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Kentucky: collaborating with state agencies to identify populations at risk of drug overdose deaths

In Kentucky, a state at the heart of the opioid crisis, investigators at the University of Kentucky College of Public Health joined with Kentucky state officials to link death certificates, postmortem toxicology, and prescription history data to better identify populations at increased risk of overdose deaths. Their results appear in the June 2017 issue of Pharmaceutical Medicine.

The study was led by investigators at the Kentucky Injury Prevention and Research Center (KIPRC), a bona fide state agency within the UK College of Public Health. Dr. Svetla Slavova and Dr. Terry Bunn (KIPRC director), and Sarah L. Hargrove worked with Dr. Tracey Corey of the Kentucky Office of the Chief Medical Examiner and Van Ingram of the Kentucky Office of Drug Control Policy.

The investigators’ objective was to assess and improve the completeness of drug-related information, to evaluate the risk for drug intoxication deaths associated with specific drugs among different demographic groups, and to show the benefit of multi-source surveillance to better target interventions and to inform policy evaluation. The study linked death certificate, prescription drug monitoring program, and postmortem toxicology data for Kentucky residents aged ≥18 years who died from drug intoxication during 2013–2014.

The most frequently listed contributing drugs were pharmaceutical opioids (60%), alprazolam (35%), and heroin (29%) (not mutually exclusive). The highest death rates from fentanyl (4 per 100,000 Kentucky population aged ≥18 years) and heroin (13 per 100,000) intoxication were among those aged 25–34 years, whereas the highest death rates associated with prescription opioids (excluding morphine and fentanyl) were among those aged 35–54 years (15 per 100,000). Appalachian county residents had a significantly higher intoxication fatality rate (34 per 100,000) than residents from non-Appalachian counties (27 per 100,000). One-quarter of death certificates did not list any specific contributing drug, but postmortem toxicology reports were available for 89% of these cases and provided information on drugs used before death. Analysis of decedents’ controlled substance prescription records suggested drug diversion (e.g., only 36% of the decedents who tested positive for oxycodone had recently filled prescriptions).

The abuse and diversion of drugs significantly impact the health and safety of Kentucky citizens. This study demonstrated the benefit of integrated multi-source drug intoxication fatality surveillance to identify drug misuse and diversion and population groups at high risk for drug poisoning mortality and to inform targeted prevention programs.