Trends in psychotropic-drug-implicated mortality: Psychotropic drugs as a contributing but non-underlying cause of death (2021)

Background: Drug overdoses have contributed to considerable years of life lost. However, focusing solely on drug overdoses, whereby drug poisoning defines the underlying cause of death, obscures the wider burden of the drug mortality crisis. We aim to describe 21 years of trends in "psychotropic-drug-implicated deaths," those where psychotropic drugs are a contributing (but not the underlying) cause of death.
Methods: We analyze deaths extracted from CDC WONDER from 1999-2019 to generate annual counts and rates for psychotropic-drug-implicated deaths in the United States, including by underlying cause of death and drug implicated.
Results: Over 21 years, 51,446 psychotropic-drug-implicated deaths occurred (33,885 medical; 17,561 external). Both medical and external psychotropic-drug-implicated deaths rose dramatically, increasing 2.5 and 5.0 times, respectively. Diseases of the circulatory system predominated underlying causes of medical deaths (74%). Non-drug suicide, transport accidents, and drownings constitute 54% of external underlying causes. Among the various underlying causes of death, psychotropic-drug-implicated deaths represent a considerable proportion, especially among external causes, with the proportion greatly increasing over the observation period. The drug implicated evolves from cocaine to opioids to psychostimulants, with the latter rising considerably.
Conclusions: The drug mortality crisis extends beyond overdose and may temper improvements observed within other causes of mortality, such as cardiovascular disease, transport accidents, and drownings. As with overdoses, psychotropic-drug-implicated deaths have risen dramatically during the 21st century. They include striking increases for drugs, such as psychostimulants, receiving less attention with overdoses. Research is needed to address prevention, intervention, and policy for psychotropic-drug-implicated deaths beyond overdose mortality.
Highlights:
• Psychotropic-drug-implicated deaths, where psychotropic drugs are a contributing but not primary cause, rose dramatically.
• Cardiovascular deaths dominate medical causes; suicide, transport accidents, drownings 54% of external causes.
• Predominant implicated drug evolves from cocaine to opioids to psychostimulants.
• Drug mortality crisis extends beyond overdose, tempers reductions in other mortality causes.
• Research on prevention, intervention, and policy for psychotropic-drug-implicated deaths needed.