Drug Intoxication Deaths Research Articles

Cardiovascular Disease in Acute Cocaine Compared to Acute Fentanyl Intoxication Deaths.

Cocaine is the most common stimulant drug that causes death in Connecticut. Unlike opioid intoxication deaths, which largely correlate with dose/concentration, cocaine deaths occur more idiosyncratically, with mechanisms of death often related to underlying cardiovascular disease. We examined 78 sole acute cocaine and 306 sole acute fentanyl intoxication deaths to assess their association with cardiovascular disease. In the cocaine cohort, 87% (68/78) had atherosclerotic and/or hypertensive cardiovascular disease while 40% (122/306) in the fentanyl cohort did. Cocaine was detected in 40% of all accidental drug intoxication deaths, 41% of all accidental drug intoxication deaths involving fentanyl, and 37% of all drug intoxication deaths involving heroin. The relatively low number of sole cocaine deaths compared to the much higher proportion of cocaine/opioid deaths may be explained by the synergistic effects encountered in many mixed drug intoxications, the contributory role of cardiovascular disease in sole cocaine deaths, and/or the increased prevalence and potency of fentanyl. The high number of sole cocaine deaths in which the decedents had co-existing heart disease compared to those from sole fentanyl deaths (P < 0.001) suggests that heart disease plays a mechanistic role in sole cocaine deaths, whereas the potency of fentanyl is the dominant mechanism in fentanyl deaths.

Etizolam and Irish drug poisoning deaths.

Etizolam and Irish drug poisoning deaths.

Stability and Volatility in the Contextual Predictors of Working-Age Mortality in the United States.

The contextual predictors of mortality in the United States are well documented, but the COVID-19 pandemic may have upended those associations. Informed by the social history of disease framework (SHDF), this study examined how the importance of county contexts on adult deaths from all causes, drug poisonings, and COVID-19-related causes fluctuated during the pandemic. Using 2018 to 2021 vital statistics data, for each quarter, we estimated associations between county-level deaths among adults ages 25 to 64 and prepandemic county-level contexts (economic conditions, racial-ethnic composition, population health profile, and physician supply). The pandemic significantly elevated the importance of county contexts-particularly median household income and counties' preexisting health profile-on all-cause and drug poisoning deaths. The elevated importance of household income may be long-lasting. Contextual inequalities in COVID-19-related deaths rose and then fell, as the SHDF predicts, but rose again along with socio-political disruptions. The findings support and extend the SHDF.

The association between urban environment and drug poisoning deaths in Hong Kong

The association between urban environment and drug poisoning deaths in Hong Kong

Suicide deaths involving opioid poisoning in the United States, by sex, 1999-2021.

Suicide remains a leading cause of death in the United States, and recent data suggest suicide deaths involving opioids are increasing. Given unprecedented increases in drug-poisoning deaths, suicidality, and suicide deaths in recent years, an updated examination of the trends in suicide deaths involving opioids is warranted. In this descriptive epidemiologic analysis, we leverage final and provisional mortality data from the US Centers for Disease Control and Prevention's WONDER database to examine trends in suicide deaths involving opioid poisoning from 1999 to 2021 by biological sex. Results reveal complex changes over time: the number and age-adjusted rate of suicide deaths involving opioid poisoning among male and female residents tended to track together, and both increased through 2010, but then diverged, with the number and rate of suicide deaths involving opioid poisoning among female residents outpacing that of male residents. However, the number and rate of suicide deaths involving opioid poisoning among male residents then began to stabilize, while that of female residents declined, closing the sex-based gap. Across all years of data, the proportion of suicide deaths that involved opioid poisoning was consistently higher among female decedents (5.8%-11.0%) compared with male decedents (1.4%-2.8%). Findings have implications for improved suicide prevention and harm reduction efforts. This article is part of a Special Collection on Mental Health.

Flawed reports can harm: the case of supervised consumption services in Alberta

Supervised consumption services have been scaled up within Canada and internationally as an ethical imperative in the context of a public health emergency. A large body of peer-reviewed evidence demonstrates that these services prevent poisoning deaths, reduce infectious disease transmission risk behaviour, and facilitate clients’ connections to other health and social services. In 2019, the Alberta government commissioned a review of the socioeconomic impacts of seven supervised consumption services in the province. The report is formatted to appear as an objective, scientifically credible evaluation of these services; however, it is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors’ assessment of the scientific evidence. The report’s findings have been used to justify decisions that jeopardize the health and well-being of people who use drugs both in Canada and internationally. Governments must ensure that future assessments of supervised consumption services and other public health measures to address drug poisoning deaths are scientifically sound and methodologically rigorous. Health policy must be based on the best available evidence, protect the right of structurally vulnerable populations to access healthcare, and not be contingent on favourable public opinion or prevailing political ideology.

Engaging families and parent advocates in research on substance use and drug policy reform: Guiding principles from a Canadian community-academic partnership.

Canada is in the midst of a public health emergency in drug poisoning (overdose) deaths. In this context parents, and especially mothers, of those who have died from drug poisoning have mobilised to advocate for urgent responses and drug policy reforms. To document this emerging women-led advocacy, we initiated a community-academic research partnership with three parent groups representing families in Canada bereaved by drug-related deaths. In this commentary, we describe four guiding principles we developed during the course of this project, to ensure an ethical and equitable approach to conducting our research partnership. In particular, we emphasise how we navigated parents' roles as vocal advocates for addressing drug stigma and expanding harm reduction while actively working to avoid eclipsing the need to centre the perspectives of people who use drugs. Meaningful and collaborative partnerships between academics and community groups may facilitate greater understandings of how families and communities can be allied in drug policy reforms urgently needed to prevent drug poisoning deaths.

Non-fatal overdose risk associated with prescribing opioid agonists concurrently with other medication: Cohort study conducted using linked primary care, secondary care and mortality records.

An apparently protective effect of opioid agonist treatment (OAT) on all-cause and cause-specific mortality risk has been widely reported. Non-fatal overdose (NFO) often precedes subsequent drug-poisoning deaths. We hypothesized that benzodiazepines, gabapentinoids, antipsychotics, antidepressants, Z-drugs or opioids increase the NFO risk when co-prescribed with OAT. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases. The cohort was linked to Hospital Episode Statistics admitted patient care data (HES-APC), neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records from the Office for National Statistics. Primary care in England. We studied patients with opioid use disorder, aged 18-64 years, who were prescribed OAT (15155 methadone and 5743 buprenorphine recipients) between Jan 1, 1998, and Dec 31, 2017. The main outcome examined was NFO risk during co-prescription of OAT with benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids. Overdose was defined according to International Classification of Diseases codes from the HES-APC data set. Negative binomial regression models were used to estimate weighted rate ratios (wRR) for NFO during co-prescription of OAT and benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids with periods of exclusive OAT usage. Among 20 898 patients observed over 83 856 person-years, we found an elevated overdose risk that resulted in hospital admission during co-prescription of OAT with benzodiazepines [wRR: 1.45; 95% confidence interval (CI) = 1.26-1.67], gabapentinoids (wRR = 2.22; 95% CI = 1.77-2.79), Z-drugs (wRR = 1.60; 95% CI = 1.31-1.96), antipsychotics (wRR = 1.85; 95% CI = 1.53-2.25) and opioids (wRR = 1.28; 95% CI = 1.02-1.60). The risk ratio for antidepressant co-prescriptions was below unity (wRR = 0.90; 95% CI = 0.79-1.02) but this result was not statistically significant. Elevated risk of non-fatal overdose among opioid agonist treatment recipients is associated with concurrent use of medication prescribed for other reasons.

Social and structural barriers and facilitators to HIV healthcare and harm reduction services for people experiencing syndemics in Manitoba: study protocol

IntroductionIn Manitoba, Canada, there has been an increase in the number of people newly diagnosed with HIV and those not returning for regular HIV care. The COVID-19 pandemic resulted in...

Xylazine Test Strips for Drug Checking

Why is this an issue?&#x0D; &#x0D; The opioid crisis is an ongoing public health concern in Canada. In 2022, a total of 7,328 apparent opioid toxicity deaths were reported, which is an average of 20 deaths per day.&#x0D; Xylazine, referred to as tranq, is an animal tranquilizer that has appeared as an adulterant in the unregulated drug supply (particularly in opioids) and is contributing to increasing numbers of drug poisoning (overdose) events and deaths.&#x0D; There is no approved drug for humans for reversing the effects of xylazine, so detection is critical.&#x0D; &#x0D; What is the technology?&#x0D; &#x0D; The Rapid Response Xylazine Test Strip by BTNX (Pickering, Ontario) is a rapid test for the detection of xylazine that can be used for drug checking in an unregulated drug supply.&#x0D; &#x0D; What is the potential impact?&#x0D; &#x0D; Xylazine can have harmful effects, such as severe skin lesions, central nervous system depression, cardiovascular effects, and death.&#x0D; The detection of xylazine using a test strip could alter consumption behaviours, such as avoiding the use of contaminated drugs, reducing the quantity consumed, injecting more slowly, or choosing to use at a supervised consumption site.&#x0D; &#x0D; What else do we need to know?&#x0D; &#x0D; The strips are currently available in Canada for $349.00 for a box of 100 or $3.49 per strip.&#x0D; Although these strips are good at checking for xylazine, they are not designed to anticipate and test for the next adulterant to enter the unregulated drug supply which could be equally or even more dangerous. Therefore, these strips would be useful as part of a robust harm reduction strategy.&#x0D;

Individual-level and neighborhood-level shifts in mortality patterns among drug poisoning deaths in a high-density Asian city: a territory-wide, case-only analysis.

The shifts in individual-level and neighborhood-level patterns of drug poisoning deaths in a high-density Asian city over time have been underestimated, although they provide essential information for community-based surveillance and interventions. A case-only analysis with a 16-y, territory-wide, population-based registry in Hong Kong was applied to compare drug poisoning deaths from 2001 to 2010 with 2011 to 2016. Drug poisoning deaths, deaths from heroin and deaths from other opioids (codeine or morphine) were extracted (ICD codes: T36-T50, T40.1, T40.2). Binomial regressions were used to estimate the shifts in mortality patterns. Among 3069 drug poisoning deaths, a significant shift in mortality patterns was found despite a decreasing mortality trend in Hong Kong. Overall, drug poisoning deaths shifted towards middle-aged/young-old, widowed/divorced, economically active, white collar and non-local born. Since 2011, more deaths from heroin were in older ages and non-local born, but less were never married and economically inactive. More deaths from other opioids were middle-aged, young-old and divorced. In particular, most decedents shifted towards young-old, especially deaths from other opioids. Compared with deaths during 2001-2010, there were 3.72- and 6.50-fold more deaths from heroin and deaths from other opioids in those aged ≥60 y since 2021 (ORs: 3.72 [2.37, 5.86], 6.50 [3.97, 10.65]), respectively. Additionally, drug poisoning deaths shifted towards areas with less neighborhood deprivation (more high-education individuals and a mix of private/public housing residents), especially deaths from other opioids. Misuse of registered drugs (e.g. opioid pain relievers) could be a rising trend among vulnerable subpopulations in Hong Kong other than illegal drug use (heroin). Health officials should provide more advice and support on drug information. Specifically, an improved health system with education regarding the appropriate use of registered drugs for medical treatments should be provided to mid-/high-income and local-born individuals.

Seasonal, weekly, and other cyclical patterns in deaths due to drug poisoning in England and Wales.

The rate of drug poisoning (or overdose) deaths in England and Wales has risen annually since 2010. The current study aimed to measure seasonal and other cyclical changes in these deaths within years. We used the daily count of deaths due to drug poisoning in England and Wales between 1 January 1993 and 31 December 2018 to investigate variation by season, weekday, week-of-month, and public holiday. We used Poisson regression to estimate the count of deaths per day for each of these variables and peak-to-low ratios. We also stratified the analysis by time period and whether an opioid was mentioned on the death certificate. 78,583 deaths occurred between 1993 and 2018, increasing from 5.50 (95% confidence interval [CI] 5.24-5.77) per day in 1993 to 13.18 (95% CI 12.66-13.72) per day in 2018. The rate peaked in Spring and was 1.07 (95% CI 1.04-1.09) times higher in April than in October. This seasonal pattern emerged in the past decade and was only present for opioid-related deaths. The rate at New Year was 1.28 (95% CI 1.17-1.41) times higher than on non-holidays; and this peak was only present for deaths that were not related to opioids. The rate was higher on Saturday than other weekdays. We did not find evidence that the number of deaths varied by week-of-month. Deaths due to drug poisoning in England and Wales are seasonal and peak in Spring and briefly at New Year. This suggests a role of external triggers. These seasonal variations are small compared with long-term increases in drug-related deaths.

Prescription drugs with potential for misuse: protocol for a multi-indicator analysis of supply, detection and the associated health burden in Ireland between 2010 and 2020

IntroductionThere is an increasing concern about the misuse of prescription drugs. Misuse refers to the intentional repurposing of prescribed drugs and/or the use of illicitly sourced prescription drugs, which may...

Drugs or despair? Unraveling the rise in deaths of despair in Illinois

PurposeIncreases in deaths of despair in the USA have been associated with economic conditions and drug availability. In the state of Illinois, deaths of despair represent a significant public health issue. This study aims to examine the relationship between county-level economic distress, drug availability and mortality from deaths of despair collectively and for each contributing cause of death individually in the state of Illinois to better understand drivers of mortality locally.Design/methodology/approachTwo cross-sectional analyses were conducted for 2010–2014 and 2015–2019. Correlations, regression analyses and relative weight analyses were applied to assess the relationship between deaths of despair mortality rate and the individual variables.FindingsDeaths of despair mortality collectively and for each cause of death individually increased significantly from 2010–2014 to 2015–2019 in Illinois. Suicide mortality was higher in rural counties and was related to economic distress, while drug poisoning and alcohol-related deaths were higher in urban counties and were related to drug availability indicators.Originality/valueWhile all three causes of death increased in the state, suicide mortality was inversely related to deaths of despair mortality. This may be because of different individual risk factors in rural versus urban areas or issues with coding cause of death. The findings of this study point to a rising public health challenge of deaths of despair mortality, particularly from substance use, in urban counties and from suicide in rural counties.

Using molecular epidemiology to trace the history of the injection-related HIV epidemic in New York City, 1985-2019.

Unintentional drug poisoning and overdose deaths in New York City (NYC) increased 175% between 2010 and 2017, partly due to the transition from noninjectable opioids to heroin injection. This transition has led to concern of a resurgent HIV epidemic among persons who inject drugs (PWID) in NYC. Thus, we sought to characterize HIV transmission dynamics in PWID. Genetic network analysis of HIV-1 public health surveillance data. We analyzed HIV diagnoses reported to public health surveillance to determine the trajectory of the HIV epidemic among PWID in NYC, from 1985 through 2019. Genetic distance-based clustering was performed using HIV-TRACE to reconstruct transmission patterns among PWID. The majority of the genetic links to PWID diagnosed in the 1980s and 1990s are to other PWID. However, since 2011, there has been a continued decline in new diagnoses among PWID, and genetic links between PWID have become increasingly rare, although links to noninjecting MSM and other people reporting sexual transmission risk have become increasingly common. However, we also find evidence suggestive of a resurgence of genetic links among PWID in 2018-2019. PWID who reported male-male sexual contact were not preferentially genetically linked to PWID over the surveillance period, emphasizing their distinct risk profile from other PWID. These trends suggest a transition from parenteral to sexual transmission among PWID in NYC, suggesting that harm reduction, syringe exchange programs, and legalization of over-the-counter syringe sales in pharmacies have mitigated HIV risk by facilitating well tolerated injection among new PWID.

The Roles of Adolescent Occupational Expectations and Preparation in Adult Suicide and Drug Poisoning Deaths within a Shifting Labor Market.

Research suggests that economic declines contribute to mortality risks from suicide and drug poisoning, but how the economy impacts individuals' risks of these deaths has been challenging to specify. Building on recent theoretical advances, we investigate how adolescent occupational expectations and preparation contribute to suicide and drug poisoning deaths in a shifting economy. We use High School and Beyond data linked to adult mortality records for men that were exposed to a decline in labor market share and wages in predominantly blue-collar occupations during early adulthood. We find that adolescent men who expected these occupations had increased risks of suicide and drug poisoning death as adults net of educational and occupational attainment in early adulthood. Family background and occupational preparation are risk factors for death by drug poisoning but not suicide. Our findings improve our understanding of how labor market uncertainty shapes individuals' vulnerability to suicide and drug poisoning death.

Association of State Social and Environmental Factors With Rates of Self-injury Mortality and Suicide in the United States

Self-injury mortality (SIM) combines suicides and the preponderance of drug misuse-related overdose fatalities. Identifying social and environmental factors associated with SIM and suicide may inform etiologic understanding and intervention design. To identify factors associated with interstate SIM and suicide rate variation and to assess potential for differential suicide misclassification. This cross-sectional study used a partial panel time series with underlying cause-of-death data from 50 US states and the District of Columbia for 1999-2000, 2007-2008, 2013-2014 and 2018-2019. Applying data from the Centers for Disease Control and Prevention, SIM includes all suicides and the preponderance of unintentional and undetermined drug intoxication deaths, reflecting self-harm behaviors. Data were analyzed from February to June 2021. Exposures included inequity, isolation, demographic characteristics, injury mechanism, health care access, and medicolegal death investigation system type. The main outcome, SIM, was assessed using unstandardized regression coefficients of interstate variation associations, identified by the least absolute shrinkage and selection operator; ratios of crude SIM to suicide rates per 100 000 population were assessed for potential differential suicide misclassification. A total of 101 325 SIMs were identified, including 74 506 (73.5%) among males and 26 819 (26.5%) among females. SIM to suicide rate ratios trended upwards, with an accelerating increase in overdose fatalities classified as unintentional or undetermined (SIM to suicide rate ratio, 1999-2000: 1.39; 95% CI, 1.38-1.41; 2018-2019: 2.12; 95% CI, 2.11-2.14). Eight states recorded a SIM to suicide rate ratio less than 1.50 in 2018-2019 vs 39 states in 1999-2000. Northeastern states concentrated in the highest category (range, 2.10-6.00); only the West remained unrepresented. Least absolute shrinkage and selection operator identified 8 factors associated with the SIM rate in 2018-2019: centralized medical examiner system (β = 4.362), labor underutilization rate (β = 0.728), manufacturing employment (β = -0.056), homelessness rate (β = -0.125), percentage nonreligious (β = 0.041), non-Hispanic White race and ethnicity (β = 0.087), prescribed opioids for 30 days or more (β = 0.117), and percentage without health insurance (β = -0.013) and 5 factors associated with the suicide rate: percentage male (β = 1.046), military veteran (β = 0.747), rural (β = 0.031), firearm ownership (β = 0.030), and pain reliever misuse (β = 1.131). These findings suggest that SIM rates were associated with modifiable, upstream factors. Although embedded in SIM, suicide unexpectedly deviated in proposed social and environmental determinants. Heterogeneity in medicolegal death investigation processes and data assurance needs further characterization, with the goal of providing the highest-quality reports for developing and tracking public health policies and practices.

The utility of lung weight to heart weight ratio as a means to identify suspected drug intoxication deaths in a medico-legal autopsy population.

Fatal intoxications are common in a medico-legal autopsy setting and are associated with sparse findings during autopsy. It has been suggested that an increased lung weight may be associated with such fatalities. Previous literature is generally limited to a descriptive approach, including only opioid deaths, and lacking a definition of "heavy" lungs. Our aim was to create a model to identify cases with heavy lungs and to assess the predictive power of "heavy" lungs in identifying cases of different types of fatal intoxications during autopsy in an unselected medico-legal autopsy population. We identified all medico-legal autopsy cases ≥18years in Sweden from 2000 through 2013. The lung weight to heart weight (LWHW) ratio was calculated. The positive predictive values (PPV) and negative predictive values (NPV) of both lung weight and LWHW ratio were calculated. Mean lung weight was higher in the intoxication group but the predictive power in the individual case was limited. Lung weight to heart weight ratio had better predictive power than lung weight alone, with a PPV of at most 0.15(0.14, 0.16 95% CI), while the NPV was 0.96 (0.95, 0.96 95% CI). The association between fatal intoxication and increased lung weight was positive, regardless of method and cutoffs used. While the PPV was poor, the NPV could reduce suspicion of fatal intoxication in the absence of other information. LHWH ratio is only a probability factor for fatal intoxication; accurate cause of death determination-as always-requires consideration of circumstances, autopsy, and toxicologic findings.

Association of Job Expectations Among High School Students With Early Death During Adulthood

Deaths from self-injury are increasing. Understanding the sources of risk is important for prevention and treatment. To estimate the risks of suicide and drug poisoning deaths among adult men whose adolescent occupational expectations were not met in adulthood. This cohort study included a sample of men interviewed as part of the High School and Beyond study, a nationally representative study of US high school sophomores and seniors in 1980, who were interviewed every 2 years through 1986; those who were sophomores in 1980 were reinterviewed in 1992. Men who survived to 1992 and reported occupational expectations were included in the present study. Death records prior to 2018 were linked to mortality databases and released in 2019. Data analysis was conducted from May to October 2020. Occupational expectations. Survival or death by suicide, drug poisoning, chronic liver disease, heart disease, cancer, or some other cause, categorized from International Classification of Diseases, Ninth Revision and Tenth Revision codes. Competing risk Fine-Gray survival models regressed cause of death on adolescent occupational expectations and covariates. The 11 680 men in the High School and Beyond cohort study had a median (interquartile range) age of 29 (28-30) years in 1992, when the analysis of their future mortality began. Most men survived until 2015 (11 060 [weighted percentage, 95.0%]). Reported causes of death were suicide (60 [weighted percentage, 0.5%]), drug poisoning (40 [weighted percentage, 0.4%]), chronic liver disease (20 [weighted percentage, 0.2%]), heart disease (130 [weighted percentage, 1.0%]), cancer (100 [weighted percentage, 1.0%]), and other (280 [weighted percentage, 2.0%]). Subhazard ratios for death by suicide and drug poisoning were 2.91 (95% CI, 1.07-7.88; P = .04) and 2.62 (95% CI, 1.15-5.94; P = .02) times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations. The actual job held by men did not attenuate the hazards of deaths from suicide and drug poisoning. In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations. Interventions to mitigate labor market changes should account for individuals' expectational ideals.

Scaling COVID-19 against inequalities: should the policy response consistently match the mortality challenge?

BackgroundThe mortality impact of COVID-19 has thus far been described in terms of crude death counts. We aimed to calibrate the scale of the modelled mortality impact of COVID-19 using...