Statement of Purpose Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and broader context surrounding overdose. Using a Social Determinants of Health (SDOH) framework, we sought to examine unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on individual characteristics, specific drug involvement, and contextual factors.
Methods/Approach We used 2015–2019 NC death certificate data to identify unintentional and self-inflicted overdose deaths. Specific drug involvement was assessed by searching three literal text death certificate fields for drug mentions. County-level contextual factors encompassed five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment) and were obtained from NC Institute of Medicine and County Health Rankings. We calculated descriptive statistics by intent for specific drug involvement and a variety of rich contextual factors.
Results During 2015–2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional. The majority of suicide overdoses occurred among females (62%) and adults ≥45 years (69%), whereas unintentional overdoses were more common among males (66%) and persons <45 years (62%). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (41%). Overall, overdose deaths tended to occur in under-resourced counties across all domains of SDOH. Compared to suicide overdoses, unintentional overdoses occurred more often among residents of under-resourced counties with differences most pronounced for economic stability-related factors.
Conclusions We identified notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement. While we observed contextual differences by intent, the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains, which highlights the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).
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