Format

Send to

Choose Destination
Drug Alcohol Depend. 2019 Jul 1;200:59-63. doi: 10.1016/j.drugalcdep.2019.03.014. Epub 2019 May 8.

Sociodemographic factors and social determinants associated with toxicology confirmed polysubstance opioid-related deaths.

Author information

1
Division of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA; Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA. Electronic address: Joshua.Barocas@BMC.org.
2
Division of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA; Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
3
Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Room 208 Box G-S121-2, Providence, RI 02912 USA.
4
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, USA.
5
Massachusetts Department of Public Health, 250 Washington Street, 6th Floor, Boston, MA 02108, USA.
6
Division of Infectious Diseases, Alpert Medical School of Brown University and the Miriam Hospital, 1125 N Main St, Providence, RI 02906, USA.

Abstract

BACKGROUND AND AIMS:

While prescribed and illicit opioid use are primary drivers of the national surges in overdose deaths, opioid overdose deaths in which stimulants are also present are increasing in the U.S. We determined the social determinants and sociodemographic factors associated with opioid-only versus polysubstance opioid overdose deaths in Massachusetts. Particular attention was focused on the role of stimulants in opioid overdose deaths.

METHODS:

We analyzed all opioid-related overdose deaths from 2014 to 2015 in an individually-linked population database in Massachusetts. We used linked postmortem toxicology data to identify drugs present at the time of death. We constructed a multinomial logistic regression model to identify factors associated with three mutually exclusive overdose death groups based on toxicological results: opioid-related deaths with (1) opioids only present, (2) opioids and other substances not including stimulants, and (3) opioids and stimulants with or without other substances.

RESULTS:

Between 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17% had opioids only, 36% had opioids plus stimulants, and 46% had opioids plus another non-stimulant substance. Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone.

CONCLUSIONS:

Polysubstance opioid overdose is increasingly common in the US. Addressing modifiable social determinants of health, including barriers to mental health services and homelessness, is important to reduce polysubstance use and overdose deaths.

KEYWORDS:

Amphetamines; Cocaine; Opioid-related overdose; Polysubstance use; Stimulants

PMID:
31100636
PMCID:
PMC6588486
[Available on 2020-07-01]
DOI:
10.1016/j.drugalcdep.2019.03.014

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center