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Increase in Drug Overdose Deaths Involving Fentanyl – Rhode Island, January 2012 – March 2014
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Details:
  • Pubmed ID:
    28340233
  • Pubmed Central ID:
    PMC5587352
  • Description:
    Objective

    This study identified socio-demographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island (RI), in response to an increase in overdose deaths (OD) involving fentanyl.

    Methods

    This cross-sectional investigation comprised all ODs reviewed by RI’s Office of the State Medical Examiners (OSME) during January 2012–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 to decedents whose cause of deaths did not involve fentanyl (N=467).

    Results

    Illicit-fentanyl-decedents were younger than other-drug decedents (p=0.005). While more other-drug 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% v. 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 of >100 morphine milligram equivalents. Most decedents’ opioid prescriptions were filled at 1–2 dispensers (83.9%), and written by 1–2 prescribers (75.8%). Notably, 29.2% of illicit-fentanyl and 10.5% of other-drug decedents filled prescriptions for buprenorphine, 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 >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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