scholarly journals What Your Death Certificate Says About You May Be Wrong: A Narrative Review on CDC’s Efforts to Quantify Prescription Opioid Overdose Deaths

Cureus ◽  
2021 ◽  
Author(s):  
John F Peppin ◽  
John J Coleman ◽  
Antonella Paladini ◽  
Giustino Varrassi
Keyword(s):  
Death Certificate ◽  
Narrative Review ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.

Economic Conditions and Drug and Opioid Overdose Deaths

2017 ◽  
Vol 76 (4) ◽  
pp. 462-477 ◽  
Author(s):  
Ezequiel Brown ◽  
George L. Wehby
Keyword(s):  
Drug Overdose ◽  
Fixed Effects ◽  
House Prices ◽  
Insurance Coverage ◽  
House Price ◽  
State Level ◽  
Economic Conditions ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths

We examine the effects of state-level economic conditions including unemployment rates, median house price, median household income, insurance coverage, and annual and weekly work time on deaths on drug overdose deaths including from opioids and prescription opioids between 1999 and 2014. We employ difference-in-differences estimation controlling for state and year fixed effects, state-specific time trends, and demographic characteristics. Drug overdose deaths significantly declined with higher house prices, an effect driven by reduction in prescription-opioid mortality, by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years. Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.

scholarly journals Improving risk factor identification for opioid overdose deaths in Tennessee

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Sarah J. Nechuta ◽  
Jenna Moses ◽  
Molly Golladay ◽  
Adele Lewis ◽  
Julia Goodin ◽  
...  
Keyword(s):  
Risk Factor ◽  
Drug Overdose ◽  
Medical Examiner ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Death Certificates ◽  
Postmortem Toxicology ◽  
Icd 10 ◽  
Overdose Deaths

ObjectiveTo examine specific drugs present based on postmortem toxicology for prescription opioid, heroin, and fentanyl overdoses classified based on ICD-10 coding. To compare drugs identified from postmortem toxicology with those listed on the death certificate for opioid overdoses.IntroductionUsing death certificates alone to identify contributing substances in drug overdose deaths may result in misclassification and underestimation of the burden of illicit and prescription opioids and other drugs in drug-related deaths. To enable timely and targeted prevention in Tennessee (TN), the identification and monitoring of new drugs and trends in use should utilize toxicology and medicolegal death investigation data directly, as recommended by others 1-3. These data can inform mortality outcome definitions for improved surveillance and risk factor identification 4-7. To our knowledge, this is the first analysis to use statewide linked toxicology and death certificate data in TN.MethodsWe identified 615 opioid involved overdose deaths in TN of unintentional (underlying ICD-10 codes: X40-X44) or undetermined (underlying ICD-10 codes: Y10-Y14) intent during June 1st to December 31st 2017. Utilizing the Interim Medical Examiner Database (I-MED), we identified postmortem toxicology reports for 454 cases, which were from one of three national laboratories used by a state Regional Forensic Center. Toxicology data were abstracted and independently verified by two co-authors and linked to the TN death statistical file that included cause of death information (literal text and ICD-10 codes) and demographics. The analysis focuses on cases with an available toxicology report.ResultsWe identified 171 prescription opioid overdoses, 221 fentanyl overdoses, and 113 heroin overdoses. Table 1 displays postmortem toxicology profiles for major drugs/classes. For prescription opioid deaths (excluding fentanyl and heroin), positive toxicology results for prescription opioids were as follows: methadone (11%), buprenorphine (14%), hydrocodone (14%), oxycodone (36%) and oxymorphone (also a metabolite, 47%). Benzodiazepines were present in close to 58% of prescription opioid overdoses; stimulants (cocaine, amphetamines, methamphetamines) in about 25%. For fentanyl and heroin deaths, prescription opioids were detected in about 26% and 34%, respectively; stimulants in about 57.9% and 52.2%, respectively, and benzodiazepines 36-37%. Fentanyl was present on toxicology in about half of heroin overdoses, and 6–monoacetylmorphine in 72.6%.ConclusionsUsing medical examiners’ data, including toxicology data, improves estimation of contributing drugs involved in opioid deaths. This analysis provides jurisdiction-specific data on drugs that can help with monitoring trends and informs risk factor identification. Future work includes adding information on prescribed opioid and benzodiazepines using TN’s Prescription Drug Monitoring Database and evaluating demographic variation in contributing drugs between toxicology and DC data to identify susceptible populations.References1. Slavova S, O'Brien DB, Creppage K, Dao D, Fondario A, Haile E, Hume B, Largo TW, Nguyen C, Sabel JC, Wright D, Council of S, Territorial Epidemiologists Overdose S. Drug Overdose Deaths: Let's Get Specific. Public Health Rep.2. Horon IL, Singal P, Fowler DR, Sharfstein JM. Standard Death Certificates Versus Enhanced Surveillance to Identify Heroin Overdose-Related Deaths. Am J Public Health. 2018;108(6):777-81.3. Mertz KJ, Janssen JK, Williams KE. Underrepresentation of heroin involvement in unintentional drug overdose deaths in Allegheny County, PA. J Forensic Sci. 2014;59(6):1583-5.4. Landen MG, Castle S, Nolte KB, Gonzales M, Escobedo LG, Chatterjee BF, Johnson K, Sewell CM. Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico. Am J Epidemiol. 2003;157(3):273-8.5. Davis GG, National Association of Medical E, American College of Medical Toxicology Expert Panel on E, Reporting Opioid D. Complete republication: National Association of Medical Examiners position paper: Recommendations for the investigation, diagnosis, and certification of deaths related to opioid drugs. J Med Toxicol. 2014;10(1):100-6.6. Slavova S, Bunn TL, Hargrove SL, Corey T. Linking Death Certificates, Postmortem Toxicology, and Prescription History Data for Better Identification of Populations at Increased Risk for Drug Intoxication Deaths. Pharmaceutical Medicine. 2017;31(3):155-65.7. Hurstak E, Rowe C, Turner C, Behar E, Cabugao R, Lemos NP, Burke C, Coffin P. Using medical examiner case narratives to improve opioid overdose surveillance. Int J Drug Policy. 2018;54:35-42. 

Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans

2019 ◽  
Vol 57 (1) ◽  
pp. 106-110 ◽  
Author(s):  
Lewei (Allison) Lin ◽  
Talya Peltzman ◽  
John F. McCarthy ◽  
Elizabeth M. Oliva ◽  
Jodie A. Trafton ◽  
...  
Keyword(s):  
Prescription Opioid ◽  
Opioid Overdose ◽  
Changing Trends ◽  
Overdose Deaths

scholarly journals Preventing Prescription Opioid Overdose Deaths

2013 ◽  
Vol 28 (10) ◽  
pp. 1258-1259 ◽  
Author(s):  
Darius A. Rastegar ◽  
Alexander Y. Walley
Keyword(s):  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths

A National Epidemic of Unintentional Prescription Opioid Overdose Deaths: How Physicians Can Help Control It

2011 ◽  
Vol 72 (05) ◽  
pp. 589-592 ◽  
Author(s):  
Leonard J. Paulozzi ◽  
Richard H. Weisler ◽  
Ashwin A. Patkar
Keyword(s):  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths

scholarly journals Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances

2017 ◽  
Vol 178 ◽  
pp. 501-511 ◽  
Author(s):  
Denise B. Kandel ◽  
Mei-Chen Hu ◽  
Pamela Griesler ◽  
Melanie Wall
Keyword(s):  
Prescription Opioid ◽  
Opioid Overdose ◽  
Other Substances ◽  
Overdose Deaths

scholarly journals Opioid Mortality Following Implementation of Medical Cannabis Programs in the United States

2021 ◽  
Author(s):  
Daniel E. Kaufman ◽  
Asawer M. Nihal ◽  
Janan D. Leppo ◽  
Kelly M. Staples ◽  
Kenneth L. McCall ◽  
...  
Keyword(s):  
United States ◽  
Death Certificate ◽  
Reporting Quality ◽  
Interrupted Time Series ◽  
The United States ◽  
Opioid Overdose ◽  
Medicaid Expansion ◽  
Protective Effects ◽  
Medical Cannabis ◽  
Overdose Deaths

Abstract Introduction The United States is in the midst of an opioid overdose epidemic. Emerging evidence suggests that medical cannabis (MC) may reduce use of opioids for pain in some individuals, with potential impacts on opioid-related overdose. However, there may be other important differences between states that did, and did not, adopt MC. Methods This study evaluated differences following legal MC sales on US opioid-related overdose deaths, corrected for population, from 1999 to 2017 using an interrupted time series. Comparisons by MC status were also made for Medicaid expansion and the Centers for Disease Control death certificate reporting quality (0: <good, 1: good, 2: excellent). Results Overdose deaths were significantly higher in MC states from 2012–2017. Overdose death slopes over time increased in states with (pre=1.46±0.46, post=2.90±0.58, p<0.05) and without (pre =0.20±.10, post=1.04±0.22, p<0.005) MC. Post-legalization slopes were significantly higher in MC states (p<0.01). Two states without (11.1%) as compared to 11 states with (91.7%) MC expanded Medicaid by 2014 (χ2[1]=19.03, p<0.0005). MC states (1.50±0.23) had higher death certificate reporting quality relative to states without MC (0.78±0.22, p<0.05). Discussion MC states had higher rates of opioid overdoses. Although there was no decrease in association with MC introduction, these results were confounded by states without MC having lower overdose reporting quality. Medicaid expansion was also more common in states with MC. Finally, the potency of fentanyl analogues may have obscured any protective effects of MC against illicit opioid harms.

scholarly journals Quantifying the Epidemic of Prescription Opioid Overdose Deaths

2018 ◽  
Vol 108 (4) ◽  
pp. 500-502 ◽  
Author(s):  
Puja Seth ◽  
Rose A. Rudd ◽  
Rita K. Noonan ◽  
Tamara M. Haegerich
Keyword(s):  
Prescription Opioid ◽  
Opioid Overdose ◽  
Overdose Deaths
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