Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014

Area of Science:

• Public Health
• Toxicology
• Epidemiology

Background:

• Rising overdose deaths (ODs) in Rhode Island prompted an investigation into fentanyl-related fatalities.
• Understanding risk factors associated with illicit fentanyl involvement is crucial for public health interventions.

Purpose of the Study:

• To identify sociodemographic, substance use, and opioid prescriber/dispenser risk factors among drug overdose decedents in Rhode Island.
• To compare decedents with illicit fentanyl involvement to those with other drug-related overdose deaths.

Main Methods:

• A cross-sectional study analyzed data from 536 overdose decedents in Rhode Island (January 2012-March 2014).
• Data sources included medical examiner records, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases.
• Decedents were categorized into illicit fentanyl-involved (N=69) and other drug-involved (N=467) groups.

Main Results:

• Illicit fentanyl decedents were younger than other drug decedents.
• While other drug decedents showed more postmortem evidence of heroin and pharmaceutical use, third-party reports indicated higher recent heroin use among illicit fentanyl decedents.
• Approximately 35% of decedents filled opioid prescriptions within 90 days of death, with one-third exceeding 100 MME/day; most prescriptions came from 1-2 prescribers/dispensers.
• Notably, 29.2% of illicit fentanyl decedents filled buprenorphine prescriptions, compared to 10.5% of other drug decedents.

Conclusions:

• Illicit fentanyl overdose deaths frequently involved co-use of other illicit substances like cocaine and heroin.
• A significant proportion of decedents obtained high-dose opioid prescriptions ( >100 MME/day) from a limited number of prescribers and dispensers.
• Prescribers and dispensers should utilize PMP data and review patient substance abuse history to mitigate risks and protect patients.