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Original Research

Mental Illness and Psychotropic Drug Use Among Prescription Drug Overdose Deaths: A Medical Examiner Chart Review

Robin L. Toblin, PhD; Leonard J. Paulozzi, MD; Joseph E. Logan, PhD; Aron J. Hall, DVM; and James A. Kaplan, MD

Published: April 15, 2010

Article Abstract

Objective: Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes.

Method: In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program.

Results: Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug.

Conclusions: Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.

J Clin Psychiatry 2010;71(4):491-496

Submitted: July 28, 2009; accepted October 5, 2009.

Corresponding author: Robin L. Toblin, PhD, Office of Research and Evaluation, Federal Bureau of Prisons, 320 First St NW, Washington, DC 20534 (

Volume: 71

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