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



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).



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.



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.
Division of Unintentional Injury Prevention.|Division of Violence Prevention, National Center for Injury Prevention and Control.|Division of Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Office of Public Health Scientific Services.
Melissa C
MC
Mercado
Division of Violence Prevention, National Center for Injury Prevention and Control.|Division of Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Office of Public Health Scientific Services.
Steven A
SA
Sumner
Obstetrics and Gynecology Residency Program, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island.
M Bridget
MB
Spelke
Division of Unintentional Injury Prevention.
Michele K
MK
Bohm
Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
David E
DE
Sugerman
Office of Chief Medical Examiner, State of Connecticut, Farmington, Connecticut, USA.
Christina
C
Stanley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D012237:Rhode Island / Q000453:epidemiology; D055815:Young Adult
D013287:Illicit Drugs; D009294:Narcotics; D005283:Fentanyl