Tackling Substance Use Disorder
Epidemiologic Perspective on Substance Use and Drug Overdose in Minnesota: Key findings, novel insights, and innovative public health surveillance strategies
F
rom 2000 through 2021, over 10,000 Minnesotans have died from a drug overdose.1 Furthermore, preliminary 2021 death data indicate that drug overdoses will surpass falls as the leading cause of injury mortality in Minnesota, highlighting the alarming rise in drug overdose deaths over the past two decades.2 Currently, the drug overdose epidemic is characterized by novel psychoactive substances, including synthetic opioids, psychostimulants, and benzodiazepines. Drug overdose deaths, however, are just the top of the injury pyramid. For every overdose death there were 11 nonfatal hospital-treated drug overdoses in 2020.3 This article highlights key findings and emerging trends in drug overdose deaths and nonfatal hospital-treated drug overdoses in Minnesota. This includes discussion of the limitations of current public health surveillance systems and improvements being undertaken to provide comprehensive and timely information to support prevention efforts around drug overdose and substance use in Minnesota. Fatal Drug Overdose
Analysis of death certificate data has shown that the Minnesota drug overdose mortality rate increased by 34% from 2019 to 2020, rising from 14.2 to 19.0 per 100,000 population.1 The increase in drug overdose deaths is driven primarily by opioids, with about 60% of drug overdose deaths involving opioids.4 Much of
By Nate Wright, MPH
12
Summer 2022
the growth in opioid-involved overdose deaths can be attributed to synthetic opioids, which death scene investigation and toxicology results indicate are likely due to illicitly manufactured fentanyl.5,6 Opioids, however, are not the only substances of concern. All drug categories increased in 2020.5 Of particular concern are psychostimulants, which toxicology findings indicate are primarily methamphetamine. Psychostimulant-involved deaths have virtually paralleled the increase in synthetic opioid-involved deaths, with the number of psychostimulant-involved deaths nearly quadrupling in the past six years.7 Increases in drug overdose deaths over the past few years have also been characterized by polysubstance use. For example, from 2017 to 2019, nearly 50% of psychostimulant-involved deaths involved at least one opioid; 57% of cocaine-involved deaths involved at least one opioid; and 82% of benzodiazepine-involved deaths involved at least one opioid. Across each of these categories, the contribution of synthetic opioids has grown substantially from less than 10% in 2011 to 2013 to 33% or more of deaths in 2017 to 2019.8
Furthermore, over the past 10 years, 18% of opioid-involved deaths involved alcohol.9 Death certificates are a critical data source for public health surveillance, but there are important limitations. First, death certificates are not timely. It may take weeks for a death certificate to be finalized and made available for analysis. Second, death certificates lack detailed toxicology data, with 13% of drug overdose deaths lacking any information on specific drugs involved.1 Finally, death certificate data lack circumstantial information on the events leading up to and at the time of death that are crucial for prevention and response efforts. With support from the Centers for Disease Control and Prevention, we have implemented the State Unintentional Drug Overdose Reporting System (SUDORS) that provides comprehensive and timely information on drug overdose deaths. This system collects and abstracts data from death certificates and medical examiner/coroner reports, including scene findings, autopsy reports, and toxicology findings. The goals of SUDORS are to better understand the circumstances that surround overdose deaths; improve overdose data timeliness and accuracy; and identify specific substances causing or contributing to overdose deaths.10 SUDORS has shown that four out of five people who died of a drug overdose in Minnesota had an identified opportunity for intervention.11 This includes a recent release from institution (e.g., hospital or jail/prison), history of prior overdose, an
MetroDoctors
The Journal of the Twin Cities Medical Society
