Route of drug use among North Carolina drug overdose decedents, 2018-2023

To describe the route of drug use among overdose decedents in North Carolina.

We use data from the North Carolina State Unintentional Drug Overdose Reporting System from 2018 to 2023. We include variables on the characteristics of the decedents and context of the overdose, including the reported route of drug use and the drugs involved.

There were 19,520 overdose deaths, largely involving opioids (87.7%), particularly fentanyl and its analogues (75.5%), stimulants (61.3%), and benzodiazepines (20.9%). Route of drug use was not documented for most (53.9%) deaths. In 2018, the most common route of drug use among decedents was injection (36.6%), followed by snorting (6.3%), smoking (3.6%), and ingestion (1.7%). In 2023, the percentage of overdose deaths involving injection (18.1%), snorting (17.8%), and smoking (18.3%) were similar to one another and the prevalence of ingestion increased to 4.7%.

Increasing numbers of overdoses caused by non-injection drug use suggests a need for broader public health intervention that extend beyond the population injecting drugs. However, data on route of drug use is missing for over half of all overdose fatalities in North Carolina. More complete data on route of drug use will allow for more nuanced interpretation.