Trends in unintentional polysubstance overdose deaths and individual and community correlates of polysubstance overdose, North Carolina, 2009-2018

Background: Polysubstance involvement is increasing among fatal drug overdoses. However, little is known about the epidemiology of polysubstance drug overdoses. This paper describes emerging trends in unintentional polysubstance overdose deaths in North Carolina (NC) and examines associations with individual and community factors. Methods: Using 2009–2018 NC death certificate data, we identified unintentional drug overdose deaths and commonly involved substances (opioids, stimulants, benzodiazepines, alcohol, and antiepileptics). We examined polysubstance combinations, comparing opioid and non-opioid involved deaths. We examined individual level correlates from death certificate data and community level correlates from the American Community Survey and Robert Wood Johnson Foundation County Health Rankings to quantify associations. Results: From 2009–2018, 53 % of opioid and 19 % of non-opioid overdose deaths involved multiple substances. During this period, polysubstance overdose death increased dramatically, from 2.9 to 12.1 per 100,000 persons, with the greatest increases among drug combinations involving stimulants. The most common polysubstance combinations were: opioids and stimulants (12.1 % of overdose deaths); opioids and benzodiazepines (9.0 %); opioids and alcohol (5.1 %); opioids, stimulants, and benzodiazepines (3.1 %); and opioids, benzodiazepines, and antiepileptics (2.2 %). Compared to overdoses involving opioids alone, overdoses involving combinations of opioids, stimulants, and benzodiazepines involved younger individuals (53.7 % in 15−34 years of age vs. 40.7 %). Men comprised two-thirds of overdoses involving opioids alone, however, overdoses involving opioids, benzodiazepines, and antiepileptics were predominantly among women (60.6 %). Conclusions: Polysubstance involvement has increased among overdose deaths in NC. These findings can be used to inform public health interventions addressing polysubstance deaths and associated individual and community level factors

Complications in Using Real-World Data to Study the Health of People Who Use Drugs

For the past two decades, the United States has suffered dramatic increases in a fatal drug overdose. Overdoses represent one major health concern facing people who use drugs, in a milieu including injection drug use-related infections. Accordingly, the use of real-world data to study drug-related harms, such as overdoses and injection drug-related infections, has become more common in the medical literature. Real-world data sources include electronic health records and administrative claims that can be leveraged to understand health needs and longitudinal health utilization patterns in specific groups of patients, including people who use drugs. Researchers developed various algorithms that use combinations of drug-related diagnosis codes for substance use disorders and overdoses. However, limited attention to date has been paid to the methodologic and ethical implications arising from the limitations of these algorithms

Opioid Overdose Deaths among Formerly Incarcerated Persons and the General Population: North Carolina, 2000–2018

Objectives. To compare opioid overdose death (OOD) rates among formerly incarcerated persons (FIPs) from 2016 to 2018 with the North Carolina population and with OOD rates from 2000 to 2015. Methods. We performed a retrospective cohort study of 259 861 North Carolina FIPs from 2000 to 2018 linked with North Carolina death records. We used indirectly standardized OOD mortality rates and ratios and present 95% confidence intervals (CIs). Results. From 2017 to 2018, the OOD rates in the North Carolina general population decreased by 10.1% but increased by 32% among FIPs. During 2016 to 2018, the highest substance-specific OOD rate among FIPs was attributable to synthetic narcotics (mainly fentanyl and its analogs), while OOD rates for other opioids were half or less than that from synthetic narcotics. During 2016 to 2018, the OOD risk for FIPs from synthetic narcotics was 50.3 (95% CI 5 30.9, 69.6), 20.2 (95% CI 5 17.3, 23.2), and 18.2 (95% CI 5 15.9, 20.5) times as high as that for the North Carolina population at 2-week, 1-year, and complete follow-up after release, respectively. Conclusions. While nationwide OOD rates declined from 2017 to 2018, OOD rates among North Carolina FIPs increased by about a third, largely from fentanyl and its analogs