Increase In Drug-related Deaths Research Articles

Pregnancy-Associated Mortality During the Pandemic: Disparities by Rurality

IntroductionIn the US, rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic. MethodsCross-sectional US vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the pre-pandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality. ResultsDuring the pandemic, rural—compared to suburban and urban—areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95%CI: 48.8, 59.4), drug-related causes (19.0, 95%CI: 16.0, 22.4), suicide (4.4., 95%CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95%CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from pre-pandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic. ConclusionsRural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.

False-Positive Rate for Suspected Drug-Related Deaths Following Full Autopsy.

The sharp increase in drug-related deaths has tempted medical examiner/coroner offices to perform external examinations with comprehensive toxicology testing instead of performing a standard autopsy. Compounding the problem of an increasing workload has been the decrease in available forensic pathologists. Opting for external examinations on suspected drug-related fatalities, however, is antithetical to current best practices. The purpose of this study was to review case files, autopsy reports, and toxicologic results of all deaths that were autopsied at the authors' facility and decide whether significant disease processes or injuries that would supersede the results of toxicologic testing and external examination findings alone were being missed.

378 Improving Opioid Stewardship in General Surgical Practice

Abstract Aim The last 30 years has demonstrated a steady increase in drug-related deaths, with opioids implicated in at least 2,219 deaths in 2021 in England and Wales1. Inpatient opioid prescribing in surgery has been demonstrated to correlate with long term use post-discharge2. We aim to improve opioid stewardship at our DGH to reduce ‘opioid-load’ in the community, thereby reducing likelihood of long-term post-operative use. Method Intervention included teaching for junior doctors, audit meeting presentation and posters designed collaboratively with acute pain team. Prospective data collected for 92 patients discharged from general surgery from October 2022 and compared to previous data pre-intervention from June 2020. Opioid prescriptions were converted to Milligrams of Morphine Equivalence (MMgEq) for analysis. Results Following intervention, max average 58.64 MMgEq/day compared to 85.88 MMgEq/day previously. Max PRN prescription now 49.77 MMgEq/day compared to 57.18 MMgEq/day. Increased involvement of acute pain team (15.9% to 20%) and improved use of multimodal analgesia (PCA - 3% to 13%, NSAIDS - 2% to 16.5%, rectus sheath blocks – 1% to 4.2%). Discharge prescribing also improved; only 57.6% discharged with opioids, 89% had documented plan for GP and 49% had specific duration. Conclusions Our results demonstrate marked improvement in surgical opioid prescribing. There is potential for further improvement including introduction of opioid misuse risk calculator and formalising opiate prescribing guidelines in surgery.

ThTP6.6 Improving Opioid Stewardship in General Surgical Practice

Abstract Aim The last 30 years has demonstrated a steady increase in drug-related deaths, with opioids implicated in at least 2,219 deaths in 2021 in England and Wales1. Inpatient opioid prescribing in surgery has been demonstrated to correlate with long-term use post-discharge2. We aim to improve opioid stewardship at our DGH to reduce ‘opioid-load’ in the community, thereby reducing likelihood of long-term post-operative use. Method Intervention included teaching for junior doctors, audit meeting presentation and posters designed collaboratively with acute pain team. Prospective data collected for 92 patients discharged from general surgery from October 2022 and compared to previous data pre-intervention from June 2020. Opioid prescriptions were converted to Milligrams of Morphine Equivalence (MMgEq) for analysis. Results Following intervention, max average 58.64 MMgEq/day compared to 85.88 MMgEq/day previously. Max PRN prescription now 49.77 MMgEq/day compared to 57.18 MMgEq/day. Increased involvement of acute pain team (15.9% to 20%) and improved use of multimodal analgesia (PCA - 3% to 13%, NSAIDS - 2% to 16.5%, rectus sheath blocks – 1% to 4.2%). Discharge prescribing also improved; only 57.6% discharged with opioids, 89% had documented plan for GP and 49% had specific duration. Conclusions Our results demonstrate marked improvement in surgical opioid prescribing. There is potential for further improvement including introduction of opioid misuse risk calculator and formalising opiate prescribing guidelines in surgery. 1 ONS. Deaths related to drug poisoning in England and Wales: 2021 registrations. August 2022 2 Vijayagopal et al. (2022). SP1.1.4 Caveat Chirurgicus - Opioid use following surgery. British Journal of Surgery. 109.

Policy windows for drug consumption rooms in Finland.

Background: Use of drug consumption rooms is a novel harm reduction approach to reach marginalised and isolated people who used drugs, under the high risk of overdose deaths and infectious diseases. The aim of this article was to evaluate the policy opportunities and barriers of the Helsinki City initiative for establishing the first drug consumption room (DCR) in Finland from the multiple streams framework. Method: A qualitative interview research method is used to evaluate the perspectives of stakeholders. By including 23 participants, we analysed the political, social and policy level advantages and disadvantages of the current initiative. Findings: Our results show that the cost of DCRs, the COVID-19 burdens on public resources, the requirement of legislative change, public unawareness, potential policy failure of DCRs, and its impacts on electoral votes constitute the main policy barriers. On the other hand, an increase in drug-related deaths, economic benefits of DCR for society, its effects on street safety and public order, being a local initiative, prospectus change in national drug strategy plans and motivation to catch up with EU standards were underlined as policy opportunities. Four issues, leadership, moral perspective, social change and generational differences, act as mediating factors, which are fluctuated according to public opinions and political environment. Conclusion: By applying the multiple streams framework, our results show that experts’ DCR problematisation is still beyond the public and political interest, which needs additional effort around problem identification and prioritisation. Besides public unawareness, the COVID-19 situation seems to be postponing policy progress since the primary attention and available funds have already been dedicated to public health. Already having a local initiative and an upcoming drug strategy plan might be good formal leverage, but unexpected events might also trigger discussions.

Drug fatalities and treatment fatalism: Complicating the ageing cohort theory.

Deaths related to drug 'misuse' remain at an all-time high in the United Kingdom (UK). Older heroin consumers are particularly at risk, with the highest rates of deaths among people aged 40-49 and the steepest rises in the over-fifty age bracket. Accordingly, a popular theory for the UK's increase in drug-related deaths, made by the government, and propelled in the media, is that there is an ageing cohort of heroin users with age-related health complications predisposing them to an overdose. However, drawing on in-depth interviews with those people deemed to be most at risk, this article works to complicate this theory, with participants citing a shift in (a) experience and responsibility, (b) route of administration, (c) desired effects, (d) acceptance of their drug use and 'user' status and (e) valuing health. Disrupting age as a given risk factor, this article turns attention away from the individual and these 'natural' processes to what participants describe as a singular, punitive, and inflexible treatment system and its intersecting structures. Approaching life and death as a matter of sociomaterial 'mattering', this article rethinks a reductionist, causal link between age and drug-related death with a treatment despondency and fatalism that could prove fatal.

Update on technologies, medicines and treatments.

An abstract presented at the 2020 European Association for the Study of Diabetes (EASD) suggests that, in future, we might be able to monitor longer term exposure to glucose through our tears. The study measured glycated albumin (GA) in lacrimal fluid and found this to be strongly correlated to glycated albumin in blood, an indicator of glycaemia over a 2 week period.

The political consequences of opioid overdoses.

The United States suffered a dramatic and well-documented increase in drug-related deaths from 2000 to 2018, primarily driven by prescription and non-prescription opioids, and concentrated in white and working-class areas. A growing body of research focuses on the causes, both medical and social, of this opioid crisis, but little work as yet on its larger ramifications. Using novel public records of accidental opioid deaths linked to behavioral political outcomes, we present causal analyses showing that opioid overdoses have significant political ramifications. Those close to opioid victims vote at lower rates than those less affected by the crisis, even compared to demographically-similar friends and family of other unexpected deaths. Moreover, among those friends and family affected by opioids, Republicans are 25% more likely to defect from the party than the statewide average Republican, while Democrats are no more likely to defect; Independents are moderately more likely to register as Democrats. These results illustrate an important research design for inferring the effects of tragic events and speak to the broad social and political consequences of what is becoming the largest public health crisis in modern United States history.

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

BackgroundThe United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms.MethodsWe generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices.FindingsA high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection.ConclusionCurrently, harm reduction equipment and resources for safe injecting are not meeting the needs of people who inject drugs who are street homeless or unstably housed. Preparation of injections with non-sterile water sources could precipitate bacterial and fungal infections, particularly when used without the application of heat. It is crucial that water for injection, also skin cleaning, is made available for the unstably housed and that harm reduction messaging is tailored to speak to the everyday realities of people who prepare and inject drugs in public spaces.

Attitudes Towards Forensic Autopsy Standard B3.7 and the Use of Physician Extenders in Select Autopsy Cases.

Studies have demonstrated that autopsy is the gold standard for determining cause and manner of death. Indeed, the current National Association of Medical Examiners standard B3.7 states that a forensic pathologist (FP) shall perform a forensic autopsy when the death is by apparent intoxication by alcohol, drugs, or poison. Unfortunately, the recent increase in drug-related deaths has led to some question about the feasibility of maintaining compliance with standard B3.7. We constructed a voluntary survey to address consensus on standard B3.7 and the use of supervised accredited pathologists' assistants (PAs) in performing select medicolegal autopsies. Additional questions were included to help characterize variables related to FP's workload and experience. Each of these variables was predicted to influence FP's attitudes toward B3.7 and the use of PAs. Our respondent pool (n = 107) consisted primarily of actively practicing FPs with administrative responsibilities (42%) and actively practicing FPs without administrative responsibilities (41%). Sixty-five percent agreed that standard B3.7 is appropriate. Opinion on the use of PAs was split between those who agreed (45%) and those who did not (44%). Tendency to agree with either B3.7 or the use of PAs was not a function of FP's individual or office workload; however, respondents were more likely to agree with B3.7 if they previously experienced a case where internal autopsy findings radically altered diagnosis in an otherwise suggestive overdose case (P < 0.001). In certain offices and under certain conditions, the use of PAs may be one solution to ensuring all potential overdose deaths receive an autopsy.

Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis

Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA. In this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014. We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention. We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time. To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach. After adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0-14·6; p<0·0001) in drug-related deaths within counties. Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0-2·0; p<0·0001) and 2·6% (2·1-3·1; p<0·0001) in drug-related mortality, respectively. The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates. Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R2=0·975). Between counties, high rates of incarceration were associated with a more than 50% increase in drug-related deaths. Reduced household income and high incarceration rates are associated with poor health. The rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders. None.

The contribution of drug-related deaths to the US disadvantage in mortality.

BACKGROUND The USA ranks last in life expectancy among high-income countries. Since 2000, excess US mortality has been particularly concentrated in the working ages, which are also the ages hardest hit by the increase in drug deaths. This study measures the effect of drug-related mortality on the gap in life expectancy between the USA and other countries. METHODS Data from the Human Mortality Database and the World Health Organization were combined to construct age-standardized mortality rates for 2000-14 in 12 high-income countries and the USA for seven broad causes of death, including drug use. The contribution of each cause to the difference in life expectancy between the USA and the other 12 countries was estimated. RESULTS In 2014, the increase in drug-related deaths accounted for 10-15% of the US disadvantage in mortality, but with marked differences by age group. For working-age men, the increase in drug-related deaths accounted for up to 38% of the difference. Overall, American mortality is higher than the comparison countries across a wide range of causes. CONCLUSIONS The severity of the drug epidemic appears to be specific to the USA, but it only partly contributes to the American shortfall in mortality.

The contribution of drug-related deaths to the US disadvantage in mortality

The USA ranks last in life expectancy among high-income countries. Since 2000, excess US mortality has been particularly concentrated in the working ages, which are also the ages hardest hit by the increase in drug deaths. This study measures the effect of drug-related mortality on the gap in life expectancy between the USA and other countries. Data from the Human Mortality Database and the World Health Organization were combined to construct age-standardized mortality rates for 2000-14 in 12 high-income countries and the USA for seven broad causes of death, including drug use. The contribution of each cause to the difference in life expectancy between the USA and the other 12 countries was estimated. In 2014, the increase in drug-related deaths accounted for 10-15% of the US disadvantage in mortality, but with marked differences by age group. For working-age men, the increase in drug-related deaths accounted for up to 38% of the difference. Overall, American mortality is higher than the comparison countries across a wide range of causes. The severity of the drug epidemic appears to be specific to the USA, but it only partly contributes to the American shortfall in mortality.

Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

PurposeThe purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths.Design/methodology/approachUsing quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age.FindingsThe data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area.Research limitations/implicationsThe research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles.Practical implicationsThis research contributes to making unarguable links between entrenched structural inequality and increased drug-related death.Social implicationsThis paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms.Originality/valueWhile several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.

Confronting an Upsurge in Opiate Deaths with Limited Resources.

The dramatic increase in drug-related deaths in the last decade has presented fiduciary and logistical difficulties to medicolegal jurisdictions of all types and sizes. New Hampshire, with a centralized state medical examiner system of death investigation, has been confronted with the task of investigating these drug-related deaths against the backdrop of statutory hurdles inhibiting a nimble response to the situation. This has led to a collaborative approach with law enforcement and the state Department of Justice in terms of triaging drug deaths to full autopsy versus external examination with toxicology testing. Preliminary data suggest that between 11 and 13% of suspected drug deaths have an alternative cause of death revealed by autopsy. Positive toxicological findings were documented in 97.5% of cases in which only an external examination was performed; however, some of these cases may have had undetected, significant internal findings that could have accounted for an alternative cause of death if an autopsy had been performed. While the case triage system described has temporarily addressed the acute problem, the issue of the medical examiner's appropriate role in the adequate evaluation of public health and safety remains extant. Furthermore, noncompliance with the National Association of Medical Examiners inspection and accreditation standards puts this agency, and others facing the same issues, at risk of losing full accreditation status until such resource issues are addressed by legislators and other stakeholders in the quality of medicolegal death investigation in the United States.

Romania's Drug Policy from 2005 to 2012: Experiences with Implementation

Even with the relatively high rate of illicit drug use in Romania, drug prevention remains a relatively low political and professional priority. Policies focus primarily on the criminalization of drug use rather than on prevention and treatment. By studying official Romanian drug policies and legislative documents, as well as national and European reports on the state of the ‘‘drug problem,’’ this article focuses on the impact of policy on drug use, treatment, and prevention, with an emphasis on the criminalization of drug use and the resultant trends and practical impacts. The reported lifetime use of illicit drugs has been rising slowly but steadily over the last few years. Contraction of communicable diseases among intravenous drug users is also trending upwards. And with the emphasis on criminalization of drug use and the accompanying marginalization of users, drug-law-related offences are also likely to increase. Unmet needs in drug prevention, a declining tendency to seek drug treatment, and an increase in drug-related deaths are also indicators of the negative effects of the current policy on drug use, criminalization, infections, and the lack of effective prevention. As Romania continues to face serious financial limitations, evidence-based research on drug use is needed; best practice guidelines have to be followed in order to improve access to drug prevention, treatment, and harm-reduction services.

The Prevalence of Fentanyl in Drug-Related Deaths in Philadelphia 2004–2006

Fentanyl is an increasingly common drug of abuse. The Philadelphia Medical Examiner's Office reported 252 drug-related deaths in Philadelphia that tested positive for fentanyl during the year 2006 in comparison to 22 and 19 in 2005 and 2004, respectively. We reviewed the data from 2004 to 2006 from the Philadelphia Medical Examiner's office. Key words such as fentanyl, drug, cocaine, ethanol, medic (medication), tox (intoxication), or poison were used as search words. In comparison to 2004 and 2005 data, there was a statistically significant increase in number of drug-related deaths (DRDs) and the percentage of DRDs that tested positive for fentanyl in 2006. We postulate that the increase in DRDs in 2006 may be related to increase use or abuse of fentanyl, lack of general public awareness that fentanyl is a potent opioid, inadequate dose of naloxone and/or the surge of clandestinely manufactured fentanyl.

Drugs associated with drug-related deaths in Edinburgh and Glasgow, November 1990 to October 1992.

Between 1991 and 1992 there was a four-fold increase in drug-related deaths in Glasgow. Comparing records of the drug-related deaths for November 1990-October 1991 and November 1991-October 1992 in Edinburgh and Glasgow, it was found that the increase in Glasgow was statistically significant and that heroin, often mixed with other drugs, which most often included temazepam, diazepam and alcohol, was implicated in the increase in deaths in Glasgow. A number of the deceased had been prescribed temazepam or diazepam. Discussed are the hazards of drug mixing and the possibility that the use of buprenorphine by drug injectors previously had kept the number of overdoses relatively low.

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■ Aims The aim is to describe the development of the availability, attitudes to, and personal use of illegal drugs among the adult population in Norway, based on survey data from 1968 until today. Compared with data on young people, the data on drugs for the adult population have been collected more rarely, and results have not been widely reported. ■ Data and Method Surveys directed to the adult population with questions about drugs were performed in 1968, 1985, 1991, 1994, 1999 and 2004. The samples are selected in a three stage stratified quota procedure, and are representative for the whole adult population age 15 years and over. The data were collected with a face-to-face interview, mainly about alcohol. The drug questions were answered in writing, and in such a way that the interviewer did not see the answers. The availability of all kinds of drugs was measured by asking if the respondents think they could get hold of it in 2–3 days. ■ Results The availability of drugs has increased. In 2004, some 35 per cent said they could get hold of cannabis, while some 20 per cent could get other drugs. The attitudes towards own use were measured by asking if the respondents would try the drugs if it was not illegal. In 2004 about 8 per cent were positive about trying cannabis, with less than 2 per cent for all the other drugs. The attitudes have not varied much for any of the drugs between 1994 and 2004 and for cannabis have been rather stable since 1968. Lifetime prevalence of cannabis use has increased continuously since 1968, and was about 13.5 per cent in 2004. Last year prevalence increased until 1994, but has stabilised at about 3.7 per cent since then. For other drugs the lifetime prevalence has been stable at less than 2 per cent, with around 3 per cent for amphetamines. Last year, the prevalence of these drugs was less than 1 per cent, possibly with a slightly decreasing tendency. For cannabis the highest prevalence (both lifetime, previous year, and previous 30 days) is in the age group 20–24 years. ■ Conclusion The results are somewhat contrary to reports about increased problematic drug use in Norway during the 1990s. Survey methods are however not the best method to estimate problem drug use. The stability and even tendency to decrease of the prevalence of present drug use shown here might, however, indicate a decrease in the recruitment of problem drug users. Other signs point in the same direction: The sharp increase in drug-related deaths in Norway during the 1990s has given way to a decrease in the latest years. The prevalence of present drug use in youth surveys shows a decreasing trend.

Drug Misuse in Scotland: Policy, Prevalence, and Public Health

The paper outlines the nature and extent of illegal drug use in Scotland. The paper provides a detailed discussion of the impact of HIV among injecting drug users in Scotland. It is shown that although HIV remains a major public health concern within parts of Scotland, most notably in Edinburgh and Dundee, HIV infection remains low elsewhere within Scotland. Although concern in relation to HIV has receded in light of the continuing low prevalence, there has been growing concern over the marked increase in drug-related deaths among drug users within parts of Scotland. Within the policy sphere greater attention is now being given to topic of drug prevention and the impact of drug use on community well being.