BACKGROUND: Exposure to prescription medications has been associated with increased risk of drug overdose. Understanding non-medical use of prescription drugs can help to describe drug use patterns.

METHODS: We conducted a statewide cross-sectional study of fatal drug overdoses in Tennessee during 2021 using data from the State Unintentional Drug Overdose Reporting System (SUDORS). SUDORS collects information on accidental and undetermined fatal drug overdoses from sources including death certificates, autopsy reports, toxicology, and prescription drug monitoring program data (PDMP). Analysis was limited to deaths with a toxicology report and linked to PDMP data. We identified opioid, benzodiazepine, stimulant, and gabapentin prescriptions filled within 365 days of death and compared prescription information to substances on toxicology using descriptive statistics to assess non-medical use of prescription medication in Tennessee.

RESULTS: We identified 2,547 Tennessee SUDORS overdoses with toxicology in 2021. Prescription opioids were present in toxicology in 23.1% of decedents, prescription benzodiazepines in 16.7%, and gabapentin in 9.9% of decedents. Non-medical use of prescription medications was present in 54.2% of decedents who had a prescription medication on toxicology but did not have a prescription for that substance in the 365 days prior to death. Of decedents with a prescription opioid on toxicology, 50.2% filled a prescription opioid in the 365 days prior to death. Of decedents with a prescription benzodiazepine on toxicology, 43.1% filled a benzodiazepine prescription in the 365 days before death. For gabapentin, 60.9% of decedents who had gabapentin on toxicology filled a gabapentin prescription in the year prior to death.

CONCLUSIONS: Non-medical use of prescription medication is prevalent in Tennessee. While many fatal drug overdoses in Tennessee are attributed to illicit substances prescription medications still play a role in overdose. Understanding these trends can facilitate development of harm reduction strategies.

Issue: Medical toxicology physicians are dedicated to the care, treatment, and prevention of poisonings. The majority of patients treated by medical toxicologists present after acute drug overdose, including the overdose of illicit street drugs and prescription medications. Medical toxicology research has historically relied on poison center data, which has limitations including reliance on telephone-based encounters rather than in-person evaluations and the lack of race/ethnicity data. There was a need to develop a comprehensive registry of poisonings, including intentional and unintentional overdoses, to advance medical toxicology research.

Description: The Toxicology Investigators Consortium (ToxIC) was established in 2010 under the American College of Medical Toxicology (ACMT). ToxIC first started with the creation of the ToxIC Core Registry, a comprehensive registry of patients evaluated by medical toxicology physicians. The ToxIC Core Registry now contains over 95,000 cases across 70 sites in the U.S. and partners with CDC and FDA to inform data surveillance on drug overdoses. The most prevalent agent class among patients in the ToxIC Core Registry in 2022 was opioids (15.9%), followed by ethanol (14.9%), analgesics (12.8%), and antidepressants (9.0%). Among the opioid class, 53.9% were fentanyl exposures and only 9.4% were heroin exposures.

Lessons Learned: Over the past 12 years, the ToxIC Core Registry has incorporated new measures on overdose intentionality, psychiatric and medical comorbidities, prior overdose history, and discharge resources such as take-home naloxone kits. Furthermore, it has served as the foundational infrastructure for multi-center research and surveillance projects on opioid overdoses.

Recommendations: ToxIC continues to improve the Core Registry, initiate new surveillance projects, build new partnerships with other public health and substance use partners, and increase dissemination of findings. ToxIC continues to serve as a multicenter infrastructure for public health surveillance and epidemiological studies.

Background: Deaths due to drug overdose have significantly increased during the COVID-19 pandemic. While some studies have examined characteristics of U.S. counties with high drug/opioid overdose mortality before the pandemic, little is known about the county-level factors associated with high drug overdose deaths during the COVID-19 pandemic.

Methods: We analyzed county-level drug overdose mortality rates in 2020 using the National Center for Health Statistics data linked to PolicyMap data via county FIPS code. PolicyMap includes county-level information related to sociodemographic and socioeconomic composition, incarceration rates, as well as geographic factors related to access. The main outcome measure was a binary indicator of “high drug overdose mortality”, defined as having a drug overdose mortality rate higher than the 2020 national average (28.3/100,000 population). Using a multivariable logistic regression model, we examined the county-level factors associated with high drug overdose deaths during the COVID-19 pandemic.

Results: Of 3,130 counties, 835 (26.7%) had high drug overdose mortality rates. Factors associated with higher odds of being a county with high drug overdose mortality include higher proportion of: white residents (adjusted odds ratio(aOR):1.03; 95% CI, 1.02-1.04), families living in poverty (aOR:1.03; 95% CI, 1.00-1.07), and residents with poor mental health (aOR:1.51; 95% CI, 1.40-1.63), as well as higher unemployment rates (aOR:1.30; 95%, 1.23-1.37), violent crime rates (aOR:1.36; 95% CI, 1.10-1.67), and incarceration rates (aOR:1.26; 95% CI, 1.15-1.37). In addition, compared to rural counties, both metropolitan (aOR:3.83; 95% CI, 2.93-5.01) and micropolitan (aOR:1.53; 95% CI, 1.14-2.06) counties had higher odds of drug overdose mortality.

Conclusion: Our study confirms socioeconomic, geographic, and demographic factors associated with high drug overdose mortality in US counties that appear to have persisted during the pandemic. Policymakers should take these factors into account when considering policies and interventions to address the persistent challenge of drug overdose deaths and to improve health equity.

Background: The rate of drug overdose including prescription opiate abuse and other substance overdoses in the United States of America has skyrocketed in the last past decade. The limitations of opioid abuse and overdose surveillance systems impede the development of targeted interventions to address this epidemic, especially in rural communities. This study aimed to explore new ways to effectively monitor drug overdose using 911 call dispatch county-level data using a GIS mapping system.

Method: We reported the data using simple analysis without drawing any conclusions. From January 5, 2022, to December 5, 2022, we registered the number of people who get any type of overdose including opioids which 911 call dispatch officers have responded.

Results: We recorded a total number of overdose cases N = 110 overdose cases with females: 61 cases and males: 46 cases, Unknown: 01 cases, and Information Not Given: 2 cases. The data were stratified to identify different age ranges. 0 – 17 = 18 cases, 18 – 44 = 56, 45 – 64 = 26, 65 and older = 8, and for those who wish to not give their information was labeled – Not given: 2. Even though the rate of overdose including opioids has increased in the past decade in the United States, the case of an overdose in rural communities has surged.

Conclusion: In Tooele County, the case of opioid overdose and other substances have increased as well. Targeted intervention based on county-level data is warranted. Future research is needed in rural communities to avoid preventable death and lower Years of Potential Life Lost (YPLL) in rural communities.