Associations between Circumstances Surrounding Overdose and Underlying Classes of Polysubstance Overdose Deaths

Abstract

Background

The overdose crisis is worsening, with polysubstance overdose deaths involving psychostimulants increasing in the U.S. Substance-specific prevention and intervention activities may not be as effective for polysubstance use, so we sought to classify substances used among overdose decedents to identify unique factors related to these classes.

Methods

We used data from the Nevada State Unintentional Drug Overdose Reporting System, Jan 2019–Jun 2021, which comes from death certificates, coroner/medical examiner reports, and postmortem toxicology. Latent class analysis, multinomial logistic regression, and Chi-squared tests determined underlying drug use classes, differences in characteristics and circumstances surrounding overdose, and assessed relationships between circumstances and drug use classes.

Results

We identified four latent classes: (1) prescription drugs (19.1%), (2) predominately methamphetamine (31.4%), (3) multi-drug (28.9%), and (4) opioid and stimulant (20.6%). Compared to other classes, the prescription drug class had a higher percentage of female decedents, from rural counties, with mental health diagnoses, who died at home. The predominately methamphetamine class had a higher percentage of decedents experiencing homelessness. The multi-drug use class had higher percentage of younger and Hispanic decedents. Those in the opioid and stimulant class had higher odds of being recently released from an institutional setting, compared to the multi drug class.

Conclusions

These underlying classes were associated with several characteristics and circumstances that can prove useful for prevention, treatment, and harm reduction agencies when designing programs and interventions to target specific groups of people at-risk for drug overdose.

Keywords:

• Polysubstance
• drug overdose
• circumstance
• mortality

Acknowledgments

We would like to acknowledge the abstraction team and staff at Southern Nevada Health District, Clark County Coroner and Medical Examiner Office, Washoe County Regional Medical Examiner Office, Nevada Department of Health and Human Services, Division of Public and Behavioral Health, Office of Public Health Investigations and Epidemiology (OPHIE), and Nevada Department of Health and Human Services, Office of Analytics.

Disclosure of interest

The authors report no conflict of interest.

Additional information

Funding

The data collected and used for this publication was supported by the Nevada State Department of Health and Human Services through Grant Number NU17CE925001 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department nor the Centers for Disease Control and Prevention. All research was conducted independently.