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The impact of fentanyl on state- and county-level psychostimulant and cocaine overdose death rates by race in Ohio from 2010 to 2020: a time series and spatiotemporal analysis.
Estadt, Angela T; White, Brian N; Ricks, JaNelle M; Lancaster, Kathryn E; Hepler, Staci; Miller, William C; Kline, David.
Afiliación
  • Estadt AT; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA. estadt.24@osu.edu.
  • White BN; Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA.
  • Ricks JM; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, USA.
  • Lancaster KE; Division of Public Health Sciences, Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA.
  • Hepler S; Department of Statistical Sciences, Wake Forest University, Winston-Salem, USA.
  • Miller WC; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
  • Kline D; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Harm Reduct J ; 21(1): 13, 2024 Jan 17.
Article en En | MEDLINE | ID: mdl-38233924
ABSTRACT

BACKGROUND:

Over the past decade in the USA, increases in overdose rates of cocaine and psychostimulants with opioids were highest among Black, compared to White, populations. Whether fentanyl has contributed to the rise in cocaine and psychostimulant overdoses in Ohio is unknown. We sought to measure the impact of fentanyl on cocaine and psychostimulant overdose death rates by race in Ohio.

METHODS:

We conducted time series and spatiotemporal analyses using data from the Ohio Public Health Information Warehouse. Primary outcomes were state- and county-level overdose death rates from 2010 to 2020 for Black and White populations. Measures of interest were overdoses consisting of four drug involvement classes (1) all cocaine overdoses, (2) cocaine overdoses not involving fentanyl, (3) all psychostimulant overdoses, and (4) psychostimulant overdoses not involving fentanyl. We fit a time series model of log standardized mortality ratios (SMRs) using a Bayesian generalized linear mixed model to estimate posterior median rate ratios (RR). We conducted a spatiotemporal analysis by modeling the SMR for each drug class at the county level to characterize county-level variation over time.

RESULTS:

In 2020, the greatest overdose rates involved cocaine among Black (24.8 deaths/100,000 people) and psychostimulants among White (10.1 deaths/100,000 people) populations. Annual mortality rate ratios were highest for psychostimulant-involved overdoses among Black (aRR = 1.71; 95% CI (1.43, 2.02)) and White (aRR = 1.60, 95% CI (1.39, 1.80)) populations. For cocaine not involving fentanyl, annual mortality rate ratios were similar among Black (aRR = 1.04; 95% CI (0.96,1.16)) and White (aRR = 1.02; 95% CI (0.87, 1.20)) populations. Within each drug category, change over time was similar for both racial groups. The spatial models highlighted county-level variation for all drug categories.

CONCLUSIONS:

Without the involvement of fentanyl, cocaine overdoses remained constant while psychostimulant overdoses increased. Tailored harm reduction approaches, such as distribution of fentanyl test strips and the removal of punitive laws that influence decisions to contact emergency services, are the first steps to reduce cocaine overdose rates involving fentanyl among urban populations in Ohio. In parallel, harm reduction policies to address the increase in psychostimulant overdoses are warranted.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cocaína / Sobredosis de Droga / Estimulantes del Sistema Nervioso Central Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Harm Reduct J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cocaína / Sobredosis de Droga / Estimulantes del Sistema Nervioso Central Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: Harm Reduct J Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos
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