Health and Human Services publication ADM 90-1717. Number of deaths resulting from each drug were calculated using the number of mentions of each drug divided by the total number of drug mentions. Percentages were then taken from the 20,000 subtotal resulting from illicit use of drugs of the previous reports. 3 Includes opiates not specified as to type. 4 As both marijuana and hashish are derived from the cannabis plant and have tetrahydrocannabinol (THC) as their psychoactive ingredient, they were probably treated as a single drug. On June 17, 1997, the Office of Applied Studies of SAMHSA said there have been no recorded deaths from an overdose of marijuana. 5 N. 57 Additional drugs most frequently mentioned which led to 279 or less deaths (drugs with less than 10 mentions are excluded).

TOP

CLOSE

Drug Name Number of Deaths % of Total  Drug Name Number of Deaths % of Total  1. Lidocaine  2. Desipramine  3. Doxepin  4. Unspec Benzodiazepine  5. PCP/PCP Combination  6. Phenobarbitol  7. Amphetamine  8. Aspirin  9. Chlordiazepoxide 10. Fluoxetine 11. Impiramine 12. Alprozolam 13. Hydantoin 14. Quyinine 15. Thioridizine 16. Secobarbital 17. Flurazepam 18. Butalbital 19. Caffeine 20. Meprobamate 21. Hydrocodone 22. Doxylamine Succinate 23. Temazopam 24. Chlorpheniramine 25. Chlorpromazine 26. Meperidine HCL 27. Theophylline 28. Carbamazepine 29. Glutethimide 222 204 204 196 182 180 158 158 150 146 128 106 92 90 90 88 86 80 76 74 64 62 60 58 56 50 48 44 44 .020 .019 .019 .019 .017 .017 .015 .015 .014 .014 .012 .010 .0087 .0086 .0086 .0084 .0082 .0076 .0072 .0070 .0061 .0059 .0057 .0055 .0053 .0048 .0046 .0042 .0042 30. Mesoridazine 31. Carisoprodol 32. Ethchlorvynol 33. Oxycodone 34. Trazodone 35. Lithium Carbonate 36. Oxazepam 37. Triazolam 38. Amobarbital 39. Dextromethorphan 40. Benztropine 41. Pentobarbital 42. Amoxapine 43. Haloperidol 44. Hydroxyzine 45. Phenylpropanolamine 46. Cyclobenzaprine 47. Ephedrine 48. Promethazine 49. Pseudophedrine 50. Lorazepam 51. Hydromorphone 52. Propanolol HCL 53. Ibuprofen 54. Digoxin 55. Oxymorphones 56. Pyrimethamine 57. Alcohol Substitutes 38 36 36 36 36 34 34 32 32 32 30 30 28 28 26 26 26 26 22 22 22 20 20 18 17 17 16 14 .0036 .0034 .0034 .0034 .0034 .0032 .0032 .0030 .0030 .0030 .0029 .0029 .0027 .0027 .0025 .0025 .0025 .0025 .0021 .0021 .0021 .0019 .0019 .0017 .0016 .0016 .0015 .0013   Steven C. Markoff is a Santa Monica, California businessman interested in U.S. Drug Policy. This report is one of a series that looks at various facts related to our nation's drug policy. Other reports include: #1 - "State-By-State Marijuana Laws" (As of December 31, 1996) #2 - "Addictiveness of Marijuana vs. Five Commonly Used Drugs" #4 - "Some of The Drugs America Takes"

TOP

CLOSE