ORIGINAL CONTRIBUTION Patterns of Abuse Among Unintentional Pharmaceutical Overdose Fatalities

couraged expanded use of opioid pain medications after careful patient evalu-ation and counseling when other treat-ments are inadequate. In subsequent years, experts have continued to advo-cate for improved pain management,3 and the Federation of State Medical Boards has encouraged adoption of model policies to promote more com-passionate pain management by clini-cians.4 States have increasingly com-plied by enacting new regulations or issuing guidelines or policy statements promoting improved pain manage-ment.5 In the10years (1997-2007) since the guidelines were first published, per capita retail purchasesofmethadone,hy-drocodone, andoxycodone in theUnited States increased 13-fold, 4-fold, and 9-fold, respectively.6 Concurrent with the increase in le-gitimate sales of opioids, diversion of these drugs to nonmedical uses has also increased. TheNational Survey onDrug Use and Health discovered that an an-nual average of 4.8%of persons 12 years or older consumed a prescription pain reliever for nonmedical reasons in the previous year during 2002-2005.7 Rates of emergency department visits for opioid analgesic overdoses have also in-creased.8 Unintentional drug poison-ing deaths increased 68 % during 1999-For editorial comment see p 2672