The rise in non‐fatal and fatal overdoses involving stimulants with and without opioids in the United States

Abstract

AimsTo examine trends and recent changes in non-fatal and fatal stimulant overdose rates with and without opioids to improve the descriptive characterization of the US overdose epidemic. Design Secondary analysis of non-fatal and fatal drug overdose trends, focusing on the most recent years of data available to examine rate changes by demographics (2015-16 for non-fatal and 2016-17 for fatal). Setting Non-fatal drug overdoses from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample; drug overdose deaths from the National Vital Statistics System. Participants/cases International Classification of Diseases, Ninth Revision, Clinical Modification(ICD-9-CM) and Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes for cocaine, psychostimulants and opioids were used to classify non-fatal drug overdoses. Drug overdose deaths were identified using ICD-10 multiple cause-of-death codes for cocaine, psychostimulants, all opioids, heroin and synthetic opioids.Measurements Percentage of changes in age-adjusted non-fatal and fatal rates of cocaine and psychostimulantinvolved drug overdose with and without opioids. Findings Overall, cocaine-involved non-fatal overdose rates with an opioid increased from 2006 to 2016 [annual percentage change (APC) = 14.7], while rates without an opioid increased from 2006 to 2012 (APC = 11.3) and then remained stable (APC = À7.5). Psychostimulant-involved non-fatal rates with and without an opioid increased from 2006 to 2016 (APC = 49.9 with opioids; 13.9 without opioids). Cocaine-involved death rates with and without opioids increased from 2014 to 2017 (APC = 46.0 with opioids, 23.6 without opioids). Psychostimulant-involved death rates with opioids increased from 2010 to 2015 (APC = 28.6), with a dramatic increase from 2015 to 2017 (APC = 50.5), while rates without opioids increased from 2008 to 2017 (APC = 22.6). In 2016, 27% of non-fatal cocaine-and 14% of psychostimulant-involved overdoses included a reported opioid; 72.7% of cocaine-and 50.3% of psychostimulant-involved deaths involved an opioid in 2017. From 2015 to 2016, cocaine-involved and psychostimulant-involved non-fatal overdose rates with an opioid increased 17.0 and 5.9%, respectively; cocaineinvolved and psychostimulant-involved non-fatal overdoses without opioids decreased 13.6 and increased 18.9%, respectively. Death rates involving stimulants increased with and without opioids from 2016 to 2017 (cocaine with and without opioids = 37.7 and 23.3%; psychostimulants with and without opioids = 52.2 and 23.0%). Death rates involving stimulants with synthetic opioids increased dramatically from 2016 to 2017 (1.3-2.3 per 100 000 for cocaine and 0.3-0.8 for psychostimulants). Conclusions While increases in cocaine-involved deaths in the United States from 2006 seem to be driven by opioids, particularly synthetic opioids, increases in non-fatal and fatal overdoses involving psychostimulants are occurring with and without opioids.

Nonfatal Drug Overdoses Treated in Emergency Departments — United States, 2016–2017

“…The large increase in cocaine overdose rates (32.9%) might indicate potential increase in polysubstance overdose. A previous study found that in 2016, approximately 27% of nonfatal cocaine overdoses treated in EDs also involved an opioid, and cocaine-involved overdoses with an opioid reported increased 17% from 2015 to 2016, whereas cocaine-involved overdoses without an opioid decreased 14% (2). Future analyses examining drug combinations could help to determine the extent to which polysubstance use affects overdose surveillance of specific drug types.…”

Impact of COVID-19 Pandemic on Drug Overdoses in Indianapolis

“…Over time, increases in overdoses were initially linked to opioid pain analgesics but shifted to illicit opioids, such as heroin and fentanyl [2,[4][5][6][7]. More recently, public health officials and healthcare providers have noted a sharp increase in overdose deaths associated with illicit synthetic substances, specifically cocaine and methamphetamines, in urban areas [6][7][8].…”

Suspected Nonfatal Drug-Related Overdoses Among Youth in the US: 2016–2019

“…This finding is consistent with a recent study in which authors that found that nonfatal ED visits for psychostimulant overdoses between 2015 and 2016 increased by 10.1 for those aged 0 to 14 years, 9.4 for 15to 19-year-olds, and 9.9 for 19-to 24year-olds. 22 The increasing trend in suspected stimulant overdoses could also reflect trends in fatality data, with stimulant deaths representing a growing proportion of drug overdose deaths in the United States, specifically among cocaine and psychostimulants deaths. 22,26 According to current research, the most effective treatments for addiction to methamphetamine are multifaceted behavioral therapies that include such elements as individual counseling, family education, screening, 12-step support, and extracurricular activities.…”

“…21 Furthermore, although little is known about nonfatal heroin overdoses among youth, researchers of a recent study found that between 2015 and 2016, nonfatal psychostimulant (eg, amphetamine, MDMA) ED visits increased for 0-to 24 year-olds. 22 Timely data are essential to track sudden increases in drug exposures to facilitate an appropriate, effective, and rapid public health response. ED syndromic surveillance data collected through the Centers for Disease Control and Prevention (CDC) National Syndromic Surveillance Program (NSSP) BioSense Platform are timely and fill the data gap needed to provide information for action, with data being available for analysis within 24 to 48 hours of the visit.…”