Kentucky Drug Overdose Fatality Surveillance System Report Sheds New Light on Drug Overdose Circumstances

The Kentucky Injury Prevention and Research Center (KIPRC), an agent for the Kentucky Department for Public Health located at the University of Kentucky College of Public Health, in collaboration with the Kentucky Office of the State Medical Examiner’s Office and county coroner offices, recently published the inaugural Kentucky Drug Overdose Fatality Surveillance System (DOFSS) report.

“Kentucky’s unique DOFSS adds utility and value to drug overdose fatality surveillance by providing an additional lens to the drug overdose epidemic through the integration of multiple data sources that contribute additional case-level information that helps identify new and emerging risk factors and health conditions associated with drug overdose deaths in the Commonwealth of Kentucky,” said Dr. Terry Bunn, PhD, KIPRC director and associate professor of Epidemiology.

One important finding in the DOFSS data shows that the most common other significant condition contributing to cause of death for drug overdose deaths was hypertensive heart disease. Confirming that result, Lisinopril, an angiotensin converting enzyme (ACE) inhibitor drug that is prescribed to treat hypertension and heart failure, was the third most common prescription drug found at the scene of drug overdose deaths or at autopsy of drug overdose decedents. These results may indicate that individuals with heart disease are more susceptible to drug overdoses, or that heart-related conditions may be a primary outcome associated with substance use. Further research is needed to more fully examine this finding. DOFSS year 2016 data results will include linked dispensed prescription data from the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system that may provide additional information to generate targeted hypotheses related to this unique finding.

Also, the DOFSS figures comparing mean blood concentrations of commonly identified drugs to related therapeutic ranges in drug overdose decedents show that amphetamine was detected above the related therapeutic range, in addition to the well-known opioids (fentanyl, hydrocodone, morphine, and oxymorphone). This finding indicates that amphetamine (either licit or as a metabolite of illicit methamphetamine) is a major drug contributing to drug overdose fatalities in the Commonwealth of Kentucky that deserves further tracking through DOFSS trends over time, examining linked amphetamine prescriptions dispensed, and further research into amphetamine sourcing.

Last, DOFSS data results highlight the involvement of gabapentin in fatal drug overdoses. Gabapentin was detected in over one-third of all drug overdose decedents with available specific drug results, and was the most frequent drug detected in female drug overdose decedents and among drug overdose decedents over the age of 44 years; gabapentin also was detected in almost half of all drug overdose decedents with histories of mental illness. These results illustrate the need for more research into the prescribing of gabapentin in association with substance use and substance use treatment, either alone or in association with other health conditions, such as chronic pain.

“Our heartfelt sympathies go out to the surviving family members, friends, and others who have suffered a loss due to a fatal overdose. Our hope is that this report can help coroners, medical examiners, family members, and healthcare providers, to inform and improve scheduled drug prescribing, substance use disorder treatment, prevention, policy making, and law enforcement drug interdiction,” said Bunn, who contributed to the report along with Sarah L. Hargrove, MS, and Patrick J. Ward, MPH.

Kentucky’s Drug Overdose Fatality Surveillance System (DOFSS) is a comprehensive database that utilizes multiple

sources to enhance the Commonwealth’s analytical capacity to identify and characterize drug overdose fatalities. Without a centralized death investigation system, Kentucky drug overdose fatality data are not collected by a single agency. DOFSS bridges the gaps by inputting drug overdose decedent data into one centralized database. A comprehensive multi-source database captures additional information on drug overdose fatalities and identifies emerging trends and patterns of drug use that may not be readily identified through analysis of data from a single source.

For further reading: The DOFSS 2015 Annual Report (released October, 2017) pdf.

The Kentucky Drug Overdose Fatality Surveillance System report was supported by Cooperative Agreement Number 5 NU17CE002732-03-00, funded by the Centers for Disease Control and Prevention, and awarded to the Kentucky Injury Prevention and Research Center as the bona fide agent for the Kentucky Department for Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.