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Dartmouth undergrad examines opioid death toll

Conducting the first comprehensive analysis of prescription opioid-related deaths in New Hampshire presented some special challenges for Laura Hester, a geography major in the Dartmouth College Class of 2009. It involved driving an hour each way from Hanover, N.H., to the Chief Medical Examiner's Office in Concord almost every other day for two months in the winter. It required combing through the 1,500 death certificates from 2003 to 2007 that were loosely classified as involving "toxic substances" in order to find the 488 deaths that were due to prescription opioids. And since the certificates exist only in paper form, it required hours and hours of data entry. But all that hard work yielded a "high-quality" database, says her advisor, and an "excellent" and "very ambitious" senior honors thesis.

"I always believe that a good thesis is not concluding something," says Hester's advisor, Xun Shi, Ph.D., an associate professor of geography at Dartmouth, "but opening or beginning something that [has] great potential, in terms of both continuation of the research and the development of the researcher herself." And Hester's thesis certainly does both.

In her analysis, Hester found two trends "that are worrisome," she says. The first is the age-specific prescription opioid-related death rates for men and women in New Hampshire. The rate for males ages 18 to 24 has increased faster than any other age group. Yet for females, the largest increase has been among women ages 45 to 64. "The 18-to-24 [group] is worrisome," says Hester, because young people experience less chronic pain and thus are less likely to be prescribed opioids, such as Vicodin or OxyContin. So prescription opioids prescribed to older adults must be getting diverted to this younger group. In contrast, middle-aged women addicted to opioids are "most likely doctor-shopping," Hester surmises, going from doctor to doctor in order to get higher doses or simply more of the drugs. "So you have a law-enforcement problem in younger people and a prescribing-practices problem in older people," says Hester. "This means that you have to have two different education programs to address two different demographics."

Another "worrisome" trend Hester noticed was that the highest risk areas of New Hampshire are near the Maine border. In 2006, Maine had the fifth-highest use among all 50 states of oxycodone (also known by the brand name OxyContin), the sixth-highest use of methadone, and the ninth-highest use of morphine, according to calculations made by the Las Vegas Sun. "So it is a possibility that you are having diversion problems from Maine into New Hampshire," she notes. But this a just a guess, she adds, based on a limited data set and analysis.

Hester won't be conducting a more in-depth analysis of prescription opioid-related deaths in the Granite State herself, although she hopes others will. After graduating from Dartmouth in 2009, she's entering the Johns Hopkins School of Public Health to begin pursuing her dream of becoming an epidemiologist.


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