Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015

Abstract

Purpose:To determine the role of opioids in drug overdose deaths in Allen County, Indiana between January 1, 2008, and December 31, 2015.Methods:File review of 418 overdose deaths was performed using Indiana State Department of Health death certificates available through the Allen County Coroner’s Office. Data from autopsy and toxicology reports and coroner-requested prescribing data from Indiana’s Prescription Monitoring Program were reviewed. Cause of death and available data were analyzed to identify patterns and trends related to overdose deaths.Results:Four hundred eighteen drug overdose deaths were identified (336 accidental, 66 intentional, and 16 undetermined). Mean age was 42.5 years, 88.5% were Caucasian, and 68.7% were employed. The majority of deaths occurred at a place of residence (71.4%) and with other people present (57.5% of the time). Depression was the most common comorbidity identified. The most common drug classes identified by toxicology were opioids, followed by benzodiazepines. Significant increases in both heroin (35% of deaths in 2015 versus 8.2% in 2013) and fentanyl (30% of deaths in 2015 versus 2.2% in 2011) were observed.Conclusions:Drug overdose continues to be a significant cause of death in Allen County. The majority of deaths were accidental and in relatively young, employed individuals. Prevention and awareness strategies should be encouraged, given that the majority of overdose deaths occurred at a place of residence with other people frequently present. Additional concerns about patterns of drug use were confirmed with marked increases in both heroin and fentanyl contributing to overdose deaths in the latter part of the study.

Exploration des facteurs de risque contextuels et des caractéristiques des personnes décédées des effets toxiques aigus d’opioïdes et d’autres substances illégales : prise en compte de l’avis des coroners et des médecins légistes

“…Plusieurs études ont utilisé des données ou des rapports produits par des coroners et des médecins légistes pour faire la lumière sur les décès causés par une intoxication aigüe aux opioïdes ou à d'autres substances. Les facteurs de risque contextuels de décès par intoxication aigüe liée à une substance les plus cou ramment observés dans ces études sont des antécédents de maladie mentale 6,7 , des antécédents de tentative de suicide 7 , la sortie d'un établissement médical ou thé rapeutique 8 , une surdose non mortelle récente 9 , une sortie de prison récente 10 , la consommation de plusieurs substances 11 , des antécédents de douleurs chroniques 6 et des antécédents de consommation de substances 6 . Toutefois, la majorité de ces études visaient une province ou un terri toire en particulier, portaient sur un nombre limité de circonstances de décès par intoxication aigüe liée à une substance ou s'appuyaient sur les renseignements consignés par les coroners et médecins légistes dans des tableaux et des rapports.…”

Exploring the contextual risk factors and characteristics of individuals who died from the acute toxic effects of opioids and other illegal substances: listening to the coroner and medical examiner voice

“…5 A number of studies have used coroner and medical examiner (C/ME) data or reports to shed light on acute toxicity deaths related to opioid and other substances. Contextual risk factors for substance-related acute toxicity death commonly identified in these studies included history of mental illness, 6,7 previous suicide attempts, 7 discharge from a treatment centre or health care facility, 8 recent nonfatal overdose, 9 recent release from jail, 10 use of multiple substances, 11 history of chronic pain 6 and a history of substance use. 6 However, these studies often focussed on a single province or territory, included only limited circumstances surrounding substancerelated acute toxicity death and relied on the information recorded by the C/MEs in charts and reports.…”

Internet pseudoscience: Testing opioid containing formulations with tampering potential

“…Prescription opioids offer a therapeutic option for the management of pain, but they can also lead to physical and psychological dependence and therefore be misused and abused, resulting in harms such as addiction, overdose and even death. In fact, in recent years, an increase in the rates of deaths involving controlled prescription opioids, including fentanyl, has been recorded in the European countries [1,2] as well as in United States [3][4][5][6]. Abuse and misuse of psychotropic pharmaceuticals have been defined according to "The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)" as "use of pharmaceutical drugs .…”