Drug involvement variations in overdose death spikes: county-level analysis in Massachusetts

Area of Science:

• Public Health
• Epidemiology
• Substance Use Research

Background:

• Drug overdose deaths occur in unpredictable surges, necessitating an understanding of the substances involved during these critical periods.
• Identifying specific drugs associated with overdose spikes is crucial for effective public health interventions.
• This study focuses on Massachusetts to analyze substance involvement in overdose fatalities at state and county levels.

Purpose of the Study:

• To investigate the specific substances involved in overdose spikes within Massachusetts.
• To compare the prevalence of cocaine, psychostimulants, fentanyl, heroin, and prescription opioids during overdose spikes versus typical days.
• To analyze these patterns at both the state and county levels.

Main Methods:

• A spike detection algorithm identified daily overdose death spikes (exceeding 2 SDs of a 30-day moving average) from 9915 fatalities (2020-2023).
• General linear mixed models compared the presence of key substances (cocaine, psychostimulants, fentanyl, heroin, prescription opioids) on spike vs. typical days.
• Analysis included 8 of 14 Massachusetts counties with the highest daily overdose death counts.

Main Results:

• No significant substance differences were found at the state level between spike and typical days.
• Cocaine was more prevalent during spikes in multiple counties.
• Fentanyl was more common on typical days in two counties, while psychostimulants varied by county; heroin and prescription opioids showed limited county-specific differences.

Conclusions:

• Overdose death spikes exhibit significant substance-related heterogeneity across Massachusetts counties.
• These findings underscore the necessity for tailored, localized public health strategies.
• Understanding county-specific patterns can optimize resource allocation and improve interventions to mitigate the impact of future overdose events.