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Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014.
Pain Med. 2018 03 01; 19(3):511-523.PM

Abstract

Objective

This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl.

Methods

This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467).

Results

Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders.

Conclusions

Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

Authors+Show Affiliations

Division of Unintentional Injury Prevention. Division of Violence Prevention, National Center for Injury Prevention and Control. Division of Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Office of Public Health Scientific Services.Division of Violence Prevention, National Center for Injury Prevention and Control. Division of Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Office of Public Health Scientific Services.Obstetrics and Gynecology Residency Program, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island.Division of Unintentional Injury Prevention.Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.Office of Chief Medical Examiner, State of Connecticut, Farmington, Connecticut, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28340233

Citation

Mercado, Melissa C., et al. "Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014." Pain Medicine (Malden, Mass.), vol. 19, no. 3, 2018, pp. 511-523.
Mercado MC, Sumner SA, Spelke MB, et al. Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014. Pain Med. 2018;19(3):511-523.
Mercado, M. C., Sumner, S. A., Spelke, M. B., Bohm, M. K., Sugerman, D. E., & Stanley, C. (2018). Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014. Pain Medicine (Malden, Mass.), 19(3), 511-523. https://doi.org/10.1093/pm/pnx015
Mercado MC, et al. Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014. Pain Med. 2018 03 1;19(3):511-523. PubMed PMID: 28340233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014. AU - Mercado,Melissa C, AU - Sumner,Steven A, AU - Spelke,M Bridget, AU - Bohm,Michele K, AU - Sugerman,David E, AU - Stanley,Christina, PY - 2017/3/25/pubmed PY - 2019/3/22/medline PY - 2017/3/25/entrez SP - 511 EP - 523 JF - Pain medicine (Malden, Mass.) JO - Pain Med VL - 19 IS - 3 N2 - Objective: This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl. Methods: This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467). Results: Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders. Conclusions: Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids. SN - 1526-4637 UR - https://www.unboundmedicine.com/medline/citation/28340233/Increase_in_Drug_Overdose_Deaths_Involving_Fentanyl_Rhode_Island_January_2012_March_2014_ L2 - https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnx015 DB - PRIME DP - Unbound Medicine ER -