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. 2018 Mar 1;19(3):511-523.
doi: 10.1093/pm/pnx015.

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

Melissa C Mercado  1   2   3 , Steven A Sumner  2   3 , M Bridget Spelke  4 , Michele K Bohm  1 , David E Sugerman  5 , Christina Stanley  6
Affiliations

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

Melissa C Mercado et al. Pain Med. .

Abstract

Objective: This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl.

Methods: This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467).

Results: Illicit-fentanyl decedents were younger than other drug decedents (P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances (P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders.

Conclusions: Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

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Conflict of interest statement

Conflict of Interest and Disclosure Summary

The authors have no conflicts of interests to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC). This study was conducted at the invitation of the Rhode Island Department of Health as part of an “EPI-AID Field Investigation”. At the time, Dr. Melissa C. Mercado and Dr. David E. Sugerman were affiliated with the Division of Unintentional Injury Prevention at CDC’s National Center for Injury Prevention and Control, and Dr. Christina Stanley served as the Chief Medical Examiner at the Office of the State Medical Examiners, Rhode Island Department of Health. As an Emory University medical student, Dr. M. Bridget Spelke collaborated in this study as a CDC Experience Fellow assigned to the Division of Unintentional Injury Prevention at CDC’s National Center for Injury Prevention and Control.

Figures

Fig. 1
Fig. 1
Study Population: Drug Overdose (OD) Deaths in Rhode Island (RI), January 2012 – March 2014.
Fig. 2
Fig. 2
Number of Drug Overdose Deaths, by Week of Death – Rhode Island, January 2012 – March 2014 (N=536).
See this image and copyright information in PMC

References

    1. Office of the Rhode Island State Medical Examiners. Fatal Drug Overdoses: Rhode Island Department of Health. [cited 2014 March 7]. Available from: http://health.ri.gov/data/death/drugoverdoses/
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    1. Control of a chemical precursor used in the illicit manufacture of fentanyl as a List I chemical - Final rule, 21 CFR Part 1310, Docket No. DEA–299F, RIN 1117–AB12 (2008).

    1. Paulozzi L, Budnitz D, Xi Y. Increasing Deaths from Opioid Analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006;15:618–27. - PubMed

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