Article Text

Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices


Background According to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population.

Objective The elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS).

Methods DOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths.

Results DOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013–2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids.

Conclusions A comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.

  • surveillance
  • poisoning
  • mortality
  • drugs
  • implementation/translation

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  • Contributors All authors participated in the development and implementation of the Kentucky Drug Overdose Fatality Surveillance System (DOFSS). SLH collected data, performed data analysis, interpreted results and wrote the draft manuscript. SS performed data analysis, interpreted analytical results and co-wrote the draft manuscript. TLB established agency data use agreements, interpreted results and co-wrote the manuscript. DQ performed a legal review of relevant policies and manuscript content, and created figures 1 and 2. TC established agency data use agreements, interpreted analytical results and evaluated policy implications. WR interpreted analytical results and evaluated policy implications. MDS performed data analysis and interpreted analytical results. VI evaluated policy and practice implications.

  • Funding This publication was supported by the Grant or Cooperative Agreement Number, 1NU17CE924832-01, funded by 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 Centers for Disease Control and Prevention or the Department of Health and Human Services. This grant was received by Kentucky Injury Prevention and Research Center as the bona fide for the Kentucky Department for Public Health.

  • Competing interests None declared.

  • Patient consent None.

  • Ethics approval The study was part of the Kentucky Drug Overdose Prevention Program and was approved by the University of Kentucky Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data from this study is available for sharing.

  • Correction notice This article has been corrected since it was published Online First. Three text encoding errors in the abstract and in the final footnotes have been corrected. The symbol related to the THC value (table 4, right column) has also been corrected.

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