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Linking Death Certificates, Postmortem Toxicology, and Prescription History Data for Better Identification of Populations at Increased Risk for Drug Intoxication Deaths

NCJ Number
Pharmaceutical Medicine Volume: 3 Issue: 31 Dated: June 2017 Pages: 155-165
Svetla Slavova; Terry L. Bunn; sarah L. Hargrove; Tracey Corey; Van Ingram
Date Published
June 2017
11 pages
This study's objective was to assess and improve the completeness of drug-related information, to evaluate the risk for drug intoxication deaths associated with specific drugs among different demographic groups, and to show the benefit of multi-source surveillance to better target interventions and to inform policy evaluation.
This study linked death certificate, prescription drug monitoring program, and postmortem toxicology data for Kentucky residents ages 18 years old and older who died from drug intoxication during 2013-2014. It determined that the abuse and diversion of drugs has significantly impacted the health and safety of Kentucky citizens. It also demonstrated the benefit of using integrated multi-source drug intoxication fatality surveillance in identifying drug misuse and diversion, as well as population groups at high risk for drug overdose death. Further, it can inform targeted prevention programs. The most frequently listed contributing drugs were pharmaceutical opioids (60 percent), alprazolam (35 percent), and heroin (29 percent) (not mutually exclusive). The highest death rates from fentanyl (4 per 100,000 Kentucky population aged =18 years) and heroin (13 per 100,000) intoxication were among those aged 25-34 years; whereas, the highest death rates associated with prescription opioids (excluding morphine and fentanyl) were among those ages 35-54 years (15 per 100,000). Appalachian County residents had a significantly higher overdose fatality rate (34 per 100,000) than residents from non-Appalachian counties (27 per 100,000). One-quarter of death certificates did not list any specific contributing drug, but postmortem toxicology reports were available for 89 percent of these cases and provided information on drugs used before death. Analysis of decedents' controlled substance prescription records suggested drug diversion (e.g., only 36 percent of the decedents who tested positive for oxycodone had recently filled prescriptions). (Publisher abstract modified)