Leveraging pooled medical examiner records to surveil complex and emerging patterns of polysubstance use in the United States

Chelsea L Shover; Joseph R Friedman; Ruby Romero; Sergio Jimenez; Jacqueline Beltran; Candelaria Garcia; David Goodman-Meza

doi:10.1016/j.drugpo.2024.104397

Leveraging pooled medical examiner records to surveil complex and emerging patterns of polysubstance use in the United States

Int J Drug Policy. 2024 May 9:104397. doi: 10.1016/j.drugpo.2024.104397. Online ahead of print.

Authors

Chelsea L Shover¹, Joseph R Friedman², Ruby Romero³, Sergio Jimenez⁴, Jacqueline Beltran⁵, Candelaria Garcia⁴, David Goodman-Meza⁶

Affiliations

¹ David Geffen School of Medicine at University of California Los Angeles, Division of General Internal Medicine and Health Services Research, United States. Electronic address: clshover@mednet.ucla.edu.
² David Geffen School of Medicine at University of California Los Angeles, Center for Social Medicine, United States.
³ David Geffen School of Medicine at University of California Los Angeles, Division of General Internal Medicine and Health Services Research, United States.
⁴ Fielding School of Public Health at University of California Los Angeles, Department of Epidemiology, United States.
⁵ Fielding School of Public Health at University of California Los Angeles, Department of Community Health Sciences, United States.
⁶ David Geffen School of Medicine at University of California Los Angeles, Division of Infectious Diseases.

PMID: 38729890
DOI: 10.1016/j.drugpo.2024.104397

Abstract

Background: The United States (US) is an extreme global outlier for drug-related death rates. However, data describing drug-related deaths are generally available only on an 8-13-month lag. Furthermore, granular details about substance-involvement are often not available, which particularly stymies efforts to track fatal polysubstance and novel psychoactive substance use. Detailed medical examiner records provide a powerful source of information for drug-related death surveillance, but have been underutilized.

Methods: We pooled medical examiner data from five US states and 14 counties that together comprise 18% of the US population to examine demographic, geographic, and drug-specific trends in polysubstance drug-related deaths. We employed mixed effects logistic regression to identify demographic factors associated with polysubstance rather than single substance drug-related deaths. We assessed the correlations between drug classes and described geographic variation in the prevalence of specific drugs and the presence of novel and emerging psychoactive substances.

Results: Our sample included 73,077 drug-related deaths from 2012 through early 2022. Nearly two-thirds of drug-related deaths were polysubstance-involved, with the number and percentage growing annually. High percentages of polysubstance drug-related deaths were observed in both urban and rural jurisdictions. After adjusting for year and jurisdiction, female, American Indian and Alaska Native, and White individuals had the most elevated odds of polysubstance drug-related deaths. Drug-related deaths involving benzodiazepines or opioids, whether pharmaceutical or illicit, and other pharmaceutical drugs were most likely to have polysubstance involvement, while methamphetamine-involved deaths were least likely to involve multiple substances. Strong correlations were observed between prescription opioids and prescription benzodiazepines, fentanyl and xylazine, and designer benzodiazepines and novel synthetic opioids.

Conclusions: Analysis of detailed medical examiner records reveals the breadth and complexity of polysubstance drug-related deaths in the US. Future efforts to use this unique resource can improve population-based surveillance of drug-related deaths to better tailor interventions and solutions to this critical health crisis.

Keywords: Benzodiazepines; Epidemiology; Opioids; Polysubstance; Stimulants.