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Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance.
Int J Drug Policy. 2017 08; 46:120-129.IJ

Abstract

BACKGROUND

The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance.

METHODS

The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky.

RESULTS

Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening.

CONCLUSIONS

The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records.

Authors+Show Affiliations

Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA. Electronic address: ssslav2@email.uky.edu.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky State Police Central Forensic Laboratory, Frankfort, KY, USA.Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY; Bona Fide Agent for the Kentucky Department for Public Health, USA.Kentucky Office of the Chief Medical Examiner, Louisville, KY, USA.Kentucky Office of Drug Control Policy, Frankfort, KY, USA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

28735777

Citation

Slavova, Svetla, et al. "Heroin and Fentanyl Overdoses in Kentucky: Epidemiology and Surveillance." The International Journal On Drug Policy, vol. 46, 2017, pp. 120-129.
Slavova S, Costich JF, Bunn TL, et al. Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. Int J Drug Policy. 2017;46:120-129.
Slavova, S., Costich, J. F., Bunn, T. L., Luu, H., Singleton, M., Hargrove, S. L., Triplett, J. S., Quesinberry, D., Ralston, W., & Ingram, V. (2017). Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. The International Journal On Drug Policy, 46, 120-129. https://doi.org/10.1016/j.drugpo.2017.05.051
Slavova S, et al. Heroin and Fentanyl Overdoses in Kentucky: Epidemiology and Surveillance. Int J Drug Policy. 2017;46:120-129. PubMed PMID: 28735777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. AU - Slavova,Svetla, AU - Costich,Julia F, AU - Bunn,Terry L, AU - Luu,Huong, AU - Singleton,Michael, AU - Hargrove,Sarah L, AU - Triplett,Jeremy S, AU - Quesinberry,Dana, AU - Ralston,William, AU - Ingram,Van, Y1 - 2017/07/18/ PY - 2017/03/06/received PY - 2017/05/19/revised PY - 2017/05/28/accepted PY - 2017/7/25/pubmed PY - 2018/4/27/medline PY - 2017/7/25/entrez KW - Fentanyl KW - Heroin KW - Overdose KW - Surveillance SP - 120 EP - 129 JF - The International journal on drug policy JO - Int. J. Drug Policy VL - 46 N2 - BACKGROUND: The study aims to describe recent changes in Kentucky's drug overdose trends related to increased heroin and fentanyl involvement, and to discuss future directions for improved drug overdose surveillance. METHODS: The study used multiple data sources (death certificates, postmortem toxicology results, emergency department [ED] records, law enforcement drug submissions, and prescription drug monitoring records) to describe temporal, geographic, and demographic changes in drug overdoses in Kentucky. RESULTS: Fentanyl- and heroin-related overdose death rates increased across all age groups from years 2011 to 2015 with the highest rates consistently among 25-34-year-olds. The majority of the heroin and fentanyl overdose decedents had histories of substantial exposures to legally acquired prescription opioids. Law enforcement drug submission data were strongly correlated with drug overdose ED and mortality data. The 2016 crude rate of heroin-related overdose ED visits was 104/100,000, a 68% increase from 2015 (62/100,000). More fentanyl-related overdose deaths were reported between October, 2015, and September, 2016, than ED visits, in striking contrast with the observed ratio of >10 to 1 heroin-related overdose ED visits to deaths. Many fatal fentanyl overdoses were associated with heroin adulterated with fentanyl; <40% of the heroin overdose ED discharge records listed procedure codes for drug screening. CONCLUSIONS: The lack of routine ED drug testing likely resulted in underreporting of non-fatal overdoses involving fentanyl and other synthetic drugs. In order to inform coordinated public health and safety responses, drug overdose surveillance must move from a reactive to a proactive mode, utilizing the infrastructure for electronic health records. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/28735777/Heroin_and_fentanyl_overdoses_in_Kentucky:_Epidemiology_and_surveillance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(17)30155-X DB - PRIME DP - Unbound Medicine ER -