Prescription Drug Histories among Drug Overdose Decedents in Delaware
Authors: Tammy L. Anderson, Jascha Wagner, Guanwen Qi, Steve S. Martin, Daniel J. O’Connell, and Ellen Donnelly
Background: The US opioid epidemic largely featured deaths from prescribed medications during Wave 1 (1990–2010), but its progression since then has resulted more so from deaths to illegal opioids—such as heroin (Wave 2 – 2010–2013) and fentanyl (Wave 3 – 2013-present). As deaths to illegally manufactured fentanyl have increased, attention to the role of prescribed opioids may be waning. However, the shifting nature of today’s opioid epidemic demands we monitor how both legal and illegal drugs are involved in overdose deaths.
Objectives: The purpose of our studyis to investigate the prescription drug (Rx) records of overdose death decedents to illuminate the continued role of prescribed medications in Wave 3 deaths.
Methods: We matched drug overdose death data and prescription drug monitoring data to investigate the prescription drug records (i.e.types of opioids and other medications) of Delaware, USA, decedents who died from a drug over-dose death between January 1, 2013, and March 31, 2015 (27 months).
Results: Fentanyl decedents differed significantly from other decedents in prescribed medications, including the amount and proximity of opioid and Rx fentanyl prescriptions before death. These relationships held while controlling for demographic characteristics and contributing health conditions.
Conclusions: Our findings show a continued presence of Rx opioids in overdose deaths and that those dying from fentanyl had different Rx records than those who died from other drugs. Continued monitoring of Rx drugs, improved toxicology testing and greater data access for more research should follow to inform effective interventions.
Click here for the full article.
Is the Gender Gap in Overdose Deaths (Still) Decreasing? An Examination of Opioid Deaths in Delaware, 2013-2017.
Authors: Mieke C.W. Eckhaut, Jascha Wagner, Logan Neitzke-Spruill, Rebecca Walker, Tammy L. Anderson
Objective: Drug overdoses among men have historically outnumbered those among women by a large margin. Yet, U.S. research on the first wave of the opioid epidemic involving prescription opioids has found women to be at increased risk. The current study considers if the narrowing gender gap in overdose deaths, as observed during the first wave, has continued into the most recent third wave, dominated by synthetic opioid deaths. This requires consideration of interactions between gender, age, and type of drug implicated.
Method: Drawing on 2013-2017 Delaware toxicology reports for a total of 890 overdose deaths involving opioids, we distinguished between four gender/age groups--women 15-44, women 45-64, men 15-44, and men 45-64--to calculate crude death rates, male-to-female death rate ratios, and younger-to-older death rate ratios by type of opioid.
Results: Opioid overdose death rates during the third wave increased among both men (+102%) and women (+46%), but the larger increase among men resulted in an increase in the male-to-female death rate ratio (from 1.9 to 2.6). This trend was driven by the growing contribution of fentanyl (from 16% to 76%) and heroin overdose deaths (from 27% to 50%) compared with other opioid overdose deaths, which disproportionately affected men and younger individuals. Higher male-to-female death rate ratios were observed among older, compared with younger, individuals.
Conclusions: Overdose deaths seem to have returned to a historically familiar pattern of dominance by younger males. Our findings suggest the gender-age distribution in deaths to specific opioid types must be considered for effective intervention.
Click here for the full article
Opioids, Race, and Drug Enforcement: Exploring Local Relationships
Between Neighborhood Context and Black–White Opioid-Related Possession
Authors: Ellen A. Donnelly, Jascha Wagner, Madeline Stenger, Hannah G. Cortina, Daniel J. O’Connell, Tammy L. Anderson
Abstract: Opioid abuse has redefined drug problems in communities and shifted
police activities to redress substance use. Changing neighborhood
context around opioid issues may affect arrests and racial disparities
in their imposition. This study presents a spatial analysis of arrests
involving Blacks and Whites for possession of heroin, synthetic
narcotics, and opium offenses. We identify the ecological conditions
associated with opioid-related arrests using geographically weighted
regression (GWR) methods that illuminate local patterns by allowing
coefficients to vary across space. GWR models reveal spatial and racial
differences in opioid-related possession arrest rates. Calls for police
service for overdoses increase White arrests in more advantaged, rural
communities. Economic disadvantage and racial diversity in neighborhoods
more strongly elevate possession arrest rates among Blacks relative to
Whites. Overdose calls predict Black arrests in poorer urban areas.
Findings underscore police responsiveness to opioid problems and
Black–White differences in how opioid users interact with the criminal
Click here for the full article