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INTRODUCTION
Over the past 20 years the United States has experienced a well-documented epidemic of unintentional drug poisonings. According to the Centers for Disease Control and Prevention (CDC) unintentional drug poisonings are the second leading cause of injury death in the United States behind motor-vehicle crashes and the top cause of death for 35 to 54 year-olds (Warner et al. 2009). The major driver of this trend is the rise in use and abuse of prescription opioids. In 2002, implication of opioid analgesics in poisoning deaths was 36.5 percent and 29.4 percent of deaths were from opioids alone (Paulozzi 2006). From 1999 to 2002, deaths involving opioid analgesics increased by 91.2 percent and deaths from heroin use increased 12.4 percent (Paulozzi 2006). Deaths rates from drug overdose have increased exponentially over the past 20 years from 6.2 per 100,000 in 2000 to 14.6 per 100,000 in 2014, largely due to increases in prescription opioid deaths (Rudd et al. 2016).
Regular opioid use increases with age, and is more common among females, non-Hispanic White race/ethnicity, and those with fewer years of education (Kelly et al. 2008). However, poisoning deaths from opioid analgesics are highest among middle-aged men (Paulozzi 2006, Paulozzi and Annest 2007). Opiate poisoning deaths also vary by urban-rural status. Large metropolitan counties had the highest rate of opioid analgesic mortality in 1999, but by 2004 mortality rates were highest in rural counties, at 3.85 deaths per 100,000, which was an increase of 371 percent since 1999 (Paulozzi and Xi 2008). Other studies have shown that this increase in rural areas is due to prescription opioids such as oxycodone and methadone versus traditionally injected substances such as heroin. (Dasgupta et al. 2008, Paulozzi and Xi 2008, Paulozzi et al. 2009).
This rise in opiate overdose and death in the past 20 years is a serious public health concern. Opioid analgesics are highly addictive and patients must be aware of the consequences of regular use and abuse (Wright et al. 2014). Several studies have documented abuse of prescription opioids (e.g. injection, tearing patches, etc.) for nonmedical use with a greater risk for overdose and death (Paulozzi et al. 2006, Havens et al. 2007, Kelly et al. 2008). While opioid analgesics are important for proper medical treatment...