Assessing the Relationship between Controlled Substance Prescribing and Opioid Poisoning Toxicology

Abstract

This study updates previously reported drug overdose deaths in Allen County, Indiana with the purpose to evaluate changes in physician prescribing and drug overdose deaths following introduction of more restrictive Indiana controlled substance prescribing laws. In a retrospective review of drug overdose deaths, 2013-2017, Allen County, IN, autopsy, toxicology, police reports and prescribing data from the Indiana Scheduled Prescription Electronic Collection and Tracking Program (INSPECT) for 12 months preceding death were analyzed. Descriptive and correlational statistical measures were used. A total of 533 drug overdose deaths were reported: 414 deaths with complete records (369 unintentional, 42 intentional, 3 undetermined). Decedents, mean age 42.3 years, were more likely male (60.6%), Caucasian (89.1%) and employed (70.2%). Overdose deaths increased significantly between 2014 (n=53) and 2017 (n=133). Non-prescribed opioids were present in 293 (70.8%) deaths and 298 (72%) deaths involved multiple substances. Fentanyl-related deaths markedly increased (2 (3.2%) in 2013, 67 (50.5%) in 2017) and correlate with police fentanyl seizures. The average number of prescribed controlled substances significantly decreased. Non-prescribed controlled substances including opioids contributed to most deaths. While gains have been made with responsible opioid prescribing, the current crisis is fueled by illicit opioids.